Chronic Kidney Disease Screening Research Articles

Screening and management of hypertensive patients with chronic kidney disease referred to Hypertension Excellence Centres among 27 countries. A pilot survey based on questionnaire.

Real-life management of hypertensive patients with chronic kidney disease (CKD) is unclear. A survey was conducted in 2023 by the European Society of Hypertension (ESH) to assess management of CKD patients referred to ESH-Hypertension Excellence Centres (ESH-ECs) at first referral visit. The questionnaire contained 64 questions with which ESH-ECs representatives were asked to estimate preexisting CKD management quality. Overall, 88 ESH-ECs from 27 countries participated (fully completed surveys: 66/88 [75.0%]). ESH-ECs reported that 28% (median, interquartile range: 15-50%) had preexisting CKD, with 10% of them (5-30%) previously referred to a nephrologist, while 30% (15-40%) had resistant hypertension. The reported rate of previous recent (<6 months) estimated glomerular filtration rate (eGFR) and urine albumin-creatinine ratio (UACR) testing were 80% (50-95%) and 30% (15-50%), respectively. The reported use of renin-angiotensin system blockers was 80% (70-90%). When a nephrologist was part of the ESH-EC teams the reported rates SGLT2 inhibitors (27.5% [20-40%] vs. 15% [10-25], P = 0.003), GLP1-RA (10% [10-20%] vs. 5% [5-10%], P = 0.003) and mineralocorticoid receptor antagonists (20% [10-30%] vs. 15% [10-20%], P = 0.05) use were greater as compared to ESH-ECs without nephrologist participation. The rate of reported resistant hypertension, recent eGFR and UACR results and management of CKD patients prior to referral varied widely across countries. Our estimation indicates deficits regarding CKD screening, use of nephroprotective drugs and referral to nephrologists before referral to ESH-ECs but results varied widely across countries. This information can be used to build specific programs to improve care in hypertensives with CKD.

IJCM_385A: Establishment of a CKD Screening and treatment program at a secondary care hospital in rural Karnataka - A case study

Background: With the rapidly increasing incidence of kidney disease due to the rise in non- communicable diseases like diabetes and hypertension in India, a felt need for easily accessible Dialysis unit was found during the community assessment. Chronic Kidney Disease (CKD) education and screening program was also proposed to be established along with this to improve awareness and early detection. This would help in health system strengthening and prevent patients from travelling to far away locations for the dialysis sessions. Objective: 1. To conduct CKD education and screening camps in rural areas of Karkala taluk Methodology: The project was implemented for a duration of 12 months starting from July 2021. Camps were held along with help from local clubs &amp; Rotary Club. The following blood tests were carried out: Glycosylated Hemoglobin, Random Blood Sugar (RBS) or Fasting Blood Sugar (FBS), Serum Creatinine and Lipid Profile. These tests were done free of cost for all camp attendees. If the parameters were found to be abnormal, they were referred to Dr TMA Pai Rotary Hospital, Karkala for confirmation of the diagnosis and further management. Along with screening, Health education sessions were also be carried out to create awareness regarding diabetes and Chronic Kidney Disease among the rural population. The Dialysis unit was set up with 3 dialysis machines with funding from Rotary International under the Global Grant scheme. Dialysis was provided at subsidized to Below Poverty Line (BPL) patients. Results: A total of 10 CKD screening &amp; awareness camps were held during the project period. A total of 588 patients were screened. 132 were referred for further management. 8 patients were referred for Dialysis. Average of 170 dialysis sessions are carried out per months. 805 participants attended the training sessions. Conclusion: Similar set ups in rural areas will help in early detection of CKD and make dialysis more affordable and accessible.

