Definition Of Chronic Kidney Disease Research Articles

Chronic kidney disease in children: an update.

Chronic kidney disease (CKD) is a major healthcare issue worldwide. However, the prevalence of pediatric CKD has never been systematically assessed and consistent information is lacking in this population. The current definition of CKD is based on glomerular filtration rate (GFR) and the extent of albuminuria. Given the physiological age-related modification of GFR in the first years of life, the definition of CKD is challenging per se in the pediatric population, resulting in high risk of underdiagnosis in this population, treatment delays and untailored clinical management. The advent and spreading of massive-parallel sequencing technology has prompted a profound revision of the epidemiology and the causes of CKD in children, supporting the hypothesis that CKD is much more frequent than currently reported in children and adolescents. This acquired knowledge will eventually converge in the identification of the molecular pathways and cellular response to damage, with new specific therapeutic targets to control disease progression and clinical features of children with CKD. In this review, we will focus on recent innovations in the field of pediatric CKD and in particular those where advances in knowledge have become available in the last years, with the aim of providing a new perspective on CKD in children and adolescents.

Joint association of hyperuricemia and chronic kidney disease with mortality in patients with chronic heart failure.

The joint association of hyperuricemia and chronic kidney disease (CKD) with mortality in patients with chronic heart failure (CHF) is not conclusive. This retrospective cohort study was conducted in Chinese People's Liberation Army General Hospital, Beijing, China. We included 9,367 patients with CHF, who were hospitalized between January 2011 and June 2019. The definitions of hyperuricemia and CKD were based on laboratory test, medication use, and medical record. We categorized patients with CHF into 4 groups according to the absence (-) or presence (+) of hyperuricemia and CKD. The primary outcomes included in-hospital mortality and long-term mortality. We used multivariate logistic regression and Cox proportional hazards regression to estimate the mortality risk according to the hyperuricemia/CKD groups. We identified 275 cases of in-hospital mortality and 2,883 cases of long-term mortality in a mean follow-up of 4.81 years. After adjusting for potential confounders, we found that compared with the hyperuricemia-/CKD- group, the risks of in-hospital mortality were higher in the hyperuricemia+/CKD- group (odds ratio [OR], 95% confidence interval [CI]: 1.58 [1.01-2.46]), hyperuricemia-/CKD+ group (OR, 95% CI: 1.67 [1.10-2.55]), and hyperuricemia+/CKD+ group (OR, 95% CI: 2.12 [1.46-3.08]). Similar results were also found in long-term mortality analysis. Compared with the hyperuricemia-/CKD- group, the adjusted hazard ratios and 95% CI for long-term mortality were 1.25 (1.11-1.41) for hyperuricemia+/CKD- group, 1.37 (1.22-1.53) for hyperuricemia-/CKD+ group, and 1.59 (1.43-1.76) for hyperuricemia+/CKD+ group. The results remained robust in the sensitivity analysis. Hyperuricemia and CKD, both individually and cumulatively, are associated with increased mortality risk in patients with CHF. These results highlighted the importance of the combined control of hyperuricemia and CKD in the management of heart failure.

Octogenarians with chronic kidney disease in the nephrology clinic: Progressors vs. non-progressors.

The current definition of chronic kidney disease applied to patients over the age of 80 has increased the number of referrals to Nephrology. However not all of these patients may benefit from its assessment. This study aims to analyze the evolution of ≥80 years old patients referred to Nephrology. Single-center study including patients ≥80 years old with eGFR <60 mL/min/1,73m2 who were referred to Nephrology consultation for the first time. Clinical and analytical parameters were collected retrospectively 12 months before the visit, and prospectively at baseline, and 12 and 24 months after the initial visit. We divided patients into two groups based on annual eGFR loss: progressors (>5 mL/min/1.73m2) and non-progressors (≤5 mL/min/1,73m2). A total of 318 patients were included, mean age was 84,9 ± 4 (80-97) years. Baseline serum creatinine was 1,65 ± 0,62 mg/dL, eGRF 35 (28-42) mL/min/1,73, and albumin/creatinine ratio 36 (7-229) mg/g. 55,7% of the patients met the definition of progressor at baseline (initial-progressors), 26,3% were progressors after a 12-month follow-up and 13,4% after 24 months. 21,2% and 11,4% of initial-progressors met this definition at 12 and 24 month follow up. The main risk factor for progression was albuminuria. No relationship was found between the nephrologist intervention and the evolution of renal function among initial non-progressors. Elderly patients who have stable renal function at the time of referral will continue to have stable renal function over the subsequent 24 months and thus may not need to be referred to a nephrologist.

