Determinants Of Chronic Kidney Disease Research Articles

#2449 Prevalence and determinants of chronic kidney disease among older community-dwelling adults in Ireland

Abstract Background and Aims Chronic Kidney Disease (CKD) is a major global health challenge with substantial morbidity and mortality. In Ireland, a comprehensive understanding of the determinants of CKD is lacking, with limited data on the combined impact of socioeconomic and traditional risk factors. While the Irish Longitudinal Study on Ageing (TILDA) has offered insights into CKD burden, a detailed examination of its determinants remains unexplored. The goal of this study was to explore the prevalence and determinants of CKD at the community level within the Irish population. Method This is a retrospective cohort study that utilised cross sectional data from the first wave of TILDA conducted between 2009 and 2011. Participants aged 50 years and older who had health assessment and kidney function tests performed were included. The 2012 and 2021 Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations were employed to calculate estimated glomerular filtration rates (eGFR) based on cystatin C and creatinine levels. CKD was classified as eGFR < 60 ml/min/1.73 m². We determined the weighted prevalence of CKD using sample weights. Stepwise multivariable logistic regression models were used to identify correlates of CKD and models’ performance were assessed using AUC-ROC curves and the Akaike Information Criterion (AIC). Associations were expressed using adjusted odds ratios (AOR) with 95% confidence intervals (CIs). Results Among the 5 386 participants tested for cystatin C and serum creatinine, the weighted CKD prevalence was 11.3% based on the 2021 CKD-EPI definition (excluding race) and 13.9% using the 2012 definition. Prevalence was significantly higher in women than men, and increased with age, reaching about 45% in women over 71 years versus 29% in men. Burden of comorbid conditions in CKD individuals varied from 11% (for cancer) to 89% (for hypertension) and were significantly higher than non-CKD individuals (P< 0.001). Adjusting for age, sex, education, and employment, the adjusted odds of CKD were significantly higher for individuals with hypertension AOR 2.15 (95% CI: 1.58–2.96), diabetes AOR 2.00 (95% CI: 1.50–2.66), cardiovascular disease AOR 1.72 (95% CI: 1.43–2.21), cancer AOR 1.64 (95% CI: 1.16–2.30), and obesity AOR 2.18 (95% CI: 1.61–2.96). The likelihood of CKD was also higher for patients with a hospital admission in the previous year AOR = 1.50 (95% CI: 1.14–1.96), possession of a medical card AOR 1.41 (95% CI: 1.06–1.89), and unemployed individuals AOR 1.61, (95% CI: 1.06–2.50), while the likelihood was significantly lower for individuals with a tertiary education (versus primary) AOR 0.73 (95% CI: 0.54–0.98). With further adjustment for medications, the magnitude of these associations was greatly attenuated with increasing odds of CKD for those receiving higher medication burden: 2-3 drugs AOR 2.02, (95% CI: 1.29–3.29), 3-4 drugs AOR 2.52 (95% CI: 1. 59–4.11), and > 5 drugs AOR 4.49 (95% CI: 2.81–7.39) (see Fig. 1). The AUC score ranged from 0.84 to 0.88, indicating strong model performance. Conclusion This study brings renewed attention to observed variation in national estimates of CKD prevalence (11.3% vs 13.9%) that are derived from current prediction equations with important implications for the strategic planning and resourcing of CKD care. This study emphasises the impact of socioeconomic factors, such as health coverage and financial barriers to heath care, education attainment, and employment, on CKD beyond traditional risk factors. Furthermore, the attenuation of known risk factors with increasing medication use highlights the influence of these treatments on CKD dynamics. These findings provide valuable insights for targeted public health strategies and awareness programs in Irish communities to address the increasing burden of CKD.

Prevalence and determinants of chronic kidney disease among patients with type 2 diabetes followed in a sub-Saharan resource-limited setting during COVID-19 pandemic (case of Dschang District Dospital)

Prevalence and determinants of chronic kidney disease among patients with type 2 diabetes followed in a sub-Saharan resource-limited setting during COVID-19 pandemic (case of Dschang District Dospital)

Reconfiguration and loss of peritubular capillaries in chronic kidney disease

Functional and structural alterations of peritubular capillaries (PTCs) are a major determinant of chronic kidney disease (CKD). Using a software-based algorithm for semiautomatic segmentation and morphometric quantification, this study analyzes alterations of PTC shape associated with chronic tubulointerstitial injury in three mouse models and in human biopsies. In normal kidney tissue PTC shape was predominantly elongated, whereas the majority of PTCs associated with chronic tubulointerstitial injury had a rounder shape. This was reflected by significantly reduced PTC luminal area, perimeter and diameters as well as by significantly increased circularity and roundness. These morphological alterations were consistent in all mouse models and human kidney biopsies. The mean circularity of PTCs correlated significantly with categorized glomerular filtration rates and the degree of interstitial fibrosis and tubular atrophy (IFTA) and classified the presence of CKD or IFTA. 3D reconstruction of renal capillaries revealed not only a significant reduction, but more importantly a substantial simplification and reconfiguration of the renal microvasculature in mice with chronic tubulointerstitial injury. Computational modelling predicted that round PTCs can deliver oxygen more homogeneously to the surrounding tissue. Our findings indicate that alterations of PTC shape represent a common and uniform reaction to chronic tubulointerstitial injury independent of the underlying kidney disease.