InspeCKD - Analysis of the use of diagnostics in patients at high risk for chronic kidney disease in German general practitioner (GP) practices

Despite the high prevalence of chronic kidney disease (CKD) in Germany, only a small proportion of patients are currently diagnosed with CKD. Patients with hypertension, diabetes mellitus, and/or cardiovascular disease have a significantly increased risk of developing CKD and rapid disease progression and should therefore be screened and monitored in accordance with the guidelines. The aim of this retrospective, cross-sectional study was to gain insights into appropriate diagnosis of patients at risk for CKD in German general practitioner practices. For the analysis of the use of CKD-relevant diagnostics, electronic patient records from German general practitioner practices were analyzed. Adults with hypertension and/or diabetes mellitus and/or cardiovascular disease with a documented observation period of at least one year were included in the study. Data from a total of 448,837 patients from 1244 general practitioner practices were analyzed. 75.8% of patients had hypertension, 35.1% had cardiovascular disease, and 32.4% had diabetes mellitus. During a mean observation period of 1.7 years, serum creatinine was assessed at least once in 45.5% of patients. A urine dipstick test for albuminuria was performed in 7.9% of patients and in 0.4% of patients, urine albumin-to-creatine ratio (UACR) was measured. Laboratory diagnostics were initiated a little more frequently in high-risk patients compared to the overall cohort. The study highlights that despite known risk factors, guideline compliant CKD screening is rarely performed in German general practitioner practices, which implicates the need to increase the awareness of early diagnosis of CKD in patients at risk.

Community pharmacist-led point-of-care eGFR screening: early detection of chronic kidney disease in high-risk patients

Adherence to scheduled physician screenings for renal function monitoring in patients with chronic kidney disease (CKD) or those at high risk remains suboptimal despite the endorsement of regular screenings by several clinical practice guidelines. Our study aims to assess the effectiveness of a point-of-care CKD screening program led by these pharmacists using the PICCOLO device while recognizing the unique position of community pharmacists in primary care. We conducted an 11-month prospective point-of-care interventional research study in the United Arab Emirates to evaluate the performance of a community pharmacist-led CKD screening program for high-risk patients. Six diverse community pharmacies were selected based on staff availability, patient volume, and their offered range of services. Eligible individuals with risk factors for CKD were identified during medication evaluations. The PICCOLO Comprehensive Metabolic Panel facilitated on-site blood analysis, delivering estimated Glomerular Filtration Rate (eGFR) results within 10 to 15 min. Data also included eGFR categories, demographic information, and insights into lifestyle and health habits collected through a questionnaire. Pharmacists conducted comprehensive medication reviews and offered referrals and lifestyle guidance as part of the program. The study encompassed a total of 400 patients, with an average age of 69 ± 13.4 years within the study cohort. Notably, 38.8% (155 individuals) of the 400 patients were found to have undiagnosed CKD stages 3–5. Univariate logistic regression analysis revealed a significant association between a higher incidence of CKD stages 3–5 and factors such as older age, a history of hypertension, vascular disease, and diabetes mellitus. In the multivariate regression model, age and a history of diabetes mellitus emerged as significant predictors of an elevated risk of CKD. This study sheds light on the viability and impact of CKD screening programs conducted by community pharmacists, particularly in detecting CKD stages 3–5. The findings have implications for healthcare policies, as they can influence the enhancement of early detection and management of CKD. Moreover, these insights may catalyze focused screening initiatives and strengthen collaboration between community pharmacies and healthcare systems to benefit patients at high risk of CKD.

EPIDEMIOLOGY OF CHRONIC KIDNEY DISEASE IN PATIENTS WITH TYPE 2 DIABETES MELLITUS IN UKRAINE

The article reports on the prevalence of chronic kidney disease (CKD) in Ukrainian diabetic patients. A total of 194 patients who seeking an appointment with an endocrinologist underwent CKD screening. Materials and methods. The mean age of the patients was 64.82±0.88 years, and the duration of diabetes mellitus amounted to 9.29±0.60 years. Of these, 53.1% were female and 46.9% were male. Out of the screened patients, 79.4% had type 2 diabetes mellitus, 3.6% had type 1 diabetes mellitus, 9.3% had prediabetes, and 7.7% had other types of diabetes. We diagnosed CKD by calculating the estimated glomerular filtration rate (GFR) based on the creatinine level using the CKD-EPI Creatinine formula and determining albuminuria as the albumin-to-creatinine ratio. Results. Among diabetic patients, 26.8% had stage 1 CKD, 42.3% had stage 2, 21.6% had stage 3a, 8.2% had stage 3с, and 0.5% had each of stage 4 and 5. 70.6% of patients were found to have albumin-to-creatinine ratio (ACR) A1, 21.6% – A2, and 7.7% – A3. Of these, 30.0% were at high and very high risk of developing end-stage CKD. The regression analysis revealed a negative correlation between the duration of diabetes mellitus and the level of GFR, B (95% CI) = -0.102 (-0.179/-0.26), p = 0.009, and a positive correlation with ACR, B (95% CI) = 2.87 (0.089/5.605), p = 0.043. Conclusions. Among the examined patients with diabetes mellitus, 73.2% had stage 2-5 chronic kidney disease, and 29.3% had stage A2 and A3 albuminuria. Of these, 30% belong to the high- and very high-risk group for developing end-stage chronic kidney disease, requiring regular monitoring of glomerular filtration rate and albuminuria at least 3-4 times a year and conservative treatment. The duration of diabetes is a negative risk factor for chronic kidney disease. Hence, chronic kidney disease screening should be performed in all patients with diabetes with no exception.

