Chronic Kidney Disease Prevention Programs Research Articles

Validation of the Kidney Failure Risk Equation in the Colombian Population.

Chronic kidney disease prevention programs must identify patients at risk of early progression to provide better treatment and prolong kidney replacement therapy-free survival. Risk equations have been developed and validated in cohorts outside of Colombia, so this study aims to evaluate the discrimination and calibration of the four-variable kidney failure risk equation in a Colombian population where it has yet to be validated. External validation study of a kidney failure risk equation using a historical cohort of patients with CKD stages 3, 4, and 5, adults without a history of dialysis or kidney transplantation with a two-year follow-up, belonging to the Baxter Renal Care Services Colombia network. The discriminatory capacity of the model was evaluated by the concordance index using Harrell's C statistic, and the time-dependent area under the receiver operating characteristic (ROC) curve was estimated using the nearest neighbor method, as well as the optimal cut-off point for sensitivity and specificity. Calibration was determined by the degree of agreement between the observed outcome and the probabilities predicted by the model using the Hosmer-Lemeshow statistic. A total of 5,477 patients were included, with a mean age of 72 years, 36.4% diabetic, and a mean baseline eGFR of 36 ml/min/1.73 m2. The rate of dialysis initiation was three events per 100 patient-years, 95% CI (2.9-3.6). The optimal cutoff for sensitivity was 0.94, for specificity, 0.76, and the area under the ROC curve was 0.92. Harrell's C-statistic was 0.88 for the total population, 0.88 for diabetic patients, and 0.93 for those 65 years or older. The validation of the model showed good calibration. In this Colombian cohort, the four-variable KFRE with a two-year prediction horizon has excellent calibration and discrimination, and its use in the care of CKD Colombian patients is recommended.

National trends and projection of chronic kidney disease incidence according to etiology from 1990 to 2030 in Iran: a Bayesian age-period-cohort modeling study.

Chronic kidney disease (CKD) is a major public health problem worldwide. Predicting CKD incidence rates and case numbers at the national and global levels is vital for planning CKD prevention programs. Data on CKD incidence rates and case numbers in Iran from 1990 to 2019 were extracted from the Global Burden of Disease online database. The average annual percentage change was computed to determine the temporal trends in CKD age-standardized incidence rates from 1990 to 2019. A Bayesian age-period-cohort model was used to predict the CKD incidence rate and case numbers through 2030. Nationally, CKD cases increased from 97,300 in 1990 to 315,500 in 2019. The age-specific CKD incidence rate increased from 168.52 per 100,000 to 382.98 per 100,000 during the same period. Between 2020 and 2030, the number of CKD cases is projected to rise to 423,300. The age-specific CKD incidence rate is projected to increase to 469.04 in 2030 (95% credible interval, 399.20 to 538.87). In all age groups and etiological categories, the CKD incidence rate is forecasted to increase by 2030. CKD case numbers and incidence rates are anticipated to increase in Iran through 2030. The high level of CKD incidence in people with diabetes mellitus, hypertension, and glomerulonephritis, as well as in older people, suggests a deficiency of attention to these populations in current prevention plans and highlights their importance in future programs for the national control of CKD.

Amharic based Knowledge-Based System for Diagnosis and Treatment of Chronic Kidney Disease using Machine Learning

Chronic kidney disease is an important challenge for health systems around the world and consuming a huge proportion of health care finances. Around 85% of the world populations live in developing country of the world, where chronic kidney disease prevention programs are undeveloped. Treatment options for chronic kidney disease are not readily available for most countries in sub-Saharan Africa including Ethiopia. Many rural and urban communities in Ethiopia have extremely limited access to medical advice where medical experts are not readily available. To address such a problem, a medical knowledge-based system can play a significant role. Therefore, the aim of this research was developing a self- learning knowledge based system for diagnosis and treatment of the first three stages of kidney disease that can update the knowledge without the involvement of knowledge engineer. In the development of this system, the following procedures are followed: Knowledge Engineering research design was used to develop the prototype system. Purposive sampling strategies were utilized to choose specialists. The information was acquired by using both structured and unstructured interviews and all knowledge’s are represented by using production rule. The represented production rule was modeled by using decision tree modeling approach. Implementation was employed by using pro-log tools. Testing and evolution was performed through test case and user acceptance methods. Finally, we extensively evaluate the prototype system through visual interactions and test cases. Finally, the results show that our approach is better than the current ones.