Determinants of Chronic Kidney Disease among Diabetes Mellitus Patients at Gatundu Level 5 Hospital, Kiambu County, Kenya

The prevalence of chronic kidney disease (CKD) is rising alarmingly throughout the world, and it is one of the major public health menace due to the significant morbidity and mortality it is associated with. The burden of CKD inexplicably affects low-income nations like Kenya, where the two main public health concerns for the CKD growth rate are hypertension and diabetes mellitus. The aim of this study was to identify the determinants of chronic kidney disease diabetes mellitus patients and also assess their awareness, perspectives and prevalence of CKD. A hospital based cross-sectional study design was conducted at a rural hospital in central Kenya among adult (≥18 years) diabetes mellitus patients. Sample size was determined using Yamane Taro formula. Informed written consent was obtained from each participant and data was collected by interview and chart review; Glomerular filtration rate (GFR) was estimated from serum creatinine using modification of diet in renal disease (MDRD) formula, while CKD was defined as eGFR of less than 60mls/min/1.73m2 for more than three months. Multivariate logistic regression was used to identify independent determinants of CKD and a p-value of <0.05 was considered to be statistically significant. Majority of the participants (43.42%) were aged between50-60 years and 95 (62.5%) of them were females. Participants with history of high blood pressure had a 129.4 %(AOR;1.29495% CI, 2.401-.698) risk of having CKD, while those who did not perform physical exercises were found to be 123.3% (AOR 1.233, 95% CL,1.889-.805) times more likely to have CKD Only 39 (25.8%) of the participants had average awareness about CKD and its risk factors. The overall unadjusted prevalence of CKD among diabetic patients was 78.2% (n= 119, 95% CI). The researcher found that existing history of hypertension, lack of physical exercises, family history of kidney disease, rural residency and low levels of education were independent determinants associated ......

Chronic kidney disease and associated factors among adult population in Southwest Ethiopia.

In Ethiopia, data on the burden and determinants of chronic kidney disease (CKD) in the general population is limited. This community-based study was conducted to assess the burden and associated factors of CKD among adults in Southwest Ethiopia. The study was conducted from August 23, 2018-October 16, 2018. Study participants were selected using a random sampling method. A structured questionnaire was used to collect relevant data. Blood pressure and anthropometric indices were measured following standard procedures. About 5 ml of urine sample was collected and the dipstick test was performed immediately. A blood sample of 3-5ml was collected for serum creatinine and blood glucose level determination. The three commonest estimators of glomerular filtration rate and the National Kidney Foundation Kidney Disease Outcomes Quality Initiative were used to define and stage CKD. Data were analyzed using SPSS 21. Multivariable logistic regression was employed and p-value <0.05 was used to indicate statistically significant results. A total of 326 participants with a mean age of 39.9(SD±11.2) years were enrolled in the study. The proportions of female participants (59.8%) were relatively higher than male participants (40.2%). The mean eGFR using CKD-EPI, CG and MDRD was 124.34 (SD±23.8) mL/min/1.73m2, 110.67(SD±33.0) mL/min/1.73m2 and 131.29 (SD±32.5) mL/min/1.73m2 respectively. The prevalence of CKD was 7.4% using CKD-EPI & MDRD and 8% using CG. Similar finding using CKD-EPI & MDRD may indicate that either CKD-EPI or MDRD can be used to estimate GFR in this study area. In the age and sex-adjusted logistic regression model, hypertension was significantly associated with CKD using CKD-EPI & MDRD and age ≥40 years old was significantly associated with CKD using CG. Behavioral characteristics and other traditional risk factors were not significantly associated with CKD in the current study. The prevalence of CKD was high in the study area. Only hypertension and age ≥40 years old were significantly associated with CKD. More of the increased prevalence of CKD in the current study remained unexplained and deserves further study.

Hypertension and cardiovascular\xa0risk factor management in a\xa0multi-ethnic cohort of\xa0adults with CKD: a cross sectional study in general practice

BackgroundHypertension, especially if poorly controlled, is a key determinant of chronic kidney disease (CKD) development and progression to end stage renal disease (ESRD).AimTo assess hypertension and risk factor management, and determinants of systolic blood pressure control in individuals with CKD and hypertension.Design and settingCross-sectional survey using primary care electronic health records from 47/49 general practice clinics in South London.MethodsKnown effective interventions, management of hypertension and cardiovascular disease (CVD) risk in patients with CKD Stages 3–5 were investigated. Multivariable logistic regression analysis examined the association of demographic factors, comorbidities, deprivation, and CKD coding, with systolic blood pressure control status as outcome. Individuals with diabetes were excluded.ResultsAdults with CKD Stages 3–5 and hypertension represented 4131/286,162 (1.4%) of the total population; 1984 (48%) of these individuals had undiagnosed CKD without a recorded CKD clinical code. Hypertension was undiagnosed in 25% of the total Lambeth population, and in patients with CKD without diagnosed hypertension, 23.0% had systolic blood pressure > 140 mmHg compared with 39.8% hypertensives, p < 0.001. Multivariable logistic regression revealed that factors associated with improved systolic blood pressure control in CKD included diastolic blood pressure control, serious mental illness, history of cardiovascular co-morbidities, CKD diagnostic coding, and age < 60 years. African ethnicity and obesity were associated with poorer systolic blood pressure control.ConclusionWe found both underdiagnosed CKD and underdiagnosed hypertension in patients with CKD. The poor systolic blood pressure control in older age groups ≥ 60 years and in Black African or obese individuals is clinically important as these groups are at increased risk of mortality for cardiovascular diseases.Graphic abstract

Prevalence and determinants of chronic kidney disease in women with hypertensive disorders in pregnancy in Nigeria: a cohort study

BackgroundWorldwide, hypertensive disorders in pregnancy (HDPs) complicate between 5 and 10% of pregnancies. Sub-Saharan Africa (SSA) is disproportionately affected by a high burden of HDPs and chronic kidney disease (CKD). Despite mounting evidence associating HDPs with the development of CKD, data from SSA are scarce.MethodsWomen with HDPs (n = 410) and normotensive women (n = 78) were recruited at delivery and prospectively followed-up at 9 weeks, 6 months and 1 year postpartum. Serum creatinine was measured at all time points and the estimated glomerular filtration rates (eGFR) using CKD-Epidemiology equation determined. CKD was defined as decreased eGFR< 60 mL/min/1.73m2 lasting for ≥ 3 months. Prevalence of CKD at 6 months and 1 year after delivery was estimated. Logistic regression analyses were conducted to evaluate risk factors for CKD at 6 months and 1 year postpartum.ResultsWithin 24 h of delivery, 9 weeks, and 6 months postpartum, women with HDPs were more likely to have a decreased eGFR compared to normotensive women (12, 5.7, 4.3% versus 0, 2 and 2.4%, respectively). The prevalence of CKD in HDPs at 6 months and 1 year postpartum was 6.1 and 7.6%, respectively, as opposed to zero prevalence in the normotensive women for the corresponding periods. Proportions of decreased eGFR varied with HDP sub-types and intervening postpartum time since delivery, with pre-eclampsia/eclampsia showing higher prevalence than chronic and gestational hypertension. Only maternal age was independently shown to be a risk factor for decreased eGFR at 6 months postpartum (aOR = 1.18/year; 95%CI 1.04–1.34).ConclusionPrior HDP was associated with risk of future CKD, with prior HDPs being more likely to experience evidence of CKD over periods of postpartum follow-up. Routine screening of women following HDP-complicated pregnancies should be part of a postpartum monitoring program to identify women at higher risk. Future research should report on both the eGFR and total urinary albumin excretion to enable detection of women at risk of future deterioration of renal function.

Sociodemographic determinants of chronic kidney disease in Indigenous children.

Rates of chronic kidney disease (CKD) are disproportionately increased in Indigenous peoples. The focus has traditionally been on adults, as they experience the highest rates of kidney failure requiring kidney replacement therapy. The impacts of colonization, systemic racism, and sociodemographic marginalization however impact the health of Indigenous peoples across the lifespan. This review presents the social context within which Indigenous children develop and the impact relevant to kidney health across the developmental stages. In utero exposures impact nephron endowment which can manifest in glomerular hyperfiltration and sclerosis as well as an increased risk of congenital anomalies of the kidney and urinary tract. Young children are at increased risk of autoimmune conditions, secondary to infectious and environmental exposures, and are also exposed to the impacts of a Western lifestyle manifesting early onset overweight/obesity. Adolescents begin to manifest more severe metabolic complications such as type 2 diabetes. The impacts of early onset diabetes are associated with aggressive kidney complications and high rates of kidney failure in young adulthood. Finally, the key elements of successful prevention and treatment strategies are discussed including the importance of screening for asymptomatic, modifiable early disease, linked with clinical primary and tertiary care follow-up, and culturally relevant and safe care.

