Diagnosis Of CKD Research Articles

Prevalence of chronic kidney disease in Kazakhstan: evidence from a national cross-sectional study

To date, there have been no large-scale national studies of the prevalence of chronic kidney disease in Kazakhstan. It includes the research based on the analysis of the estimated glomerular filtration rate (eGFR). The aim of this study was to investigate the population prevalence of CKD and associated risk factors in Kazakhstan. The cross-sectional study consisted of a nationally representative sample of n = 6 720 adults aged 18 to 69 from 14 regions and 3 major cities in Kazakhstan. The study covered the period from October 2021 to May 2022. The WHO STEPS questionnaire was used for the survey. For the diagnosis of CKD, creatinine levels in collected blood samples were measured to assess eGFR. Demographic characteristics were collected and studied. The total and adjusted prevalence of factors associated with the presence of CKD were calculated and analysed using logistic regression. 73.5% (n = 4940) of participants had normal eGFR, while 25.2% (n = 1695) had mild CKD (eGFR = 60–89 mL/min/1.7 m2). The overall prevalence of CKD with eGFR < 60 ml/min/1.7 m2 was 1.3% (n = 85), of which 0.2% (n = 15) had eGFR < 45 ml/min/1.7 m2. A mild degree of CKD was most often determined in residents of the East Kazakhstan region in 10.4%, and in 7.8–8.0% of cases. The majority of CKD patients was detected in the East Kazakhstan region and Almaty city, 15.3% and 10.6% of cases respectively. In mild and CKD with GFR < 60 ml/min/1.7 m2, the age of participants was 50–69 years in 61.5% and 78.8% of cases, respectively (p < 0.001). In addition to the association with the place of residence, a statistically significant relationship was found between the risk of developing CKD and underweight (OR 1.43, 95% CI (1.09–1.88), p < 0.001), as well as the presence of obesity (OR 1.24, 95% CI (0.99–1.53), p = 0.04). We observed the prevalence of CKD with eGFR < 60 ml/min/1.7 m2 at the level of 1.3%. However, a fairly large part of study participants had a mild CKD (25.2%). The results of this study can be used for the optimization of the doctors workload and the timely provision of care to patients with CKD.

Incidence, prevalence, and treatment of anemia of non-dialysis-dependent chronic kidney disease: A retrospective database study in France.

Minimal data are available regarding the prevalence and incidence of anemia among patients with non-dialysis-dependent chronic kidney disease (NDD-CKD) in France. This was a retrospective non-interventional study of patients with a record of NDD-CKD in the Echantillon Généraliste des Bénéficiaires (EGB) database between January 01, 2012, and December 31, 2017. The primary objective was to estimate the annual incidence and prevalence of anemia of NDD-CKD. Secondary objectives included description of the demographics and clinical characteristics of patients with NDD-CKD-related anemia. An exploratory objective was to use machine learning to identify patients from the general population that might have NDD-CKD but without a recorded ICD-10 diagnosis of CKD. During 2012-2017, 9865 adult patients in the EGB database had confirmed NDD-CKD; of these, 49.1% (4848/9865) had anemia. From 2015 to 2017, estimates of incidence (108.7-114.7 per 1000 population) and prevalence (435.7-449.5 per 1000 population) of NDD-CKD-related anemia were stable. Less than half of patients with anemia of NDD-CKD were treated with oral iron, and approximately 15% were treated with erythropoiesis-stimulating agents. Based on adult French population projections in 2020 and an estimated prevalence rate in 2017 of 42.2 per 1000 population for confirmed plus possible NDD-CKD (as a proportion of the general French population), the estimated number of patients with possible NDD-CKD in France was 2,256,274, approximately five-fold greater than the number identified by diagnostic codes and hospitalizations. Anemia of NDD-CKD was shown to be a constant long-term burden in France, and its apparent prevalence may still be significantly underestimated. Given the potential treatment gap, additional initiatives to better identify and treat NDD-CKD anemia may improve patient management and treatment outcomes.

#5772 ESTIMATING CKD PREVALENCE AND INCIDENCE USING CROSS-SECTIONAL GERMAN CLAIMS DATA IN PERSONS AGED 70+

Abstract Background and Aims Little is known about trends over time and anticipated improvements in CKD diagnosis after the implementation of the Kidney Disease – Improving Global Outcomes (KDIGO) guidelines in 2012. We investigated CKD prevalence and incidence over time using claims data in persons aged 70+. Method We assessed CKD prevalence and incidence biennially in cross-sectional claims data of the German health insurance fund “AOK Nordost” for persons aged 70+ between 2012 and 2018. Data are available for n = 62,200 persons per year and were sampled equally distributed for five age strata (70-74, 75–79, 80–84, 85–89, ≥90) and for sex. CKD prevalence and incidence were estimated in 2012, 2014, 2016, and 2018 using in- and outpatient ICD-10 diagnoses (N18.3, N18.4, N18.5, N18.8, N18.9, N19). Incidence was defined as prevalent cases without a diagnosis in the four quarters preceding their first CKD diagnosis over all persons at risk (i.e., who were not prevalent in the respective previous year). Results are shown in total (standardized by age and sex using nationwide demographic distributions for a respective year) as well as stratified by age and sex. Cochran-Armitage test was applied to test time trends for incidence and prevalence from 2012–2018. Results Claims data-based CKD prevalence showed a significant constant increase from 0.18 in 2012 to 0.26 in 2018 (p &amp;lt;0.001). This time trend in CKD prevalence was consistent among all age and sex strata (Figure 1). Over the same time period, CKD incidence increased from 0.06 to 0.08 (p &amp;lt;0.001), while the percentage of persons at risk decreased from 0.81 to 0.72 between 2012 and 2018 due to increasing prevalence (Table 1). Both prevalence and incidence estimates were higher in males compared to females in all age strata (Figure 1). Conclusion The present cross-sectional analysis in claims data allows novel insights of CKD prevalence and incidence among older adults in Germany. CKD prevalence increased constantly over time after the introduction of the KDIGO guidelines in 2012. For CKD incidence, we detected only a small increase over the observation period. The extent of time trends for CKD incidence might be underestimated due to increasing prevalence.

#4494 DRUG UTILIZATION FOLLOWING INCIDENT CHRONIC KIDNEY DISEASE: AN OBSERVATIONAL STUDY IN THE UNITED STATES AND JAPAN

Abstract Background and Aims Chronic kidney disease (CKD) affects &amp;gt;840 million individuals worldwide and is a leading cause of morbidity and mortality. Complications include cardiorenal outcomes (e.g. end stage kidney disease and heart failure (HF)) and premature death, which may be preventable with early identification and appropriate treatment of CKD. Treatment of CKD with renin-angiotensin-system inhibitors (RASi) has been the main recommendation of guidelines in the past 20 years, but prescribing rates remain low and discontinuation rates remain high, particularly after adverse events like hyperkalaemia episodes. This study aims to describe RASi utilization following incident CKD. Method Adult patients with incident CKD in the United States (US; OPTUM Market Clarity until 31 March 2022) and Japan (Medical Data Vision until 28 February 2022) from 1 January 2016 onwards were included. CKD was defined as any of the following: a UACR measure of ≥30 mg/g, two estimated glomerular filtration rate (eGFR) ≥90 days apart of which the second was ≤75 ml/min/1.73 m2, or a CKD diagnosis code. Patients were included if they had an eGFR ≤60 ml/min/1.73 m2. Patients with ongoing RASi treatment at index, a history of diabetes, heart failure or dialysis were excluded. Results A total of 66,375 incident CKD patients were identified in the US (n = 32,158) and Japan (n = 34,217). Mean age was 66 and 78 years in the US and Japan, respectively, and about half of the patients were female. Mean eGFR was 48 and 40 ml/min/1.73 m2 in the US and Japan, respectively. Approximately 30% of patients had cardiovascular disease, but only 13% (US) and less than 5% (Japan) were prescribed cardiovascular preventive drugs (e.g. statins and low dose aspirin). During a 1-year follow-up after the incident CKD index date, only 15% and 5% had been initiated on RASi in the US and Japan, respectively (Figure 1). Time to RASi initiation was shorter among those with a CKD diagnosis vs those without a diagnosis (US: 15 vs 19 months, Japan: 6 vs 11 months). Of those who initiated treatment, approximately 50% discontinued within one year (Figure 1). Results for initiation and discontinuation were similar across CKD stages in both countries. Conclusion In the US and Japan, initiation of RASi was remarkably low among newly identified CKD patients, and discontinuation of initiated treatment was substantial. Given that most patients with CKD benefit from multi-drug therapy (RASi + SGLT2i) for slowing CKD progression and reduction of adverse events, efforts to increase prescribing and adherence are needed.

#3667 REVEAL-CKD: PREVALENCE OF UNDIAGNOSED STAGE 3 CHRONIC KIDNEY DISEASE IN AUSTRALIA, BRAZIL, CANADA AND SPAIN

Abstract Background and Aims Chronic kidney disease (CKD) is a progressive condition that affects &amp;gt;850 million people globally. Global clinical guidelines from K-DIGO recommend early CKD identification and management to mitigate disease progression. The REVEAL-CKD study aims to assess the prevalence of, and factors associated with, undiagnosed stage 3 CKD across 11 countries. Here we report data from 4 countries in 4 continents. Method REVEAL-CKD is a multi-national, observational study, using secondary data from electronic medical records (EMR) and claims data. For this analysis, data were extracted from Australian General Practices through Pen CS (Australia), University of Sao Paulo (Brazil), the Canadian Primary Care Sentinel Surveillance Network (CPCSSN) (Canada), and BIGPAC (Spain). The study cohort included patients aged ≥18 years with two consecutive estimated glomerular filtration rate (eGFR) values ≥30 and &amp;lt;60 mL/min/1.73 m2 recorded 91-730 days apart. The date of the second qualifying eGFR was the index date. Patients with no CKD diagnosis code before and up to 6 months after their index date were considered undiagnosed. The prevalence of undiagnosed CKD was calculated as the ratio of undiagnosed patients to all patients meeting the study inclusion criteria. Results The prevalence and baseline characteristics of undiagnosed Stage 3 CKD appear in Table 1. In all 4 countries, the undiagnosed prevalence was &amp;gt;80% and predominantly was more commonly observed in female patients, in patients aged &amp;gt; 65y, and remained high in patients with baseline comorbidities, particularly for those at highest risk of CKD (DM, CVD, HTN). Underreporting of CKD diagnosis in Brazil may be due to the inability to code for &amp;gt;1 condition in a patient. Conclusion These results indicate that a large proportion of patients across four world regions and who have biochemical evidence of early CKD lack a recorded diagnosis. An opportunity exists to identify, diagnose, and implement guideline-directed management for early CKD in order to delay its complications and improve clinical outcomes.

#4795 PEAK SYSTOLIC VELOCITY IN THE KIDNEY INTERLOBAR ARTERIES AS A POSSIBLE SCREENING MARKER OF CKD IN PREGNANT WOMEN

Abstract Background and Aims Currently, pregnancy is increasingly occurring in patients with CKD including patients with chronic renal failure (CRF) - CKD grade 3-5. Physiological renal hyperperfusion and glomerular hyperfiltration in pregnant women leads to a temporary decrease in serum creatinine values even in patients with CRF. Consequently, the CKD diagnosis during pregnancy may be difficult in women without a history of kidney disease, and the degree of kidney damage may be underestimated [1]. The aim of our study was to estimate Doppler sonography of the renal arteries as a possible CKD screening method in pregnant women. Method The study included 283 pregnant women (Table 1). Doppler sonography was performed in the main renal, segmental, interlobar and interlobular arteries in left and right kidney at the first, second and third trimesters of pregnancy. Peak systolic velocity (PSV), end-diastolic velocity, pulse index, resistive index and systolic-diastolic ratio were analyzed. Results PSV in the renal arteries was significantly lower in pregnant women with CKD 3-5 compared with healthy control group since 22 weeks of pregnancy. However, PSV in the interlobar arteries had a higher diagnostic value. The values of this parameter were significantly lower in pregnant women with all stages CKD compared with healthy control group. We found cut-off points of left and right interlobar arteries PSV for the diagnosis of CKD and CRF at the first, second and third trimesters of pregnancy and cut-off points of right and left interlobar arteries PSV linear combination at the second and third trimesters (Table 2). Conclusion In pregnant women, interlobar renal arteries PSV can be used as screening marker of CKD. Additionally, it allows to identify pregnant women with advanced stages of CKD. The linear combination of right and left interlobar arteries PSV has the greatest diagnostic value.

#4901 THE EFFECT OF CHRONIC KIDNEY DISEASE IN CONTRAST-ENHANCED ULTRASONOGRAPHY WITH ARRIVAL TIME PARAMETRIC IMAGING

Abstract Background and Aims CEUS is a reliable method to diagnose ischemic renal pathologies such as infarction, identify renal abscesses, discriminate between renal tumors and anatomical variants, describe complex cyst lesions, and monitor non-surgical renal lesions. Few studies explore the relationship between CEUS and the diagnosis or progression of CKD. The aim of this study was to evaluate the relationship between contrast-enhanced ultrasonography with arrival time parametric imaging (CEUS-PAT) and CKD. Method We prospectively evaluated 64 subjects (37 liver cirrhosis patients and 27 healthy volunteers) using CEUS-PAT to detect if the presence of CKD influences the arrival time of the contrast in the kidney. CKD was defined according to KDIGO 2021 guidelines. Ultrasonography was performed using the LOGIQ E9 (GE Healthcare, Chalfont St.Giles-UK) system, probe C1-6. CEUS was performed on each subject using SonoVue (Bracco SpA, Milan, Italy) as a contrast agent (1/2 of a vial). A 2.5 mL contrast substance followed by a 5 mL normal saline solution was infused in the cubital vein. A ratio between the arrival time of the substance in the kidney and liver was calculated. Subjects were in fasting conditions for at least 12 h. Laboratory data were extracted from the patient's GP file. The study was conducted between January -December 2018. All patients provided their informed consent for the procedures. Results The study included 64 subjects, mean age of 58.98 ± 8.90 years, predominantly male gender (56.3%). Of the 64 patients, 13 (20.3%) had chronic kidney disease. All patients with chronic kidney disease had liver cirrhosis. When comparing the two groups, with and without CKD, there was a significant difference between the ratio of the arrival time of the contrast agent into the kidney and liver, 0.85 ± 0.09 vs 0.65 ± 0.19, p = 0.0005. The factors associated with kidney disease were liver steatosis (p&amp;lt;0.0001), age over 60 years (p = 0.01) and low albumin (p&amp;lt;0.0001). Conclusion Our study indicated that the presence of CKD influences the contrast agent arrival time in the kidney. Further studies are needed to establish the predictive significance of CEUS-PAT data in CKD patients.

#4529 PACE-CKD: FINANCIAL BURDEN AND WORK PRODUCTIVITY OF PATIENTS WITH CKD AND CAREGIVERS: RESULTS FROM A US SURVEY

Abstract Background and Aims Chronic kidney disease (CKD) is a progressive condition, conferring serious mortality and morbidity in patients with advanced disease. Upon reaching end-stage kidney disease (ESKD), dialysis or kidney transplantation is typically required, leading to considerable burden to health care systems worldwide. There is a paucity of data assessing the financial wellbeing and work productivity of patients with CKD and their caregivers, compared to the general population. Therefore, the objective of this study was to conduct a quantitative online survey to estimate the financial burden and work productivity of patients with CKD and their caregivers relative to the general population. Method This non-interventional survey included adult patients with a diagnosis of CKD for at least 3 months and unpaid caregivers of CKD patients for a minimum of 1 hour per week in the previous 4 weeks. ESKD was defined by patients with CKD stage 5 or patients undergoing kidney transplantation or dialysis. Patients and caregivers were matched by key demographic characteristics (e.g. age, gender and area of residence) to respective general population cohorts. Patients and caregivers were assessed using the Consumer Financial Protection Bureau (CFPB) general financial well-being scale (scores from 0 to 100) and financial burden was assessed using the FACIT-COST score (5 point Likert type scale). Work productivity was assessed using the Work Productivity and Activity Impairment (WPAI) questionnaire (WPAI:GH for patients, adjusted WPAI-CG ADAPTED for caregivers). Results The study enrolled 199 patients (median age: 58 years) with CKD and 113 caregivers (median age: 38 years) in the United States. Candidates were enrolled between June and July 2022. In the patient cohort, 32.2% of participants were dialysis-dependent, who predominately received treatment in a clinic or hospital (79.7%) rather than at home. Caregivers most commonly cared for their parent (45.1%) or partner (25.7%); the most frequent role for caregivers was providing transport to/from medical appointments (89.4%). Patients were considered to have 17.8% worse financial wellbeing compared to the general population according to the CFPB scale (52.0 vs 63.2, respectively). Caregivers reported slightly lower financial wellbeing than the general population (55.8 vs 56.4, respectively). Patients receiving dialysis experienced a similar financial burden to non-dialysis dependent patients, with slightly worse FACIT-COST scores (22.9 vs 23.4, respectively). Further, patients and caregivers reported losses to work productivity with dialysis patients (21.6%) reporting higher absenteeism from work than non-dialysis patients (9.6%) when compared to the general population (3.6%). Similarly, carers of dialysis-dependent patients reported a higher rate of absenteeism (14.8%) compared to carers of non-dialysis dependent patients (10.6%) and the general population (5.2%). Total activity impairment was higher for dialysis dependent patients (55.5%) than for non-dialysis dependent patients (43.7%) and considerably higher versus the general population (5.7%). Caregivers for dialysis dependent patients had greater total activity impairment (44.3%) than caregivers for non-dialysis dependent patients (34.3%) and the general population (17.3%). Results for patients and caregivers in other countries (United Kingdom, Germany, and Mexico) will also be presented at the congress. Conclusion The results of this survey suggest that work productivity is impaired in both CKD patients and their caregivers and is also exacerbated further in patients who progress to dialysis and their caregivers. The survey also provides indications that the financial wellbeing in patients with CKD may be affected in comparison to the general population. Evidence based policy interventions ought to consider the progressive nature of CKD and should aim to reduce the societal burden of disease for patients and carers. Funding This study was supported by AstraZeneca.

#4762 PREGNANCY-RELATED ACUTE KIDNEY INJURY: 10-YEAR SERIES OF A NEPHRO-OBSTETRIC CLINIC

Abstract Background and Aims Pregnancy-related acute kidney injury (P-AKI) is a rare complication of pregnancy associated with significant maternal and fetal morbidity and mortality. Its incidence has progressively decreased worldwide with the improvement of obstetric care, but recently some developed countries have noticed an increase in its incidence. Adjusted definition of AKI in pregnancy is lacking, making its incidence difficult to ascertain. Herein, the authors retrospectively evaluated the causes and outcomes of P-AKI patients surveilled by the nephro-obstetric clinical team. Method Retrospective analysis of maternal, obstetric and perinatal outcomes of P-AKI patients, that were followed by the Nephro-obstetric clinical team between 2011 and 2022. Results We evaluated 29 patients, with mean age of 32 ± 6 years [17 – 42], 19 Caucasian and 9 Black, 17 nulliparous, 16 hypertensive, 7 diabetic, 1 with HIV, and 1 with systemic lupus erythematosus. Only 12 patients had CKD and 3 were renal transplant patients. In 2/29 patients P-AKI occurred before 20 weeks [15-17] due to obstructive uropathy and pregnancy hyperfiltration in a CKD G3 patient. After 20 weeks of gestation, P-AKI occurred in 27/29 patients (mean 32 weeks; range 21-41weeks), with mean SCr of 3,1 mg/dl [1,8-4,5] in previously CKD patients and mean SCr of 2.4mg/dl (1,2-58mg/dl) in the patients with normal renal function. Regarding the severity of P-AKI, 16/7/6 patients developed AKI stage 1/2/3 (KDIGO), respectively. Causes of P-AKI after 20 weeks in patients with normal renal function were preeclampsia (PE; 8/14), HELLP syndrome (1/14), hemolytic uremic syndrome (1/14), sepsis (3/14), renal obstruction (1/14), severe hypercalcemia (1/14), cortical necrosis due to hemorrhagic shock (2/14), hypovolemia and nephrotoxic agents (1/14). All patients had full renal recovery. In renal transplant patient P-AKI was related to PE (2/3), sepsis (1/3) and probable calcineurin inhibitor toxicity (1/3). Regarding CKD patients, P-AKI was caused by PE (6/10), hyperfiltration of pregnancy (3/10) and allergic interstitial nephritis (1/10). The need for renal replacement therapy occurred in 7/29, and only 2/7 became dialysis dependent (both with previous CKD diagnosis). De novo or worsening proteinuria occurred in 15/29 (3975 g/day; 431-14000 g/day) and 10/29 patients (mean 6227 mg/day; 681-14937 mg/day), respectively. Regarding fetal outcomes, there were 2 stillbirths, mean gestation duration was 33 weeks (25-41weeks), mean birth weight 1947 g (550-3950 g) and mean Apgar 1/5/10 was 8/9/10, respectively. Cesarean was performed in 19/27 patients and 7 newborns were admitted to the neonate care unit due to prematurity. Conclusion In a tertiary referral center, P-AKI was associated to a wide range of causes, frequently required a multidisciplinary approach and was associated to significant worse maternal, obstetric and perinatal outcomes.

#2977 PROGRESSION AND REGRESSION OF CHRONIC KIDNEY DISEASE IN THE UNITED STATES USING ELECTRONIC MEDICAL RECORDS

Abstract Background and Aims Chronic kidney disease (CKD) is generally considered to be progressive and may lead to end-stage kidney disease (ESKD), or death. We aim to analyze a large US database and capture CKD progression, regression, ESKD and death over a 5-year follow-up, in a real-world setting. Method A retrospective cohort study was conducted using data from IBM® Explorys electronic medical records (&amp;gt;53 million patients) from 1 Jan 2010 to 31 Dec 2019. We created two main cohorts of patients with CKD: Cohort 1 and Cohort 2. Cohort 1 was based on diagnostic codes only (ICD 9/10, n = 810,987 unique patients), and Cohort 2 on KDIGO screening and staging criteria only (eGFR, UACR/UPCR values, n = 953,396). Within these cohorts, we created individual sub-cohorts for each CKD stage (1-5), though patient categorization was not mutually exclusive (one patient could contribute to multiple main and sub-cohorts). Patients in Cohort 1 were required to have an ICD code specific to a stage, and patients in Cohort 2 were required to have two consecutive laboratory test results within 3–18 months to determine KDIGO CKD stage. Index date was the date of diagnosis or second abnormal test with at least 12 months lookback period. Progression and regression were assessed for Cohort 1 using change in ICD codes and for Cohort 2, two test results (3-18 months apart) were required with a change in KDIGO eGFR stage and at least one of the values showing an increase or decrease by ≥25% in eGFR from baseline. We performed individual follow-up for progression and regression from each CKD stage to a progression or a regression event, death, loss to follow-up, or maximum 5 years, whichever came first. For ESKD, we followed up from each CKD stage to ESKD, death, loss to follow-up, or maximum 5 years. For death, we followed up from each CKD stage to death, loss to follow-up, or a maximum of 5 years. Results Most patients in Cohort 1 (ICD) and 2 (KDIGO) had stage 3 CKD at index. Mean age was 70y in Cohort 1 and 71y in Cohort 2, with 49% and 40% males, respectively. Both cohorts were predominantly Caucasian. The prevalence of cardiovascular diseases increased with CKD stage. The proportion of patients from Cohort 2 who had at least one CKD diagnosis increased from 34% in stage 1 to 86% and 83% in stage 4 and 5, respectively. CKD regression, ESKD and death increased progressively from stage 1–5 in both cohorts, except for stage 5 in Cohort 2. Progression in Cohort 1 decreased with stage and was variable in Cohort 2. The proportion of patients experiencing at least one event corresponding to CKD regression, progression, and ESKD was higher at all stages in Cohort 1 vs. Cohort 2, particularly ESKD which was markedly higher for stage 5 (91.4% vs. 13.6%). Proportion of death was similar in both cohorts and was the highest in stages 4–5. Conclusion Substantial differences in kidney outcomes were noted between CKD classifications derived from ICD codes vs. KDIGO criteria, except all-cause mortality which was comparable across both cohorts and increased notably with stage. Changes in kidney function, both progression, regression, and ESKD occurred more frequently in Cohort 1. Our analysis suggests ICD diagnosis and KDIGO criteria might not be used interchangeably in the context of utilizing real-world data sources.

#3610 EPIDEMIOLOGY AND CLINICAL CORRELATES OF POST-AKI PROTEINURIA IN CHINESE HOSPITALIZED ADULTS

Abstract Background and Aims Acute kidney injury (AKI) has been associated with increased risks of new-onset and worsening proteinuria. However, the epidemiologic data of post-AKI proteinuria was still lacking. This study aimed to determine the incidence, risk factors and clinical correlations of post-AKI proteinuria among hospitalized patients. Method This study conducted a multicenter cohort from Chinese Renal disease Data System (CRDS), including patients aged 18–100 years with hospital-acquired AKI (HA-AKI) hospitalized at 19 medical centers throughout China. AKI was defined according to the Kidney Disease Improving Global Outcomes (KDIGO) creatine criteria. The results of both quantitative and qualitative urinary protein tests were used to determine post-AKI proteinuria. The primary outcome was the incidence of post-AKI proteinuria. Secondary outcomes included AKI recovery and kidney disease progression. Cox proportional hazard model with stepwise regression was used to determine the risk factors for post-AKI proteinuria. The associations of post-AKI proteinuria with kidney disease progression were analyzed by logistic regression models. Results Of 6,206 HA-AKI patients without proteinuria at baseline, 2,102 (33.9%) had new-onset proteinuria, whereas, of 5,137 HA-AKI with baseline proteinuria, 894 (17.4%) had worsening proteinuria after AKI (Table 1). Higher AKI stage and preexisting CKD diagnosis were risk factors for new-onset proteinuria and worsening proteinuria, whereas treatment with RAS inhibitors was associated with an 11% lower risk of incident proteinuria. About 60% and 75% of patients with post-AKI new-onset and worsening proteinuria, respectively, recovered within 3 months. Worsening proteinuria was associated with a lower incidence of AKI recovery and a higher risk of kidney disease progression (Table 2). Conclusion Post-AKI proteinuria is common and usually transient among hospitalized patients. The risk profiles for new-onset and worsening post-AKI proteinuria differed markedly. Worsening proteinuria after AKI was associated with adverse kidney outcomes, which emphasized the need for close monitoring of proteinuria after AKI.

#5603 HYPERKALAEMIA MAY LIMIT POTENTIAL RENAL INTERVENTIONS IN PATIENTS WITH LOW GFR AND SIGNIFICANT PROTEINURIA

Abstract Background and Aims Evidence-based therapies including ACE inhibitors, ARBs and mineralocorticoid receptor antagonists (MRA) can significantly delay progression of CKD, yet their use is potentially limited by hyperkalaemia risk. In this study, we describe hyperkalaemia events among CKD patients to provide a better understanding of the current unmet need. Method This was a retrospective secondary data analysis from electronic medical records (EMR) in the US TriNetX analytics data CKD subset from Jan 2015-Dec 2019. Patients with ≥1 uACR measure were included, whereby the first date of the uACR measure was considered the index date. The study cohort included patients aged &amp;gt; 18 years with a) two consecutive estimated glomerular filtration rate (eGFR) values between 20 and 90 mL/min/1.73m2 recorded 91–730 days apart prior to the index date, or, b) at least one CKD diagnosis code before the index date. Patient demographics, ACE/ARB, MRA and SGLT2i treatments on index were described. The frequency of HK (defined as serum potassium &amp;gt;5.5 mmol/L or a diagnosis code) during a 1-year baseline period and 1-year follow-up period was described by uACR (&amp;gt;700mg/g, 300–700mg/g, &amp;lt;300mg/g) and eGFR (&amp;lt;20mL/min/1.73m2, 20–45mL/min/1.73m2, 45–60mL/min/1.73m2, 60–90mL/min/1.73m2 and &amp;gt;90mL/min/1.73m2) categories. Results Baseline characteristics of the included patients are described in the table below. During the 1-year follow-up period, HK events were more frequently recorded for patients with uACR&amp;gt;700mg/g (15.3%), eGFR&amp;lt;60ml/min/1.73m2 (9.3%) and combined uACR&amp;gt;700mg/g and eGFR&amp;lt;60ml/min/&amp;lt;1.73m2 (18.3%). Conclusion The preliminary results of this analysis shows that HK occurs more frequently among patients with low eGFR and/or high uACR. Despite guidelines, uACR testing is not done frequently in clinical practice and likely performed more frequently among patients with high uACR. Further analyses and more conservative study definitions will be applied to more comprehensively clarify the unmet need among patients at risk of HK. Of particular interest are the patients who discontinued RAASi treatment after a hyperkalemia event during baseline and were not on renoprotective treatment, yet who had recurrent hyperkalemia. Adequate treatment options for these patients are currently limited, and there is a need for more renoprotective treatments with limited hyperkalemia risk.

An explainable deep learning model for prediction of early‐stage chronic kidney disease

AbstractChronic kidney disease (CKD) is a major public health concern with rising prevalence and huge costs associated with dialysis and transplantation. Early prediction of CKD can reduce the patient's risk of CKD progression to end‐stage kidney failure. Artificial intelligence offers more intelligent and expert healthcare services in disease diagnosis. In this work, a deep learning model is built using deep neural networks (DNN) with an adaptive moment estimation optimization function to predict early‐stage CKD. The health care applications require interpretability over the predictions of the black‐box model to build conviction towards the model's prediction. Hence, the predictions of the DNN‐CKD model are explained by the local interpretable model‐agnostic explainer (LIME). The diagnostic patient data is trained on five layered DNN with three hidden layers. Over the unseen data, the DNN‐CKD model yields an accuracy of 98.75% and a roc_auc score of 98.86% in detecting CKD risk. The explanation revealed by the LIME algorithm echoes the influence of each feature on the prediction made by the DNN‐CKD model over the given CKD data. With its interpretability and accuracy, the proposed system may effectively help medical experts in the early diagnosis of CKD.

Screening of immune-related secretory proteins linking chronic kidney disease with calcific aortic valve disease based on comprehensive bioinformatics analysis and machine learning

BackgroundChronic kidney disease (CKD) is one of the most significant cardiovascular risk factors, playing vital roles in various cardiovascular diseases such as calcific aortic valve disease (CAVD). We aim to explore the CKD-associated genes potentially involving CAVD pathogenesis, and to discover candidate biomarkers for the diagnosis of CKD with CAVD.MethodsThree CAVD, one CKD-PBMC and one CKD-Kidney datasets of expression profiles were obtained from the GEO database. Firstly, to detect CAVD key genes and CKD-associated secretory proteins, differentially expressed analysis and WGCNA were carried out. Protein-protein interaction (PPI), functional enrichment and cMAP analyses were employed to reveal CKD-related pathogenic genes and underlying mechanisms in CKD-related CAVD as well as the potential drugs for CAVD treatment. Then, machine learning algorithms including LASSO regression and random forest were adopted for screening candidate biomarkers and constructing diagnostic nomogram for predicting CKD-related CAVD. Moreover, ROC curve, calibration curve and decision curve analyses were applied to evaluate the diagnostic performance of nomogram. Finally, the CIBERSORT algorithm was used to explore immune cell infiltration in CAVD.ResultsThe integrated CAVD dataset identified 124 CAVD key genes by intersecting differential expression and WGCNA analyses. Totally 983 CKD-associated secretory proteins were screened by differential expression analysis of CKD-PBMC/Kidney datasets. PPI analysis identified two key modules containing 76 nodes, regarded as CKD-related pathogenic genes in CAVD, which were mostly enriched in inflammatory and immune regulation by enrichment analysis. The cMAP analysis exposed metyrapone as a more potential drug for CAVD treatment. 17 genes were overlapped between CAVD key genes and CKD-associated secretory proteins, and two hub genes were chosen as candidate biomarkers for developing nomogram with ideal diagnostic performance through machine learning. Furthermore, SLPI/MMP9 expression patterns were confirmed in our external cohort and the nomogram could serve as novel diagnosis models for distinguishing CAVD. Finally, immune cell infiltration results uncovered immune dysregulation in CAVD, and SLPI/MMP9 were significantly associated with invasive immune cells.ConclusionsWe revealed the inflammatory-immune pathways underlying CKD-related CAVD, and developed SLPI/MMP9-based CAVD diagnostic nomogram, which offered novel insights into future serum-based diagnosis and therapeutic intervention of CKD with CAVD.

Evaluation of Causes of Recurrent Hospitalization in Diabetic Chronic Kidney Disease

Background: Recurrent hospitalization in patients with diabetic renal failure increases health care related expenditure and reduces performance status. Therefore, a knowledge of such causes and prompt management could potentially reducing hospitalization burden and health expenditure. Objective: To determine the various causes of recurrent hospitalization in individuals with diabetic chronic kidney disease. Methodology: Patients diagnosed with diabetic renal failure were enrolled from the department of nephrology, Khyber Teaching Hospital during the period July 2022 to June 2023. Chronic kidney disease was confirmed as per KDIGO recommendations including eGFR &lt;40ml/min, reduction of kidney size and renal cortical echogenicity on ultrasound and renal biopsy findings consistent with diabetic nephropathy. