Prevalence Of Chronic Kidney Disease Research Articles

Long-term renal outcomes of children with cancers treated with platinum-based chemotherapy: A retrospective chart analysis.

Platinum-based chemotherapy is a mainstay of treatment for many childhood cancers but is associated with acute nephrotoxicity and long-term ototoxicity. There is emerging evidence of long-term renal complications. This study aimed to assess the prevalence of chronic kidney disease (CKD) in children treated with platinum chemotherapy (cisplatin and carboplatin) and identify potential risk factors for the development of CKD. We conducted a retrospective review of children diagnosed with hepatoblastoma, osteosarcoma, neuroblastoma, or medulloblastoma who received platinum chemotherapy over a 16 year timeframe. Patients were excluded if they did not have at least 3 years follow up data, died within 3 years of platinum chemotherapy, or if they relapsed. Clinical data were collected at baseline (first dose), 1 year, and at most recent follow up. Of 328 treated patients, 147 met the inclusion criteria and were followed for a mean of 8.1 years (range 3-15.7 years). The median age at first dose was 3.7 years (IQR 1.7-9.6 years). CKD ≥grade 2 was present in 53(36%) at last follow up and 15(10%) had tubular dysfunction. A history of acute kidney injury at any time during treatment was associated with CKD (OR 3.12 CI 1.07-9.12, p =0.04). On multivariable analysis older age at platinum therapy (OR 1.2, CI 1.1-1.4, p = 0.004) and a high aminoglycoside or vancomycin trough level (OR 4.3, CI 1.9-9.7, p<0.001) were risk factors for CKD. The high rate of CKD in children treated with platinum chemotherapy warrants long-term follow-up and screening for progressive disease.

Prevalence of chronic kidney disease among young people living with HIV in Sub Saharan Africa: A systematic review and meta-analysis.

Globally, the prevalence of chronic kidney disease (CKD) is increasing among young people living with HIV (YPLHIV), with inconsistent estimates. Aggregated data on the prevalence of CKD are needed in sub-Saharan Africa (SSA) to inform strategies for early diagnosis and management. We conducted a systematic review and meta-analysis to estimate the pooled prevalence of CKD among YPLHIV in SSA. We searched Medline/PubMed, EMBASE, African Index Medicus, and African Journals Online for articles reporting the prevalence of CKD among YPLHIV in SSA using predefined search strategies up to 15th January 2024. The reference lists of identified articles were checked for additional eligible studies. The eligibility criteria were studies among YPLHIV aged 10-24 years reporting CKD prevalence defined by either glomerular filtration rate (GFR), albumin-to-creatinine ratio (ACR) or proteinuria. We used a narrative synthesis to report differences between the included studies. The DerSimonian-Laird random effects model was used to pool the CKD prevalence, and heterogeneity was assessed using the Cochrane Q-test and I-squared values. We assessed the risk of bias in each article using the Joanna Briggs Institute checklist and publication bias in a funnel plot and Egger's test. Of 802 retrieved articles, 15 fulfilled the eligibility criteria and were included in the meta-analysis. Of these, 12 (80%) were cross-sectional studies that used estimated GFR to diagnose CKD. Only one study followed the standard definition of CKD. The pooled CKD prevalence from 15 studies was 12% (95% CI 6.0-19.5%), ranging from 0.8% to 53.1% according to the definition used, with a high degree of heterogeneity (I2 = 97.7%, p<0.001). The included studies were of moderate quality, with no evidence of publication bias. Sensitivity analysis showed that the findings were robust to the methodological and analytic approach. CKD prevalence among YPLHIV is moderately high and highly heterogeneous across SSA. The standard definition of CKD should be used to enable estimation of CKD prevalence in different studies and settings. HIV programs enrolling YPLHIV should routinely screen for CKD to ensure early diagnosis and management. PROSPERO registration number: CRD42022347588.

Association of aerobic and muscle-strengthening physical activity with chronic kidney disease in participants with hypertension

BackgroundIn Korea, chronic kidney disease (CKD) is increasingly prevalent among adults with hypertension, of which approximately 30% of the population is affected. Despite the recognized benefits of adherence to physical activity (PA) recommendations, including aerobic and muscle-strengthening activities (MSA), the impact of such adherence on the prevalence of CKD in individuals with hypertension has not been extensively studied. This study aimed to investigate the association between aerobic PA and MSA levels, and the prevalence of CKD in individuals with hypertension.MethodsThis study included 5,078 individuals with hypertension using data from the Korean National Health and Nutrition Examination Survey (2019–2021). PA levels were measured as min/week of moderate-to-vigorous PA (MVPA) based on self-reports, and MSA was quantified as the number of days per week. CKD was defined as an estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m². Logistic regression analysis evaluated the association between meeting PA guidelines and CKD after adjusting for potential confounders. Additionally, a joint analysis was conducted to assess the combined effects of MVPA and MSA on CKD.ResultsAfter adjusting for all covariates, higher MVPA was associated with a lower prevalence of CKD. Compared to the group with inactive, the group with MVPA 1–149 min/week had an odds ratio (OR) of 0.80 (95% confidence interval [CI], 0.61–1.05), the group that met the MVPA 150–299 min/week criteria had an OR of 0.85 (95% CI, 0.62–1.17), and the group that met the MVPA ≥ 300 min/week criteria had an OR of 0.53 (95% CI, 0.37–0.76). MSA alone did not show a significant association with CKD. In the joint analysis, the group that met the MVPA and MSA guidelines had the lowest OR of 0.54 (95% CI, 0.34–0.86), compared to the group that did not meet either.ConclusionsMVPA was associated with the prevalence of CKD in participants with hypertension but not in those with MSA alone. However, compared with the group that did not meet both guidelines, the group that met both guidelines showed the lowest prevalence of CKD.

Characteristics and outcomes of patients with moderate multivalvular disease in the context of tricuspid regurgitation

Abstract Background The clinical features and the long-term prognosis of patients with moderate tricuspid regurgitation (TR) in the context of concomitant moderate left-sided valvular disease (VD) are poorly characterized. Purpose This study sought to describe the characteristics and the outcomes of patients with combined moderate TR and moderate mitral or aortic VD. Methods Baseline clinical and follow-up data were collected from 2110 patients with moderate TR in combination with a moderate left-sided VD diagnosed at our centers from January 2012 to July 2020; the final cohort was divided in 4 groups as shown in Figure 1. The primary endpoint was all-cause death; secondary EP was the first occurrence of heart failure (HF) hospitalization. Results Group 1 patients (1529, 72.5%) had the highest prevalence of chronic kidney disease (897, 66%) and lowest left ventricular systolic function (LVEF &amp;lt;50%, 298, 21%), as detailed in Table 1. Coronary artery disease was most prevalent in Group 2 patients (43, 41%), which also presented with the lowest average Charlson Index scores (3.95±1.87) and most prevalent dyspnea symptoms (44, 41%). Group 3 patients (41, 1.9%) were the oldest (82±7 years), had the highest rate of comorbidities (mean Charlson score 5.2±1.6), atrial fibrillation (20, 54%) and pulmonary hypertension (17, 46%). Eventually, Group 4 patients (422, 20%) were the youngest (74±13 years), more commonly female (279, 66%) and with the highest right ventricular dysfunction rate (TAPSE &amp;lt; 17 mm, 114, 40%). After a median follow-up of 2.1 years, the primary endpoint occurred in 895 (42.4%) patients, with a significantly higher incidence in Group 3 patients (p&amp;lt;0.001) (Figure 1). The secondary endpoint occurred in 316 (15.0%) patients and, similarly, significantly more frequently in Group 3 patients (p=0.01). Subgroup analysis for the primary and secondary endpoint in patients with preserved ejection fraction (LVEF &amp;gt; 50%) confirmed the results of the primary analysis, with Group 3 as the cohort with the most adverse outcomes. Conclusions Patients with significant TR frequently exhibit concurrent left-sided VD, identifying distinct patient subgroups with varying clinical profiles. Notably, TR combined with moderate AS is associated with the most severe clinical presentation and the poorest long-term prognosis, even in patients with preserved LVEF.Figure 1.

Analysis of Nutritional Status, Body Composition, and Creatinine Levels in Hemodialysis Patients at Ibnu Sina Yw-Umi Hospital Makassar

Hemodialysis is an essential therapy for managing chronic kidney failure, helping to maintain homeostasis by removing excess fluids, solutes, and toxins from the body. The global increase in the prevalence of chronic kidney disease (CKD) has led to a rising demand for hemodialysis. This study aims to analyze the relationship between nutritional status, body composition, and creatinine levels in hemodialysis patients at Ibnu Sina YW-UMI Makassar Hospital. Using an observational cross-sectional design, the study involved 16 patients whose body mass index (BMI), muscle mass, fat mass, total body fluid, and visceral fat were measured before and after dialysis. The results revealed significant changes in nutritional status, body composition, and creatinine levels pre- and post-hemodialysis, analyzed through paired T-tests at a 0.05 confidence level. Most patients were male, aged over 45, with normal nutritional status but abnormal creatinine levels. Body composition analysis showed significant differences in muscle mass, fat mass, total body fluid, and visceral fat before and after hemodialysis, with patients with higher muscle mass tending to have elevated creatinine levels. This study emphasizes the importance of monitoring body composition and creatinine levels to support the health of hemodialysis patients and highlights the need for personalized nutritional and therapeutic interventions in CKD care. Further research is needed to explore the long-term impacts of hemodialysis on nutritional status and kidney function.

Incidental detection and quantification of coronary artery calcification in ungated thoracic computed tomography for prognostic assessment. Preliminary results from the ICARUS registry

Abstract Background Coronary artery calcium (CAC) score improves cardiovascular risk stratification in asymptomatic individuals. However, whether CAC can be quantified in ungated thoracic computed tomography (uTCT) performed for other indications, and if this CAC score associates with cardiovascular outcomes, hasn’t been confirmed yet. Purpose We aim to analyse the extension of CAC and its prognostic value in terms of major adverse cardiovascular events (MACE) in patients who underwent uTCT for other indications. Methods We analysed a preliminary sample of 115 uTCT performed in 2015 in our hospital. We studied the presence and extension of CAC and quantified the global CAC score by Agatston method using validated software. Patients were categorized according to Coronary Artery Calcium Data and Reporting System (CAC-DRS) categories. Cardiovascular risk factors, lipidic control and pharmacological therapy of the cohort were registered. We analysed the time to first 3P-MACE, defined as cardiovascular death, non-fatal myocardial infarction and non-fatal stroke, whichever occurred first. A p-value &amp;lt;0.05 was considered statistically significant. Results Mean age of the cohort was 60.8±16.1 years (53% male, 53% smokers). Mean LDL-cholesterol was 121.67±34.91 mg/dL, and 35.1% received lipid-lowering therapy. In more than half (n=59, 51.3%) of the population CAC was detected. Mean CAC score was 312.99±774.48 Agatston units, and patients were categorized in CAC-DRS category 1 (n=19, 16.5%), category 2 (n=15, 13%) and category 3 (n=25, 21.7%). Patients with CAC were older (71±10.1 vs. 50.1±14.2 years, p&amp;lt;0.001), had higher burden of cardiovascular risk factors and prevalence of chronic kidney disease (CKD; n=8, 13.6% vs. n=1, 1.8%, p=0.03) and higher levels of triglycerides (143.2±80.5 vs. 106.8±36.2 mg/dL, p=0.004), but not LDL-cholesterol. Eleven (9.6%) patients presented 3P-MACE during a mean follow-up of 6.55±2.82 years. CAC score independently predicted 3P-MACE (HR 1.06 [1.01-1.11] per 100 Agatston units, p=0.02) along with CKD (HR 6.94 [1.58-30.46], p=0.01) and basal glucose levels (HR 1.03 [1.02-1.04] per mg/dL, p&amp;lt;0.001). Conclusions CAC can be incidentally detected in more than half of our unselected cohort of patients undergoing uTCT for other indications. CAC score quantification by Agatston method is feasible in uTCT and associates with a higher risk of MACE during follow-up.Incidental CAC detection in uTCT