Neighborhood Socioeconomic Status, Health Insurance, and CKD Prevalence: Findings From a Large Health Care System

Rational & ObjectiveNeighborhood socioeconomic status (SES) and health insurance status may be important upstream social determinants of chronic kidney disease (CKD), but their relationship remains unclear. The aim of this study was to determine whether neighborhood SES and individual-level health insurance status were independently associated with CKD prevalence.Study DesignObservational study using electronic health records (EHRs).Setting & ParticipantsEHRs of patients (n = 185,269) seen at a health care system in the 7-county Minneapolis/St Paul area (2017-2018).ExposuresCensus tract neighborhood SES measures (median value of owner-occupied housing units [wealth], percentage of residents aged >25 years with bachelor’s degree or higher [education]) and individual-level health insurance status (aged <65 years: Medicaid vs other insurance; ≥65 years: Medicare vs Medicare and supplemental insurance plan) were obtained from the American Community Survey and EHR data. Neighborhood SES was operationalized into quartiles, comparing low (first quartile) versus high (fourth quartile) neighborhood SES.OutcomesCKD prevalence: estimated glomerular filtration rate < 60 mL/min/1.73 m2 or proteinuria.Analytic ApproachMultilevel Poisson regression with robust error variance with a random intercept at the census-tract level, adjusted for demographic and clinical covariates, was used to estimate the association between neighborhood SES, insurance, and CKD.ResultsNeighborhood SES and insurance were independently associated with CKD prevalence. In covariate-adjusted models, patients living in low versus high neighborhood SES had a higher CKD prevalence among both younger and older patients. For example, the prevalence ratios of CKD in low versus high neighborhood SES as defined by education among patients younger than 65 and 65 years and older were 1.11 (95% CI, 1.05-1.18) and 1.08 (95% CI, 1.04-1.12), respectively. Patients younger than 65 years receiving Medicaid had higher CKD prevalence versus those with other insurance (1.51 [95% CI, 1.43-1.6]). For patients 65 years and older, insurance was not associated with prevalence of CKD in the fully adjusted model.LimitationsOne health care system and selection bias.ConclusionsLiving in low neighborhood SES as defined by wealth and education and having Medicaid for patients younger than 65 years were associated with higher CKD prevalence.

Burden and Determinants of Chronic Kidney Disease Among Diabetic Patients in Ethiopia: A Systematic Review and Meta-Analysis.

Background: Chronic kidney disease (CKD) among diabetic patients is becoming a global health burden with a high economic cost to health systems. The incidence of CKD is higher in low-income countries such as Ethiopia. In Ethiopia, there is no national representative evidence on the burden and determinants of CKD among patients with diabetes. Therefore, this review aimed to estimates the pooled burden and determinants of CKD among patients with diabetes. Methods: Published articles from various electronic databases such as Pub Med, Google Scholar, CINAHL, Scopes, Cochrane library, the Web of Science, and African Journals Online were accessed. Also, unpublished studies from Addis Ababa digital library were identified. We included all observational studies (cross-sectional, case-control, and cohort) in the review. Data were extracted on the Microsoft Excel spreadsheet and analyzed using STATA 14.1 version. A random-effects model was used to estimate the pooled estimate with a 95% confidence interval (CI). Forest plots were used to visualize the presence of heterogeneity and estimate the pooled burden and determinants of chronic kidney disease among diabetic patients. The presence of publication bias was assessed by funnel plots and Egger’s statistical tests. Results: Published (297) and unpublished (2) literature were identified from several databases and digital libraries, of which twelve articles were selected for final meta-analysis. Significant heterogeneity was observed across studies (I2 = 85.2%), which suggests a random-effects model to estimate pooled burden. The analysis found that the pooled burden of CKD among patients with diabetes was 18.22% (95% CI: 15.07–21.38). Factors such as hypertension (OR = 2.65, 95%, CI: 1.38, 5.09), type of DM (OR = 0.33, 95%, CI: 0.14–0.76), and duration of DM (OR = 0.51, 95%, CI: 0.34–0.77) were found to have significant association with CKD. Conclusion: The current review revealed a higher burden of CKD among patients with diabetes in Ethiopia. The presence of hypertension, type II diabetes, and duration of diabetes for a longer duration were found to be independent determinants of CKD among patients with diabetes. For better control of chronic kidney disease, integrated management of hypertension and DM should be designed with a special focus on chronic diabetic patients.

Prevalence and determinants of chronic kidney disease in urban adults' populations of northern Cameroon.