The relationship between monocyte/HDL cholesterol ratio and chronic kidney disease stages, single center study

Objectives: Chronic kidney disease (CKD) is an increasing public health problem. It is very important to know the definition of CKD, its risk factors and to predict the progression of its stages. Recently, the monocyte/HDL ratio (MHR) has been thought to be a new marker of inflammation and oxidative stress. In this study, it was aimed to investigate the relationship between stages and MHR in patients with stage 3A, stage 3B and stage 4 CKD.&#x0D; Methods: A total of 632 patients with CKD, aged 18 years and older, with stage 3A, stage 3B and stage 4 (eGFR) according to CKD stage were included in our study. Our study is retrospective and the data of the patients were obtained from the hospital system. Kruskal-Wallis and post hoc Tukey HSD tests were used for statistics. p &lt; 0.05 was considered statistically significant.&#x0D; Results: The mean age of the patients included in the study was 63.4 ± 14.91(min:18max:98), and 305 (48.25%) of these patients were male and 327 (51.75%) were female. According to eGFR, 155 (24.5%) of the patients were stage 3A, 150 (23.8%) were stage 3B, and 327 (51.7%) were stage 4. In the statistical study of the groups divided into CKD stages with MHR, there was no significant difference between the groups (p: 0.245), while there was statistical significance for gender and hypertension (p: 0.004 and p: 0.044, respectively).&#x0D; Conclusion: As a result of this study, we concluded that MHR is not affected by CKD stages.

Interactive effects of intrinsic capacity and obesity on the KDIGO chronic kidney disease risk classification in older patients with type 2 diabetes mellitus

BackgroundIntrinsic capacity (IC) is a novel concept focusing on normal and healthy aging. The effect of IC on the risk of chronic kidney disease (CKD) according to KDIGO category in older type 2 diabetes mellitus (T2DM) patients has rarely been studied. We investigated whether a decline in IC is associated with the risk of CKD according to KDIGO 2012 categories.MethodsThis is a cross-sectional study. The exposure variables (IC score and body mass index) and outcome variable (KDIGO categories of the risk of CKD) were collected at the same timepoint. A total of 2482 older subjects with T2DM managed through a disease care program were enrolled. The five domains of IC, namely locomotion, cognition, vitality, sensory, and psychological capacity were assessed. Based on these domains, the IC composite score was calculated. CKD risk was classified according to the KDIGO 2012 CKD definition. Univariate and multivariate analyses were used to assess the association between IC score and KDIGO categories of risk of CKD.ResultsThe KDIGO CKD risk category increased in parallel with IC score (p for trend < 0.0001). In multivariate analysis, compared to those with an IC score 0, the odds ratio of having a KDIGO moderately increased to very high risk category of CKD was 1.76 (1.31–2.37) times higher for those with an IC score of 2–5. Furthermore, an increased IC score was associated with a higher prevalence of moderate and severe obesity. Moreover, there was a synergistic interaction between IC score and obesity on the KDIGO moderately increased to very high risk category of CKD (synergy index = 1.683; 95% CI 0.630–3.628), and the proportion of the KDIGO moderately increased to very high risk category of CKD caused by this interaction was 25.6% (attributable proportion of interaction = 0.256).ConclusionsOur findings indicate that IC score may be closely related to the KDIGO moderately increased to very high risk category of CKD. In addition, there may be a synergistic interaction between IC score and obesity, and this synergistic interaction may increase the KDIGO CKD risk stage.

Organic solvent exposure for the chronic kidney disease: updated systematic review with meta-analysis.

Studies on the relationship between organic solvent exposure and chronic kidney disease (CKD) have presented inconsistent results. Definition of CKD has changed in 2012, and other cohort studies have been newly published. Therefore, this study aimed to newly confirm the relationship between organic solvent exposure and CKD through an updated meta-analysis including additional studies. This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The search was conducted on January 2, 2023 using Embase and MEDLINE databases. Case-control and cohort studies on the relationship between organic solvent exposure and CKD were included. Two authors independently reviewed full-text. Of 5,109 studies identified, a total of 19 studies (control studies: 14 and cohort studies: 5) were finally included in our meta-analysis. The pooled risk of CKD in the organic solvent exposed group was 2.44 (1.72-3.47). The risk of a low-level exposure group was 1.07 (0.77-1.49). The total risk of a high-level exposure group was 2.44 (1.19-5.00). The risk of glomerulonephritis was 2.69 (1.18-6.11). The risk was 1.46 (1.29-1.64) for worsening of renal function. The pooled risk was 2.41 (1.57-3.70) in case-control studies and 2.51 (1.34-4.70) in cohort studies. The risk of subgroup classified as 'good' by the Newcastle Ottawa scale score was 1.93 (1.43-2.61). This study confirmed that the risk of CKD was significantly increased in workers exposed to mixed organic solvents. Further research is needed to determine the exact mechanisms and thresholds. Surveillance for kidney damage in the group exposed to high levels of organic solvents should be conducted. PROSPERO Identifier: CRD42022306521.

Urinary neutrophil gelatinase‐associated lipocalin: A novel biomarker for predicting chronic kidney disease in patients with nonalcoholic fatty liver disease

AbstractAimsNonalcoholic fatty liver disease (NAFLD) and chronic kidney disease (CKD) are common diseases worldwide. Reports of a high prevalence of CKD in NAFLD patients have been documented. Urinary neutrophil gelatinase‐associated lipocalin (NGAL) is a reliable biomarker for renal dysfunction, and it is recommended for early detection of acute kidney injury (AKI) in cirrhotic patients. Currently, there is no evidence for using urine NGAL to predict CKD in NAFLD patients. We aim to determine the proportion of CKD and identify the predictive value of NGAL and other factors associated with CKD in these patients.MethodsA single‐center, cross‐sectional study was conducted between July 2018 and December 2019 in consecutive NAFLD patients diagnosed by transient elastography (TE) or liver biopsy at a tertiary care university hospital in Bangkok, Thailand. Advanced liver fibrosis is defined as fibrosis stages 3–4. The definition of CKD is estimated glomerular filtration rate (eGFR) &lt;60 ml⋅min−1⋅1.73 m−2 based on the Kidney Disease Improving Global Outcomes (KDIGO) guideline 2012. Urine NGAL level was measured by enzyme linked immunosorbent assay technique.ResultsA total of 101 NAFLD patients were included with a mean age of 54 ± 16 years. Among these patients, 14 (13.9%), 13 (12.9%), and 32 (31.7%) had fibrosis stages 2, 3, and 4, respectively. Nine percent (9 of 101) of patients with NAFLD with a mean eGFR of 42.66 ± 17.42 ml⋅min−1⋅1.73 m−2. The statistically significant factors associated with CKD were a higher level of urine NGAL (55.1 [25.15–150.60] vs. 15.1 [9.67–25.15] ng/ml; p = 0.006), a higher level of TE (17.3 [6.85–46.20] vs. 7.7 [5.6–11.7] kPa; p = 0.038), and a presence of advanced fibrosis (77.8% vs. 40.7%; p = 0.041), compared to those without CKD. Urine NGAL was the only significant factor associated with CKD in NAFLD patients. The cutoff level of urine NGAL at 36.75 ng/ml showed odds ratio of 21.27 (95% CI: 3.97–113.82; p &lt; 0.001) and 1.02 (95% CI: 1.00–1.04; p = 0.024) by univariate and multivariate analyses, respectively. The selected urine NGAL cutoff demonstrated a sensitivity and specificity of 77.8% and 85.9% for predicting CKD, respectively.ConclusionsThe proportion of CKD in NAFLD patients was 9% and the presence of advanced fibrosis was a significant risk factor associated with CKD. Additionally, urine NGAL was significantly associated with CKD in NAFLD patients using a cutoff level of 36.75 ng/ml for predicting CKD with acceptable sensitivity and specificity. A larger prospective cohort study is needed to validate our findings.

New comprehensive reference values for kidney function indexes across adult and geriatric ages in Chinese popuplation

Background and aimsChina has the largest number of chronic kidney disease (CKD) patients. Current CKD definition has been challenged recently. We aim to reassess kidney function in healthy Chinese population, to provide a more appropriate reference range (RIs) for diagnosis, treatment, monitoring (or screening) of kidney disease and related research. Materials and methodsA total of 49627 apparently healthy people aged 18–94 years old were enrolled. Age and sex effects were explored for the kidney function indicators and RIs were calculated non-parametrically. ResultsAlbumin’s limits were lower than the national RIs, with 5.7 g/L lower in upper limit (UL) and 0.4 g/L lower in lower limit (LL) [RIs: 39.6–49.3 vs 40–55]. The LL of estimate glomerular filtration rate (eGFR) was 80.4 mL/min/1.73 m2 or 63.3 mL/min/1.73 m2 at the age of <50 or ≥70 years, respectively. Notably, eGFR showed an approximately 0.7 mL/min/1.73 m2 decrease every year. In addition, eGFR increase 0.35 mL/min/1.73 m2 per standard deviation increase in blood glucose when uric acid (UA) exceed the RIs. ConclusionUA was an important factor affecting eGFR. For healthy elderly in China, albumin’s limits were lower than the national RIs, and LLs of eGFR were nearly 60 mL/min/1.73 m2. Using national RIs for healthy elderly may be overly stringent.

Monoclonal Gammopathy of Undetermined Significance and Risk of Chronic Kidney Disease: Results of the Population-Based Iceland Screens, Treats, or Prevents Multiple Myeloma (iStopMM) Study

Background: Monoclonal gammopathy of undetermined significance (MGUS) and chronic kidney disease (CKD) are common conditions. When monoclonal gammopathy causes CKD it is referred to as monoclonal gammopathy of renal significance (MGRS) and a kidney biopsy is required to confirm the diagnosis. Because of this, some have speculated that MGRS may be severely underdiagnosed and have recommended considering a kidney biopsy in all individuals with MGUS who have microscopic hematuria, proteinuria, or declining estimated glomerular filtration rate (eGFR) of <60 mL/min/1.73m2. If MGRS were more common than previously thought, the prevalence of CKD in persons with MGUS would be expected to be higher than persons without MGUS. We aimed to compare the prevalence of CKD in individuals with and without MGUS in a large, prospective, screened, population-based cohort. Furthermore, we aimed to assess possible association between M protein concentration and kidney function. Methods: A total of 75,422 participants in the Iceland Screens, Treats or Prevents Multiple Myeloma (iStopMM) study were screened for MGUS with serum protein electrophoresis (SPEP), serum free light chains (FLC), and immunofixation (IFE). All previous clinical laboratory samples were obtained, including serum creatinine (SCr), urine albumin/creatinine ratio (ACR) and urinalysis. CKD was defined as SCr-based eGFR of <60 mL/min/1.73m2, or proteinuria or hematuria, present for >90 days. Participants diagnosed with lymphoproliferative disorders or without data on kidney function were excluded. Power analysis demonstrated that this sample size yielded 90% power to detect a 1.5% absolute difference in the prevalence of CKD in persons with and without MGUS. Prevalence of CKD was evaluated using multivariable logistic regression adjusted for age, sex and MGUS status. The association between eGFR and M protein concentration was assessed with linear regression for continuous eGFR and ordinal logistic regression for CKD categories. All models included age and M protein concentration as four knot restricted cubic splines. Sensitivity analyses were performed where CKD was defined solely by persistently lowered eGFR and as a combination of persistently lowered eGFR, proteinuria, and hematuria. Results: A total of 69,120 participants had SCr measurements and 34,294 had urine studies available. MGUS was present in 4,547 (6.6%) participants, of which 2,242 (49.3%) were non-IgM; 703 (15.5%) were IgM; 1,295 (28.5%) were light chain (LC-MGUS); and 307 (6.7%) were biclonal MGUS. A total of 6,680 (9.7%) participants had CKD defined either as eGFR <60 mL/min/1.73 m2 (N=5,915) or persistent proteinuria or hematuria (N=693), or were receiving treatment for end-stage kidney disease (N=74). Participants with MGUS were significantly older (median [IQR] age 69 [60-76] vs 60 [52-69] years) and more predominantly male (55% vs 41%) compared with participants without MGUS. After adjusting for age and sex, no significant association was found between heavy chain MGUS and CKD (odds ratio [OR] 1.00, 95% confidence interval [CI] 0.95-1.17). This also remained true for subgroups of non-IgM MGUS, IgM MGUS, and biclonal MGUS (Table). Participants with LC-MGUS were less likely to have CKD than participants without MGUS (OR 0.39, 95% CI 0.31-0.49, p <0.001). Sensitivity analyses of CKD definition yielded similar results. M protein concentration had a small negative correlation with eGFR (r= -0.08, p<0.001) but when stratified by age and sex category no significant correlation remained. No significant association was found between M protein concentration and worse eGFR category on ordinal logistic regression model adjusted for nonlinear age and sex (OR 1.01, 95% CI, 0.28-3.66). No significant correlation was found between M protein concentration and severity of proteinuria assessed with urine ACR. Conclusion: In this nationwide prospective population-based screening study of nearly 70,000 individuals, we found no association between MGUS and CKD, regardless of whether CKD was defined based on eGFR, urinary findings, or both. Furthermore, we found no association between M protein concentration and eGFR or severity of albuminuria. We conclude that in the absence of multiple myeloma, the results of SPEP, IFE, and serum FLC measurements are of little value in the evaluation of CKD. Furthermore, our results are not consistent with substantial underdiagnosis of MGRS. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Update on prognosis driven classification of pediatric AKI.