Need for chronic kidney disease prevention programs in disadvantaged populations.

Chronic kidney disease (CKD) is a key determinant of the poor health outcomes for major non-communicable diseases that are the leading cause of death in the world. CKD is a worldwide threat to public health, but the size of the problem is not fully appreciated. Early recognition of CKD and concomitant co-morbid conditions, can potentially slow progression to renal failure, increase longevity, improve quality of life, and reduce healthcare costs. Although screening programmes are attractive, there is no consensus yet on which individuals should be prioritized (high-risk group for CKD, or general population) especially in resourcepoor regions. In these settings there is not a unique blueprint of screening strategy, so that the approaches should be adapted on single-nation conditions and socioeconomic status. Effective multimodal tools are available to prevent CKD by managing its risk factors, and to slow or even halt disease progression to end-stage renal failure, as well as reduce the associated risk of cardiovascular morbidity and mortality. They can be adapted even to the poorest populations who are at the highest risk of CKD. Where management strategies have been implemented, the incidence of end-stage renal disease (ESRD) has been reduced. The hope is that all these efforts will assist to make major advances in addressing the neglected aspect of renal health, especially of poor and disadvantaged populations worldwide. Beside saving young lives, such action would minimize the present health inequity that arises mainly from the unaffordable cost of renal replacement therapy if ESRD is not prevented.

Development and psychometric evaluation of the Chronic Kidney Disease Screening Index

Objective: Public understanding of chronic kidney disease (CKD) is important to ensure informed participation in CKD prevention programs. This study aimed to develop and to test the psychometric profile of the CKD Screening Index that measures patient’s knowledge, attitudes, and practices regarding CKD prevention and early detection. Methods: A cross-sectional design was implemented and a total of 740 Jordanian patients recognized at risk for CKD were recruited by convenience sampling from out-patient departments. Development and psychometric validation of the CKD Screening Index were conducted in four phases: (1) item generation, (2) pilot study, (3) preliminary psychometric validation study to examine factor structure, and (4) final psychometric validation with 740 participants. Results: On factor analysis, 24 items categorical knowledge items loaded into one factor and yielded a Guttman Split-Half Coefficient of 0.80. In a separate factor analysis, 15 items were loaded on two attitude factors (Cronbach alpha coefficient = 0.69), and nine items loaded on two practice factors (Cronbach alpha coefficient = 0.68). The CKD Screening Index associated significantly and negatively with depressed and anxious patients compared to their counterparts. Practice implications: This promising CKD Screening Index can be used for an early identification of patients at risk for CKD, thus, allowing the development of interventions to raise these patients’ awareness. Future studies are needed on other populations with different cultural background to support reliability and validity of this new instrument.

Chronic kidney disease prevention—a challenge for Asian countries: report of the Third Asian Forum of Chronic Kidney Disease Initiatives

As an independent meeting, the third Asian Forum of Chronic Kidney Disease Initiatives was held on April 18-19, 2009, in Kaohsiung, Taiwan. Nearly 700 participants from 17 countries attended and 78 posters were presented. To begin with, status quo in Asia and in Taiwan was briefed, followed by Theme 1A "Special Epidemiology and Risk Factors", during which the interrelations between chronic kidney disease (CKD) and use of herbs, low birth weight, infections, and immunoglobulin A (IgA) nephropathy were discussed. Theme 1B dealt with both cardiovascular and renal outcomes of CKD patients. In Theme 2, five presenters from different countries shared their experiences on "Cost-effectiveness of Community-based or Nationwide CKD Prevention Programs". In between the conference themes, three international and integrative works--Kidney Disease Improving Global Outcomes, the World Kidney Day, and Kidney Early Evaluation Program--were presented and possible implications for Asia were suggested. Theme 3 was initiated with a thorough discussion on "Equation of the Estimated Glomerular Filtration Rate for Asians" and the preliminary results of a cross-country study were presented. In Theme 4, the care plan, strategies, and outcomes of timely initiation of dialysis in different countries were discussed. The final session started with a concise summary of all speeches and ended with a position statement.

Prevalence and risk factors associated with chronic kidney disease in a Uygur adult population from Urumqi

Evaluating the prevalence of kidney damage according to population-based studies in different communities has been limited in developing countries. We conducted a population-based screening study in Uygur people of Urumqi, aiming to identify the prevalence and associated risk factors of chronic kidney disease (CKD) in Uygur populations. A total of 2576 residents (>18 years) from four districts of Urumqi were interviewed from June 2007 to January 2009 and tested for haematuria, albuminuria and reduced renal function. Associations between age, gender, smoking, diabetes mellitus, hypertension, hyperuricaemia and kidney damage were examined. There were 2576 subjects enrolled in this study. After age correction, the prevalence of albuminuria, haematuria and reduced estimated glomerular filtration rate (eGFR) was 3.58%, 2.26% and 1.03%, respectively. Approximately 5.65% of the sample population had at least one indicator of kidney damage. Age, diabetes mellitus, hypercholesteremia, hyperuricaemia and hyperlipidaemia were independently associated with CKD. In the general Uygur adult population from Urumqi, 5.65% had either proteinuria, haematuria or reduced eGFR, indicating the presence of kidney damage, with an awareness of only 1.05%. The high prevalence and low awareness of CKD in this population suggest an urgent need for CKD prevention programs in Uygur people.

Challenging chronic kidney disease: Experience from chronic kidney disease prevention programs in Shanghai, Japan, Taiwan and Australia

Chronic kidney disease (CKD) is now a global health problem. One important strategy to prevent and manage CKD is to offer a prevention program which could detect CKD early as well as raise awareness of the disease. In Shanghai, a community-based study demonstrated that the prevalence of CKD was high while awareness was low. The results from Shanghai urged the necessity of a screening and prevention program of CKD. In Japan, the urinalysis screening system was established to early diagnose and prevent CKD. Due to modification of lifestyle and prevalence of diabetes, urine dip-stick test for microalbuminuria might be necessary in adults while screening for proteinuria and haematuria are necessary for students and young adults. In Taiwan, two CKD programs - a CKD care program and diabetic share care program - were initiated. The cost-effectiveness study indicated that both programs could reduce end-stage renal disease (ESRD) burden in Taiwan because integrated pre-ESRD care was important for patients with CKD stage 4 and stage 5 while a diabetic shared care program was cost-effective to prevent nephropathy to patients with diabetic mellitus. In Australia, studies demonstrated that screening of high-risk individuals as well as promoting awareness were cost-effective to early detection of CKD. Furthermore, opportunistic screening with emphasis on early detection was effective in CKD prevention. The studies from those regions share experiences on early prevention and management of CKD.

Status of chronic kidney disease prevention programs: International Federation of Kidney Foundation Members 2005/2007

The International Federation of Kidney Foundations surveyed its members on chronic kidney disease 'prevention' programs in their regions and countries in 2005 and 2007. A profile was developed, representing 28 countries (56% response). Some form of screening activity was reported in 24 of the 28 countries (85.7%). Two countries (7%) had, or anticipated development of, legislated national screening. Programs were conducted by kidney foundations or research groups, and were variously population based, focused on high risk groups or opportunistic. Tests in 63% of responding programs included weight, height, blood pressure, blood glucose, dipstick urinalysis and serum creatinine. Several programs used the USA's Kidney Early Evaluation Program's and International Society of Nephrology's templates. World Kidney Day activities contributed significantly. Stated needs were for more government recognition, firm policies and approaches, and critically, resources. Repeat responders reported progress in 2007, particularly in government interest and education delivery. Despite difficulties, programs are developing in many regions. Most need more resources and some members need substantial and sustained assistance.