Chronic kidney disease (CKD) is a major health problem with growing prevalence in sub-Saharan Africa. Assess the prevalence and determinants of CKD in Garoua and Figuil cities of the North region of Cameroon. A cross-sectional survey was conducted from January to June 2018 in the two cities, using a multi-level cluster sampling. All adults with low estimated glomerular filtration rate (eGFR) (< 60ml/min/1.73 m2) by Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation and/or albuminuria (≥ 30mg/g) were reviewed three months later. Logistic regression models (accounting for the sampling strategy) were used to investigate the predictors of the outcomes. A total of 433 participants were included, with a mean age (95%CI) of 45.0 (43.4-46.6) years, 212 (48.7%) men, 294 (67.9%) from Garoua and 218 (45.6%) with no formal education. Risk factors for chronic nephropathy were highly prevalent including longstanding use of street medications (52.8%), herbal medicines (50.2%) and non-steroidal anti-inflammatory drugs (50%), alcohol consumption (34.4%), hypertension (33.9%), overweight/obesity (33.6%), hyperuricemia (16.8%), smoking (11.3%) and hyperglycemia (6.5%). The prevalence of CKD was 11.7% overall, 10.7% in Garoua and 13% in Figuil participants. Equivalents figures for CKD G3-5 and albuminuria were 2.8%, 2.0% and 4.5%; and 9.1%, 9.3% and 8.5%, respectively. History of diabetes, increase systolic blood pressure, hyperglycemia and hyperuricemia were predictors of CKD. The prevalence of CKD is as high in these northern cities as previously reported in southern cities of Cameroon, driven mostly by known modifiable risk factors of chronic nephropathy.

Prevalence of Chronic Kidney Disease and Its Determinants in Rural Pondicherry, India-A Community Based Cross-Sectional Study

Introduction:The burden of CKD is on the rise globally and in India. There are scarce population based studies based in rural industrialized settings in India and elsewhere.Objective:To find out the prevalence and determinants of Chronic Kidney Disease (CKD) among adults in rural Pondicherry, IndiaMethods:It was a community-based cross-sectional study in 13 villages of a Primary Health Centre in rural Pondicherry. A representative sample of 422 adults more than or equal to 50 years of both genders was selected by population proportional to size methods. All the participants were screened by SCORED questionnaire to get the potential cases of CKD. We did serum creatinine, urine examination, blood pressure and anthropometric measurement for the potential cases. CKD was diagnosed by estimation of glomerular filtration rate and presence of protienuria. The data was analyzed using Statistical Package for Social Science version 24. The study was approved by the Institutional Ethics Committee of SMCMCH, Pondicherry.Results:The prevalence of CKD was found to be 24.2% in the study sample of respondents 50 years or more. Most (73.5%) of the CKD cases were at stage 2, Stage 3a had 15% and stage 3b had 2% of the cases. The determinants of CKD were (60-69 years, PR: 2.36,CI:1.36-4.07), poor nutrition(underweight, overweight and obesity)poor nutritional status (underweight:PR: 2.26,CI:1.05-4.89), (overweight:PR: 2.19,CI:1.06-4.52), (obese:PR: 2.13 CI: 1.13-4.01) and presence of at least one chronic co-morbidity(PR:5.85,CI:1.38-24.78). Majority of the patients in the CKD group had minimal proteinuria 87.25%. And 42.15% of the CKD group had no k.w:5 or k.w:6.Conclusion and Recommendation:Considering the higher prevalence of CKD in the study area, targeted screening of adult population should be undertaken as means of early detection, diagnosis, treatment and follow up of at-risk individuals to prevent further progression of CKD. Further research is required to look at the aetiology of CKD.

Dietary Proportion of Protein from Plant Sources in Relation to the Risk of Incident Chronic Kidney Disease in Korean Adults: The Health Examinees (HEXA) Study (P18-083-19)

ObjectivesDiet is an important determinant of chronic kidney disease (CKD) development. The purpose of this study was to evaluate the association of proportion of dietary protein from plant sources with the risk of incident CKD in a population-based prospective study. The purpose of this study was to evaluate the association of proportion of dietary protein from plant sources with the risk of incident CKD in a population-based prospective study. MethodsThis study analyzed data from the Health Examinee (HEXA) cohort of the Korean Genome and Epidemiology Study (KoGES) between 2005 and 2012 for 148,534 individuals who were initially free of CKD and aged 40–69 years. Baseline diet was assessed by a validated FFQ. Estimated glomerular filtration rate (eGFR) was calculated, using the CKD–EPI equation, and CKD was defined as eGFR < 60 ml/min per 1.73 m2. Multivariate Cox proportional hazard models were used to examine the risk for incident according to dietary proportion of protein from plant sources. ResultsThe mean of plant protein-total protein ratio was 59.1 ± 13.52%. There were 1041 cases of incident CKD over a median of 6.41 years of follow-up. After adjustment for demographic, clinical and dietary factors, the highest quartile of a proportion of dietary protein from plant sources was significantly associated with the development of incident CKD (HR comparing fourth to first quartile, 0.738; 95%CI, 0.583–0.933) in men, but not in women. ConclusionsWe observed that a diet with higher proportion of protein from plant sources is associated with decreased risk of incident CKD in men. This study provides evidence suggesting a potential protective effect of plant protein sources against the development of CKD. Funding SourcesN/A.