Cost-effectiveness of screening for chronic kidney disease using a cumulative eGFR-based statistic.

Routine screening for chronic kidney disease (CKD) could enable timely interventions to slow down disease progression, but currently there are no clinical guidelines for screening. We aim to evaluate the cost-effectiveness of screening for CKD using a novel analytical tool based on a cumulative sum statistic of estimated glomerular filtration rate (CUSUMGFR). We developed a microsimulation model that captured CKD disease progression, major complications, patients' awareness, and treatment adherence for a nationally representative synthetic cohort of age ≥ 30 years in the United States. In addition to the status quo with no screening, we considered four CUSUMGFR-based universal screening policies by frequency (annual or biennial) and starting age (30 or 60 years), and two targeted annual screening policies for patients with hypertension and diabetes, respectively. For each policy, we evaluated the total discounted disability-adjusted life years (DALYs) and direct health costs over a lifetime horizon and estimated the incremental cost-effectiveness ratio (ICER). We further performed one-way and probabilistic sensitivity analyses to assess the impact of parameter uncertainty. Compared with the status quo, all the CUSUMGFR-based screening policies were cost-effective under the willingness-to-pay (WTP) range of $50,000 -$100,000, with the estimated incremental cost-effectiveness ratios (ICERs) ranging from $15,614/DALYs averted to $54,373/DALYs averted. Universal annual screening with starting age of 30 was the non-dominated policy on the cost-effectiveness frontier under the WTP of approximately $25,000. Adding more recent treatment option of sodium-glucose cotransporter-2 (SGLT2) inhibitors to the treatment regimen was found to be cost-saving. Among the most influential model parameters, variation in the CKD progression rate, adherence, and testing cost resulted in the highest variability in model outcomes. CUSUMGFR-based screening policies for CKD are highly cost-effective in identifying patients at risk of end stage kidney disease in early stages of CKD. Given its simple requirement of a basic blood test, the CUSUMGFR-based screening can be easily incorporated into clinical workflow for disease monitoring and prevention.

Type 2 Diabetes and Chronic Kidney Disease: An Opportunity for Pharmacists to Improve Outcomes.

Chronic kidney disease (CKD) is an important contributor to end-stage kidney disease, cardiovascular disease, and death in people with type 2 diabetes (T2D), but current evidence suggests that diagnosis and treatment are often not optimized. This review examines gaps in care for patients with CKD and how pharmacist interventions can mitigate these gaps. We conducted a PubMed search for published articles reporting on real-world CKD management practice and compared the findings with current recommendations. We find that adherence to guidelines on screening for CKD in patients with T2D is poor with particularly low rates of testing for albuminuria. When CKD is diagnosed, the prescription of recommended heart-kidney protective therapies is underutilized, possibly due to issues around treatment complexity and safety concerns. Cost and access are barriers to the prescription of newer therapies and treatment is dependent on racial, ethnic, and socioeconomic factors. Rates of nephrologist referrals for difficult cases are low in part due to limitations of information and communication between specialties. We believe that pharmacists can play a vital role in improving outcomes for patients with CKD and T2D and support the cost-effective use of healthcare resources through the provision of comprehensive medication management as part of a multidisciplinary team. The Advancing Kidney Health through Optimal Medication Management initiative supports the involvement of pharmacists across healthcare systems to ensure that comprehensive medication management can be optimally implemented.