Long-term prognosis and predictors of death in chronic Chagas cardiomyopathy in women and men

Abstract Background Chronic Chagas cardiomyopathy (CCC) is one of the leading causes of heart failure (HF) in Latin America and carries high morbidity and mortality. Previous studies showed conflicting results in epidemiological and clinical evidence of a gender-associated risk of death in patients with HF due to CCC. Purpose This study analysed the long-term prognosis and the main predictors of death in women and men with HF due to CCC. Methods From March 2009 to January 2023, we followed a cohort of outpatients with HF due to CCC. Specific serological tests diagnosed Chagas disease. Baseline data included clinical characteristics and echocardiographic findings. Statistical analyses were performed using the Kaplan-Meier (K-M) method to analyse time-to-event data and Cox proportional hazards methods to search for predictors of death. Results We studied 739 patients, with a mean age of 57.0 ± 12.1 years, 387 (52%) male. Women had a higher mean age (58.4 ± 11.7 vs. 55.8 ± 12.3 years; p=0.001), had a higher mean baseline left ventricular ejection fraction (LVEF) (44.3±14.5 % vs. 37.0±14.5%; p&amp;lt;0.001) and a smaller left ventricular diastolic diameter (LVDD) (56.8±8.9 vs. 62.5±9.4 mm; p&amp;lt;0.001). Over a median follow-up period of 10 years, 213 (56%) men and 169 (44%) women died (K-M: log-rank p=0.043; Figure). Men received more beta-blocker therapy (52.4% vs. 47.6%; p=0.040) and had a higher prevalence of chronic kidney disease (CKD) (p=0.003) and stroke (p=0.007). HFpEF was more prevalent in women and HFrEF in men (p&amp;lt;0.001). Device implantation and transplant were similar between women and men. Cox regression analysis for death adjusted for age, sex, myocardial infarction, diabetes, CKD, stroke, atrial fibrillation (AF), and LVEF showed LVEF (HR= 0.98;95%CL:0.97-0.98), age (HR=1.03;95%CL1.02-1.04) and CKD (HR= 1.32;95%CL:1.10-1.64) as the main predictors of death. In men, the main predictors were age (HR=1.02;95%CL:1.01-1.04), CKD (HR=1.409;95%CL:1.07-1.86), and LVEF (HR=0.98;95%CL:0.97-0.99), and in women AF (HR=1.41;95%CL:1.03-1.91), age (HR=1.03;95%CL:1.01-1.04), and LVEF (HR=0.97;95%CL:0.96 -0.98). Conclusion women had a better prognosis than men, but gender was not an independent predictor of death. Prevention of comorbidities, especially CKD in men and AF in women, and higher beta-blocker therapy can significantly reduce the death rate in women and men with HF from CCC.

Longitudinal and cross-sectional associations of NT-proBNP with kidney function and chronic kidney disease: results from KORA cohort studies