Acute kidney injury (AKI) affects a large proportion of hospitalized children and increases morbidity and mortality in this population. Initially thought to be a self-limiting condition with uniformly good prognosis, we now know that AKI can persist and progress to acute kidney disease (AKD) and chronic kidney disease (CKD). AKI is presently categorized by stage of injury defined by increase in creatinine, decrease in eGFR, or decrease in urine output. These commonly used biomarkers of acute kidney injury do not change until the injury is well established and are unable to detect early stage of the disease when intervention is likely to reverse injury. The kidneys have the ability to compensate and return serum creatinine to a normal or baseline level despite nephron loss in the setting of AKI possibly masking persistent dysfunction. Though these definitions are important, classifying children by their propensity for progression to AKD and CKD and defining these risk strata by other factors besides creatinine may allow for better prognosis driven discussion, expectation setting, and care for our patients. In order to develop a classification strategy, we must first be able to recognize children who are at risk for AKD and CKD based on modifiable and non-modifiable factors as well as early biomarkers that identify their risk of persistent injury. Prevention of initial injury, prompt evaluation and treatment if injury occurs, and mitigating further injury during the recovery period may be important factors in decreasing risk of AKD and CKD after AKI. This review will cover presently used definitions of AKI, AKD, and CKD, recent findings in epidemiology and risk factors for AKI to AKD to CKD progression, novel biomarkers for early identification of AKI and AKI that may progress to CKD and future directions for improving outcome in children with AKI.

Age and the eGFR-dependent risk for adverse clinical outcomes.

Although the relative risk of kidney failure increases with more severe chronic kidney disease (CKD) independent of age, with older age the absolute risk of kidney failure at a given time horizon becomes smaller. In this article, we first review some epidemiological measures of outcome occurrence (absolute rate or risk) and association (relative measures: difference or ratio of rates or risks). We emphasize that relative measures need to be presented along with absolute measures to be understood and absolute risk is more helpful than absolute rate when making treatment decisions. We then apply these principles to the discussion of the absolute and relative rates or risks of kidney failure and death across categories of estimated glomerular filtration rate and age. Lastly, we discuss the implications of existing studies on whether the definition of CKD should account for age.

The Epidemiology of Chronic Kidney Disease-Related Pruritus and its Effect with Sleep Quality in Hemodialysis Patients in Pakistan A Cross-Sectional Study

A glomerular filtration rate of less than 60 ml/min/1.73 m2 for more than three months is the medical definition of chronic kidney disease (CKD) caused by damaged kidneys. The incidence of chronic kidney disease, which can be fatal if left untreated, has been rising for the past 30 years. An unpleasant condition, Pruritus due to chronic renal disease causes itching and decreases the quality of sleep. This study aims to examine the factors associated with Pruritus in CKD patients on maintenance hemodialysis and their impact on sleep quality. Duration and Place: Since 01/01 2019 and ending in 30/06/2019 that year, I will be working as a Post graduate trainee Nephrology in the Nephrology Department at the Institute of Kidney Diseases in Peshawar. Methodology: The department of Nephrology Institute of kidney diseases provided 120 patients with the chronic renal illness. Patients with chronic kidney disease who experienced Pruritus and sleep disruption were included in the study, but those with rashes and Pruritus unrelated to CKD were not. All patients were questioned about their age, gender, typical sleeping habits, illness severity, poor sleep quality, and the location of any pruritus they experienced. Results: CKD-associated This is how pruritis was dispersed: Eighty-one Percent of patients were older than 90, while the remaining 24 percent were younger. Only 43% of those diagnosed with Pruritus reported it affecting their ability to sleep, while 57% reported no such disruptions; also, only 31% of those diagnosed were female, and 74% were male. About 56 percent of those suffering from Pruritus have it quite seriously, whereas 44 percent do not. 62% of Pruritus people experience it on their trunks, compared to 38% elsewhere. A high degree of Pruritus was associated with the female gender, affected body parts, and lack of sleep. Conclusion: Pruritus (sometimes called "uremic pruritus") is the most prevalent skin symptom among persons with ESRD. Despite the absence of evidence linking it to uremia, a significant connection exists in men over 45, causes sleep disruption, and predominates in the trunk. Keywords: CKD-Related Pruritus, Effect, Sleep Quality, Hemodialysis