Targeted Screening for Undiagnosed Chronic Kidney Disease among Asymptomatic Immediate Family Members of Chronic Kidney Disease Patients: Experience from a Teaching Hospital in South Eastern Nigeria

Background: Chronic Kidney Disease (CKD) is a worldwide epidemic that is associated with a huge morbidity, mortality and high healthcare cost. In Nigeria, the number of patients with CKD progressing to End Stage Renal Disease (ESRD) is increasing. Early screening of individuals who are at risk of CKD has been advocated by several studies because it would reduce the morbidity and mortality associated with late presentation. Studies have found that the immediate family members/First-Degree Relatives (FDRs) of CKD patients have a greater prevalence of CKD compared with the general population and hence should be screened for kidney disease at any available opportunity.

A comprehensive analysis of albuminuria in canine chronic kidney disease.

Albuminuria, an important marker of decreased kidney function in chronic kidney disease (CKD), is not routinely used for CKD detection or proteinuria appearance. Its relationships with biochemical parameters and blood pressure in dogs are poorly understood. This study aimed to evaluate the relationship of albuminuria with various CKD markers, its correlation with the urinary protein to creatinine ratio (UPC), and hypertension in dogs with early stages of CKD. It also sought to determine the usability of the urinary albumin to creatinine ratio (UAC) for CKD screening. The study reviewed records of 102 dogs, categorising them into four groups based on disease status. UAC and UPC ratio, biochemistry and haematology variables, age, and systolic blood pressure were determined. The Pearson's correlation coefficient between log-transformed values of UPC and UAC was r = 0.902 (95% CI: 0.87 to 0.93). Median UAC ratio values were 2.1mg/g for the Healthy control group (n = 17), 54.2mg/g for early stages CKD (n = 42), 5.8mg/g for Acute sick control (n = 30), and 104mg/g for Chronic sick control (n = 13). Thresholding UAC ratio as an indicator for impaired kidney function with the threshold of 10mg/g (established based on the receiver operating characteristic curve) had a sensitivity 81.8%, specificity of 89.4%, positive predictive value (PPV) 90%, and negative predictive value (NPV) 80.1%. The correlation of UAC with biochemistry and haematology variables was statistically significant; for SDMA (μg/L), it was r = 0.566 and for other variables, it was weak to moderate. UAC was markedly elevated in cases of severe hypertension. UAC ratio was significantly different among dogs with impaired and not impaired kidney function. The correlation strength for the UAC and UPC ratios was high. UAC ratio may be a promising marker for proteinuria analysis in dogs with CKD or other kidney function alterations.

The New Creatinine-Based Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) 2021 Equation: Potential Impact on Screening for Chronic Kidney Disease in an Asymptomatic Black African Population.

In 2021, a new Chronic Kidney Disease Epidemiology (CKD-EPI) Collaboration equation was introduced that excluded race correction. We set out to compare estimated glomerular filtration rate (eGFR) determined using the creatinine-based CKD-EPI 2009 and 2021 equations and the reclassification of chronic kidney disease (CKD) eGFR staging to explore the potential ramifications of adopting the 2021 equation on reported eGFR and CKD staging. We analyzed secondary data previously utilized to determine reference intervals among Black African individuals residing in urban towns in Kenya. Serum creatinine was measured using a standardized modified Jaffé kinetic method on a Beckman AU5800 analyzer. Glomerular filtration rate (GFR) was estimated using both the 2009 and 2021 CKD-EPI creatinine equations. Classification of CKD based on eGFR was performed using the Kidney Disease: Improving Global Outcomes (KDIGO) practice guidelines. Using 533 study samples, the median eGFR was highest when determined using the race-corrected CKD-EPI 2009 equation. The CKD-EPI 2021 equation yielded a median eGFR that was similar to the non-race-corrected CKD-EPI 2009 equation. The race-corrected CKD-EPI 2009 equation classified 93.6% of participants into CKD stage G1 compared with 85.6% by the CKD-EPI 2021 equation. The CKD-EPI 2021 equation classified 14.3% of participants into CKD stage G2 compared to 6.4% by the race-corrected CKD-EPI 2009 equation. The CKD-EPI 2021 equation gave a comparable eGFR to the non-race-corrected CKD-EPI 2009 equation and its implementation in laboratories reporting eGFR in Kenya will help in identifying patients with an appropriate decrease in renal function.