Abstract Background Chronic kidney disease (CKD) and cardiovascular disease (CVD) exhibit a bidirectional and complex relationship, and share common risk factors and mechanisms of disease development. Thus, important CVD-related biomarkers, such as N-terminal prohormone of B-type natriuretic peptide (NT-proBNP), may serve as a biomarker for CKD development. Purpose We aimed to investigate the cross-sectional and longitudinal associations of NT-proBNP with kidney function and CKD in data from two population-based cohort studies. Methods We included 5854 men and women, aged 25-74 years, from the Cooperative Health Research in the Region of Augsburg (KORA) cohort studies S3 and S4, and their 1-2 subsequent follow-up surveys, with a median follow-up time of 9.4 and 13.4 years, respectively. Kidney function was assessed by 3 estimated glomerular filtration rate (eGFR) assessments, calculated using creatinine (eGFRcr), cystatin C, and combined creatinine and cystatin C. Serum NT-proBNP was logarithmically transformed followed by Z-score standardization and categorized into 4 groups (G1-4), &amp;lt;48.6, 48.6-125, 125-300, and ≥300 pg/ml. In cross-sectional analysis, linear regression and logistic regression were used to estimate β/odds ratio (OR) and their 95% confidence intervals (CIs) of continuous eGFR or prevalent CKD. For longitudinal analysis of repeated eGFR measurements during follow-up (5854 participants, 11870 observations), linear mixed-effects models were used. For incident CKD associations, interval-censored Cox regression models were performed in participants free of CKD at baseline. Results In cross-sectional analyses, higher NT-proBNP levels were associated with lower eGFR and higher prevalence of CKD across all 3 eGFR assessments. For example, results based on eGFRcr showed that the fully-adjusted β (95% CIs) for per 1 SD increase in log-transformed NT-proBNP were -1.03 (-1.42, -0.64) and -7.01 (-8.93, -5.09) 60 ml/min/1.73m2 for G4 compared to G1, respectively. Corresponding OR (95% CIs) were 2.22 (1.81, 2.74) and 13.8 (5.76, 36.4), respectively. In longitudinal analyses, participants with higher baseline NT-proBNP had a faster decline in eGFR during follow-up. The fully-adjusted β (95% CIs) for 5-year eGFRcr decline were -0.67 (-0.87, -0.47) per 1 SD increase, and -0.37 (-0.79, 0.05), -1.53 (-2.18, -0.88), -4.24 (-5.57, -2.90) 60 ml/min/1.73m2/year for G2-4. Higher NT-proBNP levels were associated with higher incident CKD risks. For associations with incident creatinine-based CKD, hazard ratio (95% CIs) were 1.16 (1.00, 1.33) per 1 SD increase and 1.03 (0.77, 1.38), 1.07 (0.75, 1.52), and 1.81 (1.07, 3.04) for G2-4. Conclusions We found associations of higher NT-proBNP with lower kidney function and higher CKD prevalence. Moreover, higher baseline NT-proBNP levels were associated with faster kidney function decline and higher incident CKD risks. Our findings indicate the potential utility of NT-proBNP as a biomarker of kidney health.Figure 1.Cross-sectional associationsFigure 2.Longitudinal associations

Heart failure and advanced chronic kidney disease: differences in characteristics, treatment and outcomes in patients with glomerular filtration rate greater or less than 30 ml/minute/m2

Abstract Introduction Heart failure (HF) is a serious health problem and continues to have a high mortality and incidence of decompensation, despite advances in its management. Chronic kidney disease (CKD) is very prevalent in patients with HF, hinders their treatment and worsens their prognosis, especially when it is advanced CKD (glomerular filtration rate-GFR &amp;lt;30 ml(min/m2). It is important to know the differential characteristics of these patients to improve their management. Purpose To analyze in a contemporary registry of HF patients followed in specialized HF units in Spain the differences in clinical characteristics and treatment between patients with HF and advanced CKD. Methods We analyzed data from the registry of the SEC-Excelente-IC quality accreditation program of the Spanish Society of Cardiology, with 1716 patients with HF included between 2019 and 2021 by 45 specialized HF units accredited by the SEC. Patients were included consecutively in two 1-month cutoffs (March and October) in that period. The clinical and demographic characteristics and comorbidities of the patients were compared according to GFR &amp;lt; or &amp;gt; 30ml/min/m2. Results Of the 1,716 patients, 11.1% had a GFR&amp;lt;30 and 88.9% &amp;gt;30 mL/min/m2. Figure 1 shows the main clinical characteristics and comorbidities of the 2 groups. Median LVEF was similar in both groups: 42 (30-58) vs 38% (29-54). The group with advanced CKD was older (77±9.6 vs 70.5±12.6 years; p&amp;lt;0.001), had greater HF severity (more admissions for HF in the last year, worse NYHA functional class and longer evolution time), and a higher prevalence of coronary heart disease, hypertension, diabetes mellitus, cognitive impairment, anemia, iron deficiency and hyponatremia. There were no differences in sex, BMI, serum potassium or other comorbidities (Figure 1). Figure 2 shows the treatment received in each group. Patients with GFR &amp;lt;30 received in a significantly lower proportion all drugs for HF (p&amp;lt;0.001), except diuretics and potassium binders (ACEI/ARA, sacubitril-valsartan, MRA, beta-blockers, digoxin and SLGT2 inhibitors), and less cardiac rehabilitation (5.2 vs 10.4%; p=0.029). Incidence of one-year mortality was significantly higher in patients with GFR&amp;lt;30 ml/min/m2 (37.2 vs 14.4 per 100 persons-year, p&amp;lt;0.001), as were HF hospitalizations (61.3 vs 33.0; p&amp;lt;0.001) and HF decompensations without hospitalization (24.1 vs 11; p&amp;lt;0.001). Conclusions In our contemporary cohort of real-life HF patients, the prevalence of advanced CKD was 11.1%. These patients had a higher severity of HF, despite which, the utilization of HF drugs, including SGLT2 inhibitors was much lower than in those with GFR &amp;gt;30 ml/min/m2. One-year mortality, HF hospitalization and HF decompensations were almost 3-times higher. This treatment trend needs to be modified to improve the prognosis of these patients.

Gender differences in long-term survival after coronary artery bypass surgery is womens cardiovascular health at risk?

Abstract Introduction Cardiovascular healthcare for women tends to be influenced by various factors. This patient group is generally associated with a worse prognosis following coronary artery bypass surgery (CABG). Aims To assess the impact of gender on long-term survival after CABG and the potential effect of age on this association; to compare the survival of these patients with the expected survival of the general national population, and to compare immediate postoperative outcomes between genders. Methods Longitudinal, retrospective, single center study, involving consecutive patients who underwent isolated primary CABG between 2004 and 2014. Exclusion criteria included emergency/salvage surgeries or the use of extracorporeal circulation without aortic clamping. Included patients were categorized into age subgroups: ≤60, 60-70, and ≥70 years. All-cause mortality was assessed in February 2023, and a time-to-event analysis was performed using Kaplan-Meier curves, Log-Rank tests, and multivariable Cox regressions. To compare expected mortality (matched for sex and age with the general population) with observed mortality in the patient cohort, survival tables for the years 2004-2022 were consulted. Kaplan-Meier curves for the reference population, stratified by gender, were constructed and compared to the surgical cohort using one-sample Log-Rank tests with specific software. Standardized mortality ratios (SMR) were estimated. The mean follow-up time was 11 years, with a maximum of 19 years. Results From 3978 patients included patient’s, 21% were women (W). W were older (mean age 67±9 vs. 63±10 years, p&amp;lt;0.001) and had a higher prevalence of cardiovascular risk factors and severe chronic kidney disease compared to men (M). M more frequently had peripheral arterial disease and smoking habits. Although three-vessel disease was similar between sexes (p=0.111), W were less frequently implanted with ≥3 grafts (p&amp;lt;0.001). At 5,10 and 15 years of follow-up, cumulative survival for MvsW was 89%vs88%, 73%vs68%, and 57%vs46%, respectively (Log-rank test p&amp;lt;0.001). After stratification by age, Log-Rank tests showed no differences between sexes. Multivariable adjustment did not identify gender as an independent predictor of long-term survival in any age subgroup. However, a time-stratified analysis at 10 years of follow-up in the ≥70 years subgroup showed that W had a higher risk than M after 10 years of follow-up (HR:0.7[0.5-0.9],p=0.03). Comparing with the survival of the Portuguese population, CABG allowed M to equalize the risk of mortality to what was expected (SMR =1.1;95%CI:0.9-1.1), but W showed a higher risk of mortality after CABG than W in the reference population (SMR =1.6,95%CI:1.3-1.8). Conclusion Women undergoing isolated primary CABG at an age &amp;gt;70 years, with longest periods follow-up, exhibited poorer long-term survival than men of the same age.Women demonstrated inferior survival outcomes compared to the general population.

Circulating ACE2 and the association of endothelial progenitor cell in CAD patients

Abstract Background/Introduction Angiotensin-converting enzyme (ACE) 2 is the homologue of ACE, and the local up-regulation of ACE2 expression associates to antiatherosclerosis. ACE2 hydrolyzes the angiogensin II, which related to impair of endothelial progenitor cell (EPC) function. EPCs maintain the integrity of vascular endothelium in case of damage. Decreased number of EPCs associate thrombosis. Purpose To investigate the circulating ACE2 and the link to EPC in CAD patients. Methods Data from 650 patients with stable angina pectoris requiring invasive coronary angiography were enrolled. They were divided into two groups according to the median value of ACE2. Two interventional cardiologists diagnosed obstructive CAD by angiography review. Demographic characteristics and clinical outcomes were compared between groups. Results In all subjects (median age 67 years, male=66.9%), a higher ACE2 level indicates elder, higher prevalence of hypertension, diabetes mellitus and chronic kidney disease. Significant EPC elevation when CAD numbers increased in higher ACE2 group (SVD vs. DVD vs. MVD = 0.005 vs. 0.006 vs. 0.007, p value=0.044). In multivariate analysis, higher ACE2 is positively correlated to triple vessel disease (TVD vs. no CAD, adjusted odds ratio=1.627, 95% CI 1.026-2.579). Conclusions Our data demonstrated higher circulation ACE2 links to EPCs in CAD patients.

Serum lipid profiles and uptake of lipid-lowering therapy in patients with premature atherosclerotic cardiovascular disease (ASCVD) in comparison to older patients with ASCVD

Abstract Background Serum lipid levels are well-established risk factors for developing atherosclerotic cardiovascular disease (ASCVD). There are multiple guideline-supported treatments for managing dyslipidaemia for secondary prevention of ASCVD events. Lipid profiles and uptake of guideline-directed lipid-lowering therapy (GDLLT) is poorly characterised in patients with premature ASCVD compared to their older counterparts. Purpose To investigate serum lipid profiles and GDLLT uptake in patients with premature ASCVD in comparison to older patients with ASCVD. Methods Consecutive patients who underwent inpatient invasive coronary angiography at our institution between January 2019-December 2021 were examined. Patients with confirmed ASCVD on coronary angiography were stratified into two groups based on the 2019 ESC/EAS Guidelines for the Management of Dyslipidaemias definition of premature ASCVD: Group 1 comprised of younger patients (&amp;lt;55 years for men, &amp;lt;60 years for women) and Group 2 comprised of older patients (≥55 years for men, ≥60 years for women). Demographics, clinical and biochemical parameters (including lipid profiles) and medications were obtained from the electronic medical record and compared between groups to identify differences in risk factor profiles. Results A total of 1437 patients (980 [68.2%] male, mean age 62.4±13.9 years) underwent coronary angiography. 916 patients (63.7%) had confirmed ASCVD, of which 225 were classified as premature ASCVD (24.6%, mean age 47.8±10.1 years) vs 691 older patients with ASCVD (75.4%, mean age 69.5±8.7 years). Group 1 patients had significantly higher mean BMI (31.7±8.1 vs 69.5±8.7; p=0.001) and lower prevalence of hypertension (54.2% vs 69.5%; p&amp;lt;0.001) or chronic kidney disease (5.3% vs 12.6%; p=0.002) compared to Group 2. There were no significant differences in sex, diabetes mellitus, or smoking history. Lipid profiles were significantly different between the two groups: Group 1 had higher levels of total cholesterol (TC), LDL-C, triglycerides, and TC/HDL-C ratio, but lower HDL-C levels (all p&amp;lt;0.001). A lower proportion of Group 1 patients were on GDLLT (42.7% vs. 60.3%; p&amp;lt;0.001). Amongst patients on GDLLT, there were similar rates in the use of high-intensity statins between groups, but Group 1 patients were significantly more likely to have an LDL-C level ≥1.8mmol/L (p=0.003). Multivariable models for individual lipid subfractions, accounting for gender, cardiovascular risk factors, and LLT use, showed that all lipid parameters remained significantly different between groups (all p&amp;lt;0.001). Conclusion Patients with premature ASCVD have significantly different lipid profiles compared to older ASCVD patients. They also have lower uptake of guideline-directed LLT and are less likely to meet recommended LDL-C targets for high-risk ASCVD despite therapy. These findings highlight the need for tailored risk factor evaluation and management in this population.