Glomerular hyperfiltration predicts the onset of chronic kidney disease in humanized sickle cell mice

Kidney disease occurs in 68% of adults with sickle cell disease (SCD), and accounts for 30% mortality. Although a high prevalence of hyperfiltration occurs in SCD, its role as a direct determinant of chronic kidney disease remains unknown. Further, while potential sex‐dependent protective mechanisms of chronic SCD complications have been reported, whether sex differences exist in SCD‐associated kidney disease is unknown. The aim of the study was to perform a longitudinal study to determine the course of renal phenotype and examine potential predictors of long‐term renal outcomes in humanized sickle cell mice (HbSS). Time course analysis of structural and functional markers of kidney injury were performed in 4‐week intervals for 24 weeks starting at 8 weeks of age in male and female HbSS and genetic controls (HbAA) mice. An early and rapid hyperfiltration occurring at 12 weeks of age in male HbSS vs. HbAA mice (GFR: 262±9 vs. 225±3 μl/min; p&lt;0.05) was followed by a progressive decline of renal function (GFR: 139±7 vs. 229±4 μl/min; p&lt;0.0001), and proteinuria (3.62±0.28 vs. 1.46±0.24 mg/24h; p&lt;0.0001). Unlike male, female HbSS mice had a diffuse hyperfiltration pattern with a peak at 20 weeks of age (GFR: 229±18 μl/min), followed by mild decline in kidney function (177±7 μl/min) and proteinuria (1.70±0.33 mg/24h) at 32 weeks of age. Following hyperfiltration male HbSS mice developed progressive glomerular damage presented with albuminuria (319±22 μg/24h) and glomerulopathy, including glomerular sclerosis, congestion, hypertrophy, basement membrane of Bowman's capsule thickening, and glomerular loss. Female HbSS mice manifested with mild albuminuria (51±9 μg/24h) and a minor degree of glomerular injury. Male HbSS mice had more severe podocyte damage subsequent to hyperfiltration when compared to age‐matched females. Interestingly, elevated levels of urinary kidney injury marker 1 (at 8 weeks of age), a gradual brush border loss, progressive extension of interstitial fibrosis and tubular iron deposition were observed in both sexes of HbSS mice throughout the study course, suggesting that early tubular dysfunction preceded the onset of glomerular damage in these mice. Moreover, female HbSS mice had significantly lower mRNA expression of hypoxia inducible factor 1α when compared to males. In male HbSS mice, hyperfiltration strongly correlated with proteinuria (R2=0.57, p&lt;0.0003), albuminuria (R2=0.4, p&lt;0.003), decreased GFR (R2=0.44, p&lt;0.004), and elevated plasma creatinine (R2=0.27, p&lt;0.03) at 32 weeks of age. Additionally, the magnitude of hyperfiltration greater than 60 μl/min was associated with the greater degree of kidney damage in male HbSS mice. Unlike male, female HbSS mice did not demonstrate with a significant loss of renal function nor severe kidney damage during the time course of the study. These data suggest that hyperfiltration predicts the development of nephropathy in male HbSS mice, while protective mechanisms existing in female HbSS mice, may delay the onset of SCD nephropathy.Support or Funding InformationSupport provided by an NIH‐funded U01 HL117684 to D.M.P, R00 HL127178 to J.S.S and ASN Ben J. Lipps Research Fellowship for M.K.This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Prediction of chronic kidney disease after acute kidney injury in ICU patients: study protocol for the PREDICT multicenter prospective observational study

Background Acute kidney injury (AKI) is frequent and associated with poor outcome in intensive care unit (ICU) patients. Besides the association with short- and long-term mortality, the increased risk of chronic kidney disease (CKD) has been recently highlighted in non-ICU patients. This study aims to describe the incidence and determinants of CKD after AKI and to develop a prediction score for CKD in ICU patients.Methods Prospective multicenter (n = 17) observational study included 1200 ICU patients who suffered from AKI (defined by an AKIN stage ≥ 1) during their ICU stay and were discharged alive from ICU. Preexisting end-stage renal disease (ESRD) and immunosuppressant treatments are the main exclusion criteria. Patients will be monitored by a nephrologist at day 90 and every year for 3 years. The main outcome is the occurrence of CKD defined by a creatinine-based estimated glomerular filtration rate (eGFR) lower than 60 mL/min/1.73 m2 or renal replacement therapy for ESRD in patients whose eGFR will be normalized (≥ 60 mL/min/1.73 m2) at day 90. Secondary outcomes include albuminuria changes, eGFR decline slope and ESRD risk in patients with preexisting CKD, cardiovascular and thromboembolic events and health-related quality of life.DiscussionThis is the first study prospectively investigating kidney function evolution in ICU patients who suffered from AKI. Albuminuria and eGFR monitoring will allow to identify ICU patients at risk of CKD who may benefit from close surveillance after recovering from AKI. Major patient and AKI-related determinants will be tested to develop a prediction score for CKD in this population.Trial registration ClinicalTrials.gov, NCT03282409. Registered on September 14, 2017

Prevalence and determinants of chronic kidney disease in northeast of Iran: Results of the Golestan cohort study.

BackgroundThe burden of chronic kidney disease (CKD) is increasing globally in particular in fast emerging economies such as Iran. Population-based studies on prevalence of CKD in Iran are scarce. The objective of the current study was to explore the prevalence and determinants of CKD in the setting of Golestan Cohort Study (GCS), the largest prospective cohort in the Middle East.MethodsIn this observational study, 11,409 participants enrolled in the second phase of GCS were included. Sex, age, literacy, residence, anthropometric measurements, smoking, opium use, self-reported history of cardiovascular diseases (heart disease and/or stroke), hypertension, diabetes, and lipid profile were the predictors of interest. The outcomes of interest were eGFR and CKD defined as eGFR< 60 ml/min/1.73m2.ResultsMean (SD) of GFR was 70.0 ± 14.7 ml/min/1.73m2 among all participants, 68.2 ± 14.2 among women, and 72.0 ± 15.0 among men. Prevalence of CKD was 23.7% (26.6% in women, 20.6% in men). The prevalence of CKD stages 3a, 3b, 4, and 5 were 20.0%, 3.3%, 0.4% and 0.1%, respectively. Female sex, older age, urban residence, history of CVD, hypertension or diabetes, larger body mass and surrogates of body fat and opium use were all associated with CKD. Opium had a significant positive association with CKD in adjusted model. All anthropometric measurements had positive linear association with CKD. Being literate had inverse association. Sex had significant interaction with anthropometric indices, with higher odds ratios among men compared with women. A significantly high association was observed between the rate of change in waist circumference and systolic blood pressure with risk of CKD.ConclusionOne in four people in this cohort had low eGFR. Obesity and overweight, diabetes, hypertension, and dyslipidemia are major risk factors for CKD. Halting the increase in waist circumference and blood pressure may be as important as reducing the current levels.

Prevalence and determinants of chronic kidney disease in the Swiss population

The prevalence of chronic kidney disease (CKD) is increasing worldwide, corresponding to an increased risk of cardiovascular disease. The latest study on prevalence of CKD involving the three linguistic regions of Switzerland dates back to 2002-2003 and definitions have changed since then. We aimed to assess the current prevalence and determinants of CKD in the Swiss general population. We analysed the data of 1353 participants from a cross-sectional population-based survey performed in 2010-2012 in the three linguistic regions of Switzerland. The prevalence of CKD and the derived cardiovascular risk categories were assessed according to the Kidney Disease - Improving Global Outcomes (KDIGO) 2012 classification, using estimated glomerular filtration rate (GFR; CKD-Epidemiological Collaboration equation) and albuminuria level. Multivariate logistic regression was used to analyse factors associated with CKD. We included 660 men and 693 women, equally distributed in four age categories (15-29, 30-44, 45-59 and over 60 years). The overall prevalence of CKD was 10.4%. The prevalence in the low, moderate, high and very high risk KDIGO categories were 89.6%, 8.4%, 1.6% and 0.5%, respectively. The prevalence of CKD was similar in all linguistic regions. In multivariate analysis, female gender, older age, diabetes and uric acid were independently associated with CKD in persons ≥45 y. In younger participants, diabetes and lower educational level were associated with CKD. In the general Swiss population, CKD affects one in ten adults. Subjects older than 60 years, as well as patients with diabetes and hypertension, show a high prevalence of CKD. Systematic screening may be recommended in this population.

Prevalence and Determinants of Chronic Kidney Disease Among Hypertensive Cameroonians According to Three Common Estimators of the Glomerular Filtration Rate.

Hypertension is a risk factor for renal diseases, which, in turn, are precursors of hypertension. The authors assessed the prevalence and determinants of chronic kidney disease (CKD) among 336 hypertensive adult Cameroonians (mean age, 60.9±11.3 years; 63.4% women) at Yaoundé. Any participant with an estimated glomerular filtration rate <60 mL/min/1.73 m(2) regardless of the equation used (Cockcroft-Gault [CG], Modification of Diet in Renal Disease [MDRD], and Chronic Kidney Disease Epidemiology Collaboration [CKD-EPI]) and/or dipstick proteinuria was reviewed 3 months later. Participants presented a high prevalence of diabetes (18.5%), dyslipidemia (17.6%), gout/hyperuricemia (10.7%), overweight/obesity (68.8%), self-medication (37.5%), and alcohol consumption (33.3%). Hypertension was uncontrolled in 265 patients (78.9%). The prevalence of CKD was 49.7%, 50.0%, and 52.1% according to MDRD, CKD-EPI, and CG equations, respectively. Advanced age, adiposity, and severity of hypertension were determinants of CKD. Nearly half of the hypertensive patients had CKD regardless of the estimators used, predicted by well-known risk factors.

Prevalence and determinants of chronic kidney disease in rural and urban Cameroonians: a cross-sectional study.

BackgroundChronic kidney disease (CKD) is a global public health problem that disproportionally affects people of African ethnicity. We assessed the prevalence and determinants of CKD and albuminuria in urban and rural adults Cameroonians.MethodsThis was a cross-sectional study of 6-month duration (February to July 2014), conducted in the health district of Dschang (Western Region of Cameroon), using a multistage cluster sampling. All adults diagnosed with albuminuria (≥30 mg/g) and/or decreased estimated glomerular filtration rate (eGFR) (<60 ml/min/1.73 m2) were re-examined three months later. Logistic regression models were used to relate baseline characteristics with prevalent CKD.ResultsWe included 439 participants with a mean age of 47 ± 16.1 years; with 185 (42.1 %) being men and 119 (27.1 %) being urban dwellers. There was a high prevalence of hypertension (25.5 %), diabetes (9.8 %), smoking (9.3 %), alcohol consumption (59.7 %), longstanding use of herbal medicine (90.9 %) and street medications (87.5 %), and overweight/obesity (53.3 %) which were predominant in rural area. The prevalence of CKD was 13.2 % overall, 14.1 % in rural and 10.9 % in urban participants. Equivalents figures for CKD stages G3-G4 and albuminuria were 2.5 %, 1.6 % and 5.0 %; and 12.1 %, 14.1 % and 6.7 % respectively. Existing hypertension and diabetes were associated with all outcomes. Elevated systolic blood pressure and the presence of hypertension and diabetes were the predictors of albuminuria and CKD while urban residence was associated with CKD stages G3-G4.ConclusionThe prevalence of CKD and albuminuria was high in this population, predominantly in rural area, and driven mostly by the commonest risk factors.Electronic supplementary materialThe online version of this article (doi:10.1186/s12882-015-0111-8) contains supplementary material, which is available to authorized users.

Sickle cell trait is not associated with chronic kidney disease in adult Congolese patients: a clinic-based, cross-sectional study.

SummaryObjectiveThe aim of this study was to evaluate the determinants of chronic kidney disease (CKD) with special emphasis on sickle cell trait (SCT).MethodsThree hundred and fifty-nine patients (171 men and 188 women), aged 18 years or older, with reduced kidney function (eGFR < 90 ml/min/1.73 m2) and seen at secondary and tertiary healthcare in Kinshasa were consecutively recruited in this cross-sectional study. Serum creatinine and haemoglobin electrophoresis were performed in each patient. CKD was defined as < 60 ml/min/1.73 m2. Logistic regression analysis was used to assess determinants of CKD with a special emphasis on SCT. A p-value < 0.05 defined the level of statistical significance.ResultsSCT was present in 19% of the study population; its frequency was 21 and 18% (p > 0.05) in patients with and without CKD, respectively. In multivariate analysis, sickle cell trait was not significantly (OR: 0.38; 95% CI: 0.559–1.839; p = 0.235) associated with CKD; the main determinants were dipstick proteinuria (OR: 1.86; 95% CI: 1.094–3.168; p = 0.02), the metabolic syndrome (OR: 1.69; 95% CI: 1.033–2.965; p = 0.03), haemoblobin ≥ 12 g/dl (OR: 0.36; 95% CI: 0.210–0.625; p = 0.001), and personal history of hypertension (OR: 2.16; 95% CI: 1.202–3.892; p = 0.01) and of diabetes mellitus (OR: 2.35; 95% CI: 1.150–4.454; p = 0.001).ConclusionSCT was not an independent determinant of CKD in the present case series. Traditional risk factors emerged as the main determinants of CKD.