Optimizing Care Delivery in Patients with Chronic Kidney Disease in the United States: Proceedings of a Multidisciplinary Roundtable Discussion and Literature Review.

Approximately 37 million individuals in the United States (US) have chronic kidney disease (CKD). Patients with CKD have a substantial morbidity and mortality, which contributes to a huge economic burden to the healthcare system. A limited number of clinical pathways or defined workflows exist for CKD care delivery in the US, primarily due to a lower prioritization of CKD care within health systems compared with other areas (e.g., cardiovascular disease [CVD], cancer screening). CKD is a public health crisis and by the year 2040, CKD will become the fifth leading cause of years of life lost. It is therefore critical to address these challenges to improve outcomes in patients with CKD. The CKD Leaders Network conducted a virtual, 3 h, multidisciplinary roundtable discussion with eight subject-matter experts to better understand key factors impacting CKD care delivery and barriers across the US. A premeeting survey identified topics for discussion covering the screening, diagnosis, risk stratification, and management of CKD across the care continuum. Findings from this roundtable are summarized and presented herein. Universal challenges exist across health systems, including a lack of awareness amongst providers and patients, constrained care team bandwidth, inadequate financial incentives for early CKD identification, non-standardized diagnostic classification and triage processes, and non-centralized patient information. Proposed solutions include highlighting immediate and long-term financial implications linked with failure to identify and address at-risk individuals, identifying and managing early-stage CKD, enhancing efforts to support guideline-based education for providers and patients, and capitalizing on next-generation solutions. Payers and other industry stakeholders have opportunities to contribute to optimal CKD care delivery. Beyond addressing the inadequacies that currently exist, actionable tactics can be implemented into clinical practice to improve clinical outcomes in patients at risk for or diagnosed with CKD in the US.

Cost-Effectiveness of School Urinary Screening for Early Detection of IgA Nephropathy in Japan

The evidence for and against screening for chronic kidney disease in youths who are asymptomatic is inconsistent worldwide. Japan has been conducting urinary screening in students for 50 years, allowing for a full economic evaluation that includes the clinical benefits of early detection and intervention for chronic kidney disease. To evaluate the clinical effectiveness and cost-effectiveness of school urinary screening in Japan, with a focus on the benefits of the early detection and intervention for IgA nephropathy, and to explore key points in the model that are associated with the cost-effectiveness of the school urinary screening program. This economic evaluation with a cost-effectiveness analysis used a computer-simulated Markov model from the health care payer's perspective among a hypothetical cohort of 1 000 000 youths aged 6 years in first grade in Japanese elementary schools, followed up through junior and high school. The time horizon was lifetime. Costs and clinical outcomes were discounted at a rate of 2% per year. Costs were calculated in Japanese yen and 2020 US dollars (¥107 = US $1). School urinary screening for IgA nephropathy was compared with no screening. Outcomes were costs and quality-adjusted life-years (QALYs). Cost-effectiveness was determined by evaluating whether the incremental cost-effectiveness ratio (ICER) per QALY gained remained less than ¥7 500 000 (US $70 093). In the base case analysis, the ICER was ¥4 186 642 (US $39 127)/QALY, which was less than the threshold. There were 60.3 patients/1 000 000 patients in the no-screening strategy and 31.7 patients/1 000 000 patients in the screening strategy with an end-stage kidney disease. Cost-effectiveness improved as the number of screenings decreased (screening frequency <3 times: incremental cost, -¥75 [US $0.7]; incremental QALY, 0.00025; ICER, dominant), but the number of patients with end-stage kidney disease due to IgA nephropathy increased (40.9 patients/1 000 000 patients). Assuming the disutility due to false positives had a significant impact on the analysis; assuming a disutility of 0.01 or more, the population with no IgA nephropathy had an ICER greater than the threshold (¥8 304 093 [US $77 608]/QALY). This study found that Japanese school urinary screening was cost-effective, suggesting that it may be worthy of resource allocation. Key factors associated with cost-effectiveness were screening cost, the probability of incident detection outside of screening, and IgA nephropathy incidence, which may provide clues to decision-makers in other countries when evaluating the program in their own context.