Cardiovascular disease burden and risk factor management in cancer survivors: insights from a large-scale East London cohort

Abstract Introduction Improvements in cancer survival have led to an urgent need to address long-term health issues among survivors, notably increased risk of cardiovascular disease (CVD). Shared risk factors may underpin at least part of this excess risk. Aims To investigate differences in cardiovascular risk profile between cancer survivors and controls; and to assesses the management of hypertension and statin use among cancer survivors compared with controls in a multi-ethnic and socio-economically diverse population. Methods The data were obtained from electronic health records of 1.2 million people registered with general practices in East London. It provides a snapshot of health records at the time of data extraction (01/01/2023). We identify individuals with record of past cancer (grouped into 20 cancer types) and their cardiovascular profile. Each cancer-exposed patient was age- and sex-matched to four non-cancer comparators. Multivariable logistic regression, with extensive adjustment for demographic and health-related variables, was used to elucidate the independent associations of past cancer with a range of cardiovascular outcomes. Patterns of guideline-directed risk factor control among cancer patients with hypertension and ischaemic CVDs (vs non-cancer controls) were assessed. Results The study consisted of 18,839 cancer survivors and 75,356 matched controls (64±15 years, 43% male), with marked ethnic diversity (cancer survivors: 48% White, 24% Black and 22% Asian) and socio-economic deprivation. Compared to matched controls, patients with past cancer had a higher prevalence of hypertension (44% vs. 41%) and chronic kidney disease (18% vs. 14%). We observed a higher prevalence of CVDs including venous thromboembolism (VTE) (5.6% vs. 2.8%), atrial fibrillation (AF) (6.5% vs. 5%), and heart failure (HF) (4.4% vs. 3.4%) among cancer survivors. Regression models fully adjusted for shared risk factors demonstrated an increased risk of a range of CVDs in patients with (any) past cancer, including VTE (OR 2.01), HF (OR 1.31) and AF (OR 1.27). CVD risk varied across cancer types (Figure 1). For example, lung cancer survivors had an elevated risk of VTE (OR 4.02), AF (OR 2.47), IHD (OR 1.45) and peripheral artery disease (OR 1.67) while colorectal cancer survivors had increased risks of VTE (OR 2.68), HF (OR 1.4) and AF (OR 1.32). In subgroup analyses, control of blood pressure and cholesterol did not differ significantly across cancer survivors and matched controls with hypertension and ischaemic CVDs, respectively. Conclusion We show higher burden of VRFs and an increased risk of CVDs among cancer survivors compared with non-cancer controls, with notable variation across cancer types. The lack of difference in control of blood pressure and cholesterol between cancer survivors and controls suggests that these risk factors did not explain the increased risk. Suggesting that an individualised approach to risk management is likely to be warranted.Risk of CVDs in Cancer Survivors

Chronic kidney disease in patients with heart failure in German primary care practices: the InspeCKD study

Abstract Background Chronic kidney disease (CKD) is, alongside type 2 diabetes mellitus, the most common comorbidity in patients with heart failure (HF), with a prevalence of 40-50%. HF patients should therefore be screened, monitored, and treated according to international Kidney Disease Improving Global Outcomes (KDIGO) conclusions for early identification and intervention of CKD, with annual determination of eGFR to monitor kidney function and annual urine albumin-to-creatinine ratio (UACR) testing as appropriate. Early diagnosis is important as therapeutic options can be offered to slow the progression of CKD and reduce the risk of cardiovascular complications and mortality. Purpose Currently, there are only limited data available regarding screening, diagnosis and treatment of CKD for HF patients in German primary care physician (PCP) practices. Therefore, this analysis of the InspeCKD study was designed to examine the frequency of use of CKD-specific laboratory diagnostics in HF patients in routine PCP care. Methods In the current data analysis, fully anonymized patient data from German PCP practices were evaluated. In accordance with the screening recommendation of the KDIGO guideline, adult patients with diabetes, hypertension and/or cardiovascular disease, including HF, with at least one year of observation period were included in the analysis. Results The overall patient cohort comprised 448.837 patients from 1.244 German PCP practices. Of the 7.9% HF patients, 6.1% participated in a disease management program (DMP) for coronary heart disease. The average age of HF patients was 74 years. The prevalence of diagnosed CKD in HF patients during the observational period (mean: 1.7 years) was 26.8%. Within the subgroup of patients with HF, serum creatinine to estimate GFR was measured at least once in 48.5% of patients. Urine dipstick testing for albuminuria was performed in 7.4% of patients and UACR was measured at least once in 0.3% of patients. In patients with at least one documented measurement, eGFR and UACR were checked 2.2 and 0.9 times, respectively, per patient and year. Of the HF patients with laboratory-confirmed CKD according to KDIGO criteria, 81.8% were not diagnosed with CKD. Conclusion The analysis shows that, given the high prevalence of CKD in HF patients and the current KDIGO recommendations for early identification and intervention of CKD, a substantial proportion of HF patients in German PCP practices did not receive adequate laboratory diagnostics for early diagnosis of CKD. In addition, the majority of patients with laboratory-confirmed CKD were not diagnosed. Early detection of CKD and the use of evidence-based therapeutic options can significantly reduce the risk of CKD progression. In conclusion, there is an urgent need to raise awareness among PCPs about secondary and tertiary prevention of CKD in patients with HF and to include coordinated CKD screening recommendations in HF guidelines.