Effects of a Change in the Definition of Chronic Kidney Disease on Geriatric Assessment Parameters

Effects of a Change in the Definition of Chronic Kidney Disease on Geriatric Assessment Parameters

The relevance of geriatric assessments on the association between chronic kidney disease stages and mortality among older people: a secondary analysis of a multicentre cohort study.

Backgroundage-adapted definition of chronic kidney disease (CKD) does not take individual risk factors into account. We aimed at investigating whether functional impairments influence CKD stage at which mortality increases among older people.Methodsour series consisted of 2,372 outpatients aged 75 years or more enrolled in a multicentre international prospective cohort study. The study outcome was 24-month mortality. Kidney function was assessed by estimated glomerular filtration rate (eGFR) and albumin-to-creatinine ratio (ACR). Geriatric assessments included handgrip strength, short physical performance battery (SPPB), cognitive impairment, dependency in basic activities of daily living (BADL) and risk of malnutrition. Analysis was carried out by Cox regression, before and after stratification by individual functional impairments. Survival trees including kidney function and functional impairments were also investigated, and their predictivity assessed by C-index.Resultsoverall, mortality was found to increase starting from eGFR = 30–44.9 ml/min/1.73 m2 (hazard ratio [HR] = 3.28, 95% confidence interval [CI] = 1.81–5.95) to ACR = 30–300 mg/g (HR = 1.96, 95%CI = 1.23–3.10). However, in survival trees, an increased risk of mortality was observed among patients with impaired handgrip and eGFR = 45–59.9 ml/min/1.73 m2, as well as patients with ACR < 30 mg/g and impaired handgrip and SPPB. Survival tree leaf node membership had greater predictive accuracy (C-index = 0.81, 95%CI = 0.78–0.84 for the eGFR survival tree and C-index = 0.77, 95%CI = 0.71–0.81 for the ACR survival tree) in comparison with that of individual measures of kidney function.Conclusionsphysical performance helps to identify a proportion of patients at an increased risk of mortality despite a mild–moderate impairment in kidney function and improves predictive accuracy of individual measures of kidney function.

MO393: Kidney Echogenicity and Kidney Length as Surrogate Markers of Kidney Function With an Increased Echogenic Pattern Being the Most Predictive of Renal Dysfunction, Particularly in HIV