Metabolomics study reveals blood biomarkers for early diagnosis of chronic kidney disease and IgA nephropathy: A retrospective cross-sectional study

Background and aimsChronic kidney disease (CKD) causes low quality of life and alarming morbidity and mortality. The crucial to retard CKD progression is to diagnose early for timely treatment. IgA nephropathy (IgAN) is a typical CKD and the most common glomerulonephritis. Both CKD and IgAN lack accurate and sensitive blood biomarkers for early diagnosis. Here we report the potential of plasma biomarkers for early diagnosis of CKD and IgAN. Materials and methodsPlasma levels of metabolites derived from tryptophan were quantified with an LC-MS/MS-based metabolomics for two cohorts. Based on the predictive probability of each metabolite, multivariate models including logistic regression and random forest were used to establish the early diagnostic biomarkers for CKD and IgAN. ResultsThe plasma melatonin diagnosed early CKD (stages Ⅰ−Ⅱ) with an accuracy exceeding 95%, and a panel of melatonin and tryptophan achieved a remarkable 100% accuracy in diagnosing early CKD. Furthermore, indole-3-lactic acid had an excellent ability to distinguish IgAN among CKD patients. Based on the CKD screening and IgAN diagnosis primarily contributed by melatonin and indole-3-lactic acid, early IgAN could be diagnosed with an accuracy of over 85%. ConclusionsThis study provides promising plasma biomarkers for early diagnosis of CKD and IgAN.

Chronic Kidney Disease in Older Adults. Consensus Statement of Russian Association of Gerontologists and Geriatricians, Scientific Society of Nephrologists of Russia and Eurasian Association of Therapists

The prevalence of chronic kidney disease (CKD) increases with age, but CKD is often underdiagnosed in older adults and regarded as age-related changes of kidney function. Screening for CKD is mandatory in older adults and should include estimated glomerular filtration rate (eGFR) using both the CKD EPI creatinine-based formula and the albumin/creatinine ratio in a urine spot sample. In older adults the diagnostic criteria of CKD are the same as in younger subjects. CKD is associated with advanced ageing and requires careful assessment of geriatric syndromes. Renal function should be assessed at least annually, considering a rate of decline in eGFR greater than 1 ml/min/1.73 m2 per year as significant. Older adults with CKD are characterized by high comorbidity; risk factors for CKD and geriatric syndromes overlap. CKD should be considered among a number of comorbid conditions that increase the risk of deterioration of geriatric status and underline the need for multidisciplinary management based on a comprehensive geriatric assessment. Patients with eGFR &lt;60 ml/min/1.73 m2 should be considered at high risk for renal and extrarenal adverse drug effects. In these patients, inappropriate medications, supplements, and vitamins should be carefully identified and corrected using STOPP/START criteria. eGFR and estimated creatinine clearance should be carefully monitored during treatment with drugs that can potentially affect renal function and/or the dose of which is adjusted based on renal function, as well as during acute illness or exacerbation of chronic conditions.

Ultrasensitive sensing urinary cystatin C via an interface-engineered graphene extended-gate field-effect transistor for non-invasive diagnosis of chronic kidney disease

Early chronic kidney disease (CKD) has strong concealment and lacks an efficient, non-invasive, and lable-free detection platform. Cystatin C (Cys C) in urine is closely related to the progress of CKD (especially at the early stage), which is an ideal endogenous marker to evaluate the impairment of renal function. Thus, the accurate detection of urinary Cys C (u-Cys C) is great significant for early prevention and treatment and delaying the course of the disease of CKD patients. Herein, we developed an extended-gate field-effect transistor (EG-FET) sensor for ultrasensitive detection of u-Cys C, which consists of a monolithic interface-engineered graphene EG electrode array and a commercially available MOSFET. Laser-induced graphene (LIG) loaded with sputtered Au NPs in the presence of adhesive Cr (Au NPs/Cr/LIG) boosts the electrical performance of the EG electrode. Meanwhile, Au NPs also serve as linkers to immobilize papain that can selectively form protein complexes with Cys C. Supported by the synergistic effect of multilevel interface-engineered graphene, our sensor exhibits a good linear correlation within the u-Cys C concentration range of 5 ag/μL to 50 ng/μL with low detection limit of 0.05 ag/μL. Our work makes accurate, specific and rapid detection of u-Cys C feasible and promising for early screening for CKD.