Experience of Continuous Ambulatory Peritoneal Dialysis In Remote Area of Southeast Bangladesh

Background: Chronic kidney disease (CKD) is a major public health problem that continues to increase in prevalence globally. The prevalence of chronic kidney disease is increasing day by day in low to middle income countries (LMICs). People living in LMICs have the highest need for renal replacement therapy (RRT) despite they have lowest access to various modalities of treatment. As continuous ambulatory peritoneal dialysis (CAPD) does not require advanced technologies, very much infrastructure, dialysis staff support, it should be an ideal form of RRT in LMICs, particularly for those living in remote areas. To authors knowledge there was scarcity of data regarding CAPD performance in remote area of Bangladesh. This study was aimed to report the characteristics and outcomes of CAPD in ESRD patients lived in least developed area of Bangladesh. Methods: This prospective study was conducted in Cox’sbazar Medical College Hospital, Cox’sbazar and Parkview hospital Ltd, Chattogram, Bangladesh. Data were collected by questionnaire from the patients of any age with end-stage renal disease (ESRD) who underwent CAPD in 2018–2021. The baseline characteristics, PD-related complication as well as patient and technique survivals were analyzed. Results: Out of 31 patients who underwent CAPD, 18 (58%) were male on the age range of 15–79 years. The mean follow-up duration was 18 months. Mortality was inversely related with the EF of echocardiography. The peritonitis rate was 0.48 episodes per patient per year. The 1, 3 and 4-year patient survival rates were 64.34% (95% CI = 52.5–81.5), 23.79% (95% CI = 17.9 – 57.4) and 3.22% (95% CI = 31.2–77.5) respectively. Conclusions: In this study, CAPD performance was poorer than usual reference. Cardiac compromised patient and inappropriate dwell might be the main contributing factors behind this scenario. The peritonitis rate was nearly similar to that of developed countries. CAPD was cost effective than HD in remote area. Some accessible measures may be taken to make CAPD a more acceptable RRT modality with improved outcomes in poor socioeconomic backgrounds area. J Dhaka Med Coll. 2023; 32(1) : 24-31

Kidney and cardiovascular outcomes in older population with mildly to moderately decreased kidney function - A nationwide cohort study.

Although the prevalence of chronic kidney disease (CKD) is increasing in the aging population, the clinical relevance of the CKD definition (glomerular filtration rate [GFR] &lt; 60 ml/min/1.73 m2) in older populations remains debatable. We investigated the clinical outcomes in older populations with mildly to moderately decreased GFR (45-59 ml/min/1.73 m2, CKD stage 3A). A total of 7,789,242 participants aged ≥ 40 years with estimated GFR (eGFR) ≥ 45 ml/min/1.73 m2 in national health screening examination from 2012 to 2017 were included in this retrospective cohort study using the Korean National Health Insurance Service database. The main outcomes included kidney failure, cardiovascular disease (CVD), and all-cause death. Cox regression hazard models were used to estimate the hazard ratios. The proportion of participants with eGFR 45-59 ml/min/1.73 m2 was 10.0% and 16.3% in the old (65-74 years) and very old (75 ≥ years) groups, respectively. Mildly to moderately decreased eGFR was associated with a higher risk of kidney failure, CVD, and all-cause death compared with eGFR 60-89 ml/min/1.73 m2 in the old and very old groups, regardless of proteinuria (adjusted hazard ratio [95% confidence interval] in the very old group without proteinuria: kidney failure 3.048 [2.495-3.722], CVD 1.103 [1.066-1.142], and all-cause death 1.172 [1.144-1.201]). Mildly to moderately decreased eGFR was associated with an increased risk of kidney failure, CVD, and all-cause death in the older population, regardless of proteinuria, suggesting the importance of appropriate monitoring and management in this population.

Impact of Home-Based Rehabilitation on Renal Prognosis in Patients with Chronic Kidney Disease.

The increasing prevalence of chronic kidney disease (CKD) requires effective preventive measures, particularly due to an aging population. This study aimed to assess the effectiveness of home visit rehabilitation in preventing renal function decline among patients with CKD. In this retrospective study, patients with non-dialysis CKD undergoing home visit rehabilitation were compared with those receiving outpatient care at the Nippon Medical School Hospital between August 2017 and August 2023. Patients' backgrounds were matched using propensity scores derived from a logistic regression model. The primary endpoint was the annual change in the estimated glomerular filtration rate (eGFR), and the secondary endpoint was the annual change in blood parameters (Δblood urea nitrogen, Δcreatinine, Δtotal protein, Δalbumin, ΔC-reactive protein, Δhemoglobin, and Δhematocrit). Furthermore, the incidence of clinical outcomes, including mortality, hospitalization rate, and dialysis initiation rate, were analyzed within the additional 1-year observation period. Overall, 128 patients (64 matched pairs) were analyzed. After a mean follow-up period of 12.7 ± 4.6 months, there was no significant difference in the eGFR between both groups (40.1 ± 13.7 vs. 37.8 ± 13.8 mL/min/1.73 m2, p = 0.36), but the annual decline in eGFR (%/year) was significantly lower in the rehabilitation group (-1.1 ± 29.8% vs. -11.8 ± 27.7%/year, p = 0.037). The annual change in the level of each blood test parameter and clinical outcomes were not significantly different between the two groups. Home-based rehabilitation interventions may mitigate the progression of renal impairment in patients with CKD.