Abstract BACKGROUND AND AIMS Non-communicable diseases (NCDs) are rapidly emerging as a major cause of chronic kidney disease (CKD) in Africa with a reported prevalence of 10.7% locally. At current, few high-quality studies assessing the epidemiology of CKD in South Africa have been published. Alarmingly, CKD is now at epidemic proportions and is a leading cause of mortality with significant cost implications. This study aims to investigate economic means of predicting renal function in CKD by exploring the association between estimated glomerular filtration rate (eGFR) and renal morphology evaluated by ultrasound (US). METHOD This is a retrospective descriptive chart review conducted at the Department of Nephrology, Inkosi Albert Luthuli Central Hospital (IALCH), Cato Manor, Kwa-Zulu Natal from January 2016 to December 2016. A total of 455 patients who had met the Kidney Disease Improving Global Outcomes (KDIGO) definition of CKD with eGFR (MDRD) and kidney US performed were included. Demographic, clinical, laboratory and kidney morphological data [kidney length (KL), increased echogenicity (IE) and loss of corticomedullary differentiation (LCMD)] on US were collected and analyzed with SPSS software (v. 27). Associations between eGFR, parameters on US and CKD risk factors were determined using logistic regression analysis. RESULTS Black Africans (75.2%; n = 342) and females (56.9%; n = 259) predominated the sample. Whilst, Indians, Whites and Coloreds comprised of 20.4%, 2.42% and 1.98% of the study respectively. The median age was 45.8 ± 14.3 years. Hypertension (34.9%), diabetes (26.8%), HIV (27.5%) and glomerulonephritis 9.89% were the four most frequently reported risk factors, of which Black Africans comprised more than 50% of cases (P &amp;lt; 0.001). A significant proportion of patients 65.7% (n = 307) had end-stage renal disease with a median eGFR of 14.4 ± 12.8mL/min/1.73m2 (P &amp;lt; 0.001). The median right and left KL were short at 8.49 ± 2.16 cm and 8.60 ± 2.20 cm respectively. Black Africans were also found to have significantly shorter KLs and lower eGFRs (P &amp;lt; 0.001). The dual effect of IE and LCMD predisposed to significantly shorter KLs and lower eGFRs than in the presence of one or no abnormality on US (P &amp;lt; 0.001). IE [−9.29 odds ratio (OR); 95% confidence interval (CI) (−13.8 to −4.77); P &amp;lt; 0.001] and KL [right: 5.02 OR; 95% CI (3.44–6.60); P = 0.04; left: 5.11 OR; 95% CI (3.56–6.66); P = 0.04] were found to be significant predictors of eGFR. HIV was the only risk factor found to be negatively associated with all determined measures of renal function, as well as the sole predictor of IE [2.31 OR; 95% CI (0.17–3.15); P = 0.02]. CONCLUSION The CKD epidemic is driven by the complex interplay between communicable (HIV) and NCDs (HPT/DM) and has emerged as important public health and economic threat in Southern Africa. Africans are most vulnerable presenting with an advanced and accelerated disease course. GFR determination and US are inexpensive means of determining renal function, particularly in resource-limited settings. IE and KL are surrogate markers of kidney function with an increased echogenic pattern being most predictive of kidney dysfunction in CKD, particularly in HIV.

MO430: Octogenarians Referred to the Nephrologist: Evolution and Progression Risk Factors

Abstract BACKGROUND AND AIMS The actual definition of chronic kidney disease (CKD) applied to patients ˃80 years has generated an increase in the number of referrals to Nephrology for consultation. Nowadays there is a debate about the evolution of kidney function in elderly patients, from physiological evolution of kidney function to identifying which factors are associated with a real progression of CKD. The aim of this study is to analyse the evolution of kidney function in patients ˃80 years referred to Nephrology for consultation for the first time. METHOD A single-centre retrospective study in which we included patients ˃80 years with an estimated glomerular filtration rate (eGFR) &amp;lt;60 mL/min/1,73m2 who were referred to Nephrology consultation from 2015 to 2018. We collected clinical and analytical parameters at the following points in time: 12 months before the visit, baseline and 12 months after the initial visit. We divided patients into two groups based on annual eGFR loss: Group 1 progressors (&amp;gt;5 mL/min/1.73m2) and group 2 non-progressors (≤5 mL/min/1.73m2). RESULTS A total of 348 patients were included in the study, 55.2% were women and the mean age was 84 years (80–97). At the time of first medical visit, the mean creatinine value was 1.6 ± 0.6 mg/dL, median eGRF was 38 mL/min/1.73m2 (29–44) and median albumin/creatinine ratio was 55 mg/g (6–419), with 12% of the patients, presenting albuminuria over 1000 mg/g. The most frequent referral criteria were worsening of renal function (85.6%). Comorbidities were very common, and hypertension, dyslipidaemia and diabetes mellitus were present in 89.4%, 42.8% and 42.2% respectively. A total of 51% of the patients met the definition of progressor at baseline (initial-progressors) and 29.4% were progressors after a 12-month follow-up. Interestingly, only 21.6% of initial-progressors kept meeting this definition 12 months after (Figure 1). The main risk factors for progression were a higher baseline eGFR (P &amp;lt; 0.001) and albuminuria (P &amp;lt; 0.002). No association with comorbidities was found in the multivariate analysis. CONCLUSION The majority of patients ˃80 years evaluated by a Nephrologist were non-progressors at 12 months according to our definition (70.6%). It is more important to estimate the progression of CKD patients and request albuminuria and/or proteinuria than an isolated GFR value. It is likely that non-progressors do not need to be followed by a Nephrologist and may remain under primary care control.