Efficacy of Salivary Urea and Creatinine Compared to Serum Levels in Chronic Kidney Disease Patients: A Cross-sectional Study

Introduction: Chronic Kidney Disease (CKD) has become an impending health concern due to the massive rise in the number of patients with diabetes mellitus and hypertension. Monitoring CKD patients typically requires regular invasive testing, and a simple diagnostic test that does not involve venipuncture would greatly benefit patients and healthcare professionals. Extensive research is being conducted to explore the use of saliva as a Non invasive tool for evaluation of systemic diseases like CKD. However, most of these studies have focused on End Stage Renal Disease (ESRD) patients. Aim: To investigate the correlation between salivary urea and creatinine levels and their serum counterparts in CKD patients and healthy controls. Additionally, the study aimed to assess the efficacy of salivary urea and creatinine compared to serum urea and creatinine in predicting CKD. Materials and Methods: The present cross-sectional study was conducted between January 2021 and July 2022 in the Department of Biochemistry, in collaboration with the Department of Medicine, at Heritage Institute of Medical Sciences in Varanasi, Uttar Pradesh, India. The study included a total of 60 participants: 30 CKD patients (stage 1-3) and 30 age-matched healthy controls. Serum and salivary urea were analysed using the Urease-Glutamate Dehydrogenase (GLDH) method, and creatinine was measured using the Modified Jaffe’s method on the Dirui-300B autoanalyser. Data were statistically analysed using Pearson’s correlation coefficient. The sensitivity, specificity, and Area Under the Curve (AUC) of salivary urea and creatinine were evaluated in comparison to their serum counterparts. Results: The participants consisted of 30 CKD patients with a mean age of 54.8±8.8 years and 30 age-matched healthy controls with a mean age of 52.42±8.4 years. A significant difference in salivary urea and creatinine levels was observed between the control and CKD groups. There was a strong and significant correlation (p-value &lt;0.01) between salivary creatinine and serum creatinine in both the control group (r-value=0.76) and the CKD group (r-value=0.82). Additionally, a strong and significant correlation (p-value &lt;0.01) was found between salivary urea and serum urea in the CKD group (r-value=0.63). However, the correlation between salivary and serum urea was not significant in the control group, with an r-value of 0.58 and a p-value of 0.24. Both salivary urea and creatinine demonstrated high sensitivity (90% and 89%, respectively), specificity (80% and 80%, respectively), and AUC (0.78 and 0.86, respectively) compared to their serum counterparts, validating their practical clinical utility. Conclusion: The concentration of urea and creatinine in saliva can reflect kidney damage and help monitor kidney function in CKD patients. Standardising the protocol for evaluation of salivary urea and creatinine and establishing a reference range will make it useful for screening for CKD.

EE116 Quantifying the Future Impact of Chronic Kidney Disease Screening Programs in Belgium

EE116 Quantifying the Future Impact of Chronic Kidney Disease Screening Programs in Belgium

Relationship between the neutrophil-to-lymphocyte ratio and estimated glomerular filtration rate in patients with primary aldosteronism: a cross-sectional study

Objective: To investigate the associations between neutrophil-to-lymphocyte ratio (NLR) and estimated glomerular filtration rate (eGFR) in patients with primary aldosteronism (PA). Methods: This study was a cross-sectional study. Consecutive patients diagnosed with PA and admitted to the Second Affiliated Hospital of Nanchang University from October 2017 to April 2022 were enrolled. General information, blood routine, renal function, and other clinical data of the patients were collected. Based on the median NLR of the enrolled patients, NLR<median was defined as low NLR. Low eGFR was defined as an eGFR<60 ml·min-1·1.73 m-2. Multiple linear regression and multivariate logistic regression models, smooth curve fitting and threshold effect exploration were used to analyze the relationship between NLR and eGFR in PA patients, and stratified analysis and interaction tests were used to evaluate potential variables that may affect the correlation between NLR and eGFR. Results: This study finally included 743 PA patients, aged (50.3±10.4) years, 42.9% (319/743) were female, and the median NLR was 2.3. After adjusting for sex, age, body mass index (BMI) and other factors, multiple linear regression analysis showed that high NLR was negatively correlated with eGFR (β=-4.9, P=0.008), and multivariate logistic regression analysis showed that high NLR was associated with low eGFR (OR=3.1, P=0.002). In the corrected smooth curve, NLR is U-shaped correlation with eGFR, and the inflection point is at NLR=3.5. When the NLR was<3.5, the eGFR decreased with the increase of NLR (corrected β=-4.7, P<0.001); When the NLR was≥3.5, the eGFR increased with the increase of NLR (corrected β=5.8, P=0.031). The results of stratified analysis showed that there was an interaction between the association of NLR and eGFR with the presence or absence of hyperlipidemia (P interaction=0.017), and the correlation between NLR and eGFR was stronger in PA patients with hyperlipidemia. Conclusion: In the PA patients, there is a U-shaped relationship between NLR and eGFR, and higher NLR is associated with lower eGFR. PA patients with elevated NLR should undergo additional screening for chronic kidney disease and receive related preventive interventions.

Chronic Kidney Disease Predicts Adverse Major Cardiovascular Events and Adverse Limb Events in Patients With Diabetes and Peripheral Arterial Disease.

This study aims to explore the effect in each stage of chronic kidney disease (CKD) on the major adverse cardiovascular events (MACE) in diabetes mellitus (DM) patients with peripheral arterial disease (PAD). A total of 246 DM patients with diagnosed PAD were enrolled in this study. Of these, 86 patients (35%) died and 34 patients had non-fatal cardiovascular events occurred at the last 7 years follow-up. The baseline eGFR obtained from the first quantified eGFR value within 6 months from the date of enrollment estimated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI). Then, based on eGFR at entry, we defined CKD as an eGFR < 60 mL/min/1.73 m2, and stratified all patients into four groups: eGFR-1, normal eGFR (≥90 mL/min/1.73 m2); eGFR-2, mildly decreased eGFR (60-89 mL/min/1.73 m2); eGFR-3, moderately decreased eGFR (30-59 mL/min/1.73 m2); and eGFR-4, severely decreased eGFR (<30 mL/min/1.73 m2). The mean eGFR was 54.4 ± 28.9 mL/min/1.73m2, and more than 30% of all patients had CKD (eGFR <60 mL/min/1.73m2). The seven-year cumulative incidence of MACE was 29.8% (95% confident interval [95% CI] 15.5-35.7) for eGFR-1 group, 40.4% (95% CI 27.4-45.2) for eGFR-2group, 66.2% (95% CI 47.6-71.4) for eGFR-3 group, and 94% (95% CI 75.0-99.0) for eGFR-4 group. In addition, after adjustment, hazard ratio (HR) for MACE was 2.36 (95% CI 1.26-4.40) in the eGFR-3 group and 7.62 (95% CI 3.71-15.66) in the eGFR-4 group. Restricted mean survival time (RMST) for survival analysis was consistent with HR in this study. After adjusting confounders, relative to eGFR-1 group, an association between the eGFR group and MACE outcome was found only in eGFR-3 group and eGFR-4 group. The moderate to severe reduction in eGFR, was an independent risk factor for MACE among DM patients with PAD throughout a 7-year follow-up duration. Thus, early CKD screening might be essential in the management of diabetic patients with PAD.

Awareness of chronic kidney disease and its risk factors in the former Soviet Union countries

&lt;b&gt;Purpose:&lt;/b&gt; Assessment of public knowledge of chronic kidney disease (CKD) is an essential step in&lt;b&gt; &lt;/b&gt;development of CKD prevention and screening programs. Our aim was to estimate the level of public CKD knowledge and its predictors in the former Soviet Union countries using a validated questionnaire.&lt;br /&gt; &lt;b&gt;Materials and methods: &lt;/b&gt;This cross-sectional survey was conducted in 10 countries using an adapted validated online questionnaire. Descriptive statistics were used to describe participants’ characteristics and assess public CKD knowledge level. A multiple linear regression analysis was performed to identify predictors of CKD knowledge.&lt;br /&gt; &lt;b&gt;Results: &lt;/b&gt;2,715 participants satisfied the inclusion criteria. Respondents having higher level of education, living in countries belonging to the lower middle-income countries, having a personal history of diabetes and hypertension, and having a family history of kidney disease showed significantly better CKD knowledge.&lt;br /&gt; &lt;b&gt;Conclusions:&lt;/b&gt; The level of CKD knowledge among the population of post-Soviet states was found to be low, although some personal characteristics were associated with better CKD knowledge.