Prognostic impact of switching to the 2021 chronic kidney disease epidemiology collaboration creatinine-based equation in Caucasian patients with type 2 diabetes: the Renal Insufficiency and Cardiovascular events (RIACE) Italian Multicenter Study

BackgroundA Chronic Kidney Disease (CKD) Epidemiology Collaboration (EPI) formula not including a Black race coefficient has been recently developed and is now recommended in the US. The new (2021) equation was shown to yield higher estimated glomerular filtration rate (eGFR) values than the old (2009) one in a non-Black general population sample, thus reclassifying a significant number of individuals to a better eGFR category. However, reclassified individuals were previously shown to have a lower risk of progression to end-stage kidney disease, but higher adjusted risks for all-cause death and morbidity and mortality from cardiovascular disease than those not reclassified. This study evaluated the prognostic impact of switching from the 2009 to the 2021 CKD-EPI equation in non-Black individuals with type 2 diabetes.MethodsThe Renal Insufficiency And Cardiovascular Events (RIACE) was a prospective cohort study enrolling 15,773 Caucasian patients in 19 Italian centers in 2006–2008. Cardiometabolic risk profile, treatments, complications, and comorbidities were assessed at baseline and eGFR was calculated with the two equations. Vital status was retrieved on 31 October 2015 for 15,656 participants (99.3%).ResultsWith the 2021 equation, the eGFR value increased in all patients, except for 293 individuals with a 2009 eGFR ≥ 105 ml·min− 1·1.73 m− 2. The median difference was 4.10 ml·min− 1·1.73 m− 2 and was higher in males, older individuals and those in the G2 category. Reclassification decreased the percentage of patients with reduced eGFR from 17.28 to 13.96% and with any CKD from 36.23 to 34.03%. Reclassified individuals had better cardiometabolic risk profile and lower prevalence of complications and use of medications than non-reclassified individuals. Risk of death versus the 2009 G1 category was lower for reclassified than non-reclassified participants in all eGFR categories and, particularly, in each 2009 eGFR category, though difference was significant only in the G4-G5 category. The Receiver Operator Characteristic curves were statistically, but not clinically different with the two equations.ConclusionChanging from the 2009 to the 2021 CKD-EPI equation results in higher eGFR and lower CKD prevalence, with a lower risk of death in reclassified patients with an eGFR < 30 ml·min− 1·1.73 m− 2, but virtually no impact on mortality prediction.Trial registration: ClinicalTrials.gov, NCT00715481, retrospectively registered 15 July, 2008.

Febuxostat in patients with hyperuricemia and gout: is the nephroprotective effect real?

Hyperuricemia (HU) and gout are independent risk factors for chronic kidney disease (CKD). Worldwide, the increasing prevalence of CKD leads to a deterioration in the quality and duration of life of patients and an increase in mortality. If HU plays a significant role in the development of renal failure, then lowering high uric acid (UA) levels should theoretically contribute to the improvement of kidney function. The main method of lowering UA levels is administration of a urate-lowering therapy – xanthine oxidase (XO) inhibitors. The nephroprotective effect of one of the XO inhibitors, febuxostat has been demonstrated in animal models.The article analyzes the currently available data on the use of febuxostat in patients with HU and gout and different levels of renal function impairment and discusses the possible mechanisms of the drug's nephroprotective effect.

Inside CKD: a microsimulation modelling study projects the clinical and economic burden of chronic kidney disease in Hungary.

The Inside CKD programme implemented a microsimulation modelling approach to project the clinical and economic burden of chronic kidney disease (CKD) between 2024 and 2027 in Hungary. Using the peer-reviewed Inside CKD microsimulation, a virtual Hungarian population was generated that was derived from national records, local demographic data and published epidemiological data. These inputs defined the likelihood of a change in health state for each individual as they progressed through the model in annual increments. Individual CKD status, including disease progression, cardiorenal complications and associated costs, was tracked annually to generate the population-level projections of the clinical and economic burden of CKD. By 2027, people with CKD were projected to constitute 13.3% of the Hungarian national population. The prevalence of heart failure, myocardial infarction and stroke in people with CKD were projected to remain consistently high, reaching 323 447, 69 188 and 120 118 by 2027, respectively. Kidney replacement therapy cases were predicted to remain high at 20 515 in 2024 and 22 325 in 2027, with associated costs increasing from 71.4 billion HUF in 2024 to 79.6 billion HUF in 2027. Total annual healthcare costs associated with treating CKD were projected to constitute 5.4% of the overall national healthcare budget in 2027. Inside CKD demonstrates that the future burden of CKD in Hungary will be substantial unless current management strategies change. The high prevalence of undiagnosed CKD and associated cardiorenal complications highlight the urgent need for policy interventions focused on early diagnosis and timely intervention to mitigate the future burden of CKD.