CKD prevalence based on real-world data: continuous age-dependent lower reference limits of eGFR with CKD–EPI, FAS and EKFC algorithms

PurposeSeveral recent articles discuss the need for a definition of chronic kidney disease (CKD) that embarks age-dependency and its impact on the prevalence of CKD. The relevance is derived from the common knowledge that renal function declines with age. The aim of this study was to calculate age-dependent eGFR lower reference limits and to consider their impact on the prevalence of CKD.MethodsA real-world data set from patients with inconspicuous urinalysis was used to establish two quantile regression models which were used to calculate continuous age-dependent lower reference limits of CKD–EPI, FAS and EKFC–eGFR based on either single eGFR determinations or eGFR values that are stable over a period of at least 3 months (± 10% eGFR). The derived lower reference limits were used to calculate the prevalence of CKD in a validation data set. Prevalence calculation was done once without and once with application of the chronicity criterion.ResultsBoth models yielded age-dependent lower reference limits of eGFR that are comparable to previously published data. The model using patients with stable eGFR resulted in higher eGFR reference limits. By applying the chronicity criterion, a lower prevalence of CKD was calculated when compared to one-time eGFR measurements (CKD–EPI: 9.8% vs. 8.3%, FAS: 8.0% vs. 7.2%, EKFC: 9.0% vs. 7.1%).ConclusionThe application of age-dependent lower reference intervals of eGFR together with the chronicity criterion result in a lower prevalence of CKD which supports the estimates of recently published work and the idea of introducing age-dependency into the definition of CKD.

Reflections on the KDIGO Definition of Acute Kidney Injury and Its Integration in the Concept of Acute Diseases and Disorders and Chronic Kidney Diseases

Acute kidney injury (AKI) describes a heterogeneous group of conditions, without specification of their etiology and diagnosed only by indirect markers of glomerular filtration rate (GFR), such as serum creatinine and urine output. Bedside estimation of GFR and detection of structural alterations with novel biomarkers, and stress tests have more recently been developed. These novel findings should probably be included in future AKI definitions. Chronic kidney disease (CKD) is defined by abnormalities in kidney function and structure that persist over &gt;3 months and is classified according to cause, GFR, and albuminuria. Acute kidney disease (AKD) is the term representing patients with abnormalities of function and structure with a duration of ≤3 months that fall outside the definitions of AKI or CKD. Since AKI is by definition also AKD, 2 types of AKD have been proposed, one with and one without AKI. AKD without AKI is common, often undetected, occurs frequently in the outpatient population and shows increased risk of CKD, ESKD and mortality. Alternatively, AKD has also been defined as the period of incomplete recovery following an AKI episode, the latter limited for the duration of 7 days. This contribution discusses the pros and cons of the existence of these 2 definitions of AKD.

Chronic kidney disease and renal replacement therapy: an overview for the advanced clinical practitioner

Chronic kidney disease (CKD), also known as chronic renal failure (CRF), is a common, globally significant condition, with associated significant mortality and morbidity. Due to the disease prevalence, advanced clinical practitioners (ACPs) in a variety of primary and secondary care settings will encounter patients with this diagnosis who will require care and treatment. This article examines definitions of CKD, describes a clinical approach to a patient with CKD, including key history and examination findings, and provides a brief overview of renal replacement strategies for the patient with end-stage renal failure. ACPs require a thorough understanding of this condition and the key elements of treatment and care in this population.

Healthy and unhealthy aging on kidney structure and function: human studies.

This review is intended to provide an up-to-date analysis of the structural and functional alterations of the kidneys that accompany healthy and unhealthy aging in humans. Macro- and micro- structural changes and glomerular filtration rate (whole kidney and single nephron) accompanying aging will be stressed. Comparative findings concerning distribution of anatomic changes of the kidney healthy and unhealthy aging are reviewed. Challenges concerning definition of chronic kidney disease (CKD) in otherwise healthy aging patients are discussed. The complex interactions of CKD and aging are discussed. The role of podocyte dysbiosis in kidney aging is reviewed. Kidney aging is a complex phenomenon often difficult to distinguish from CKD. Nonetheless, phenotypes of healthy and unhealthy aging are evident. Much more information concerning the molecular characteristics of normal kidney aging and its relevance to chronic kidney disease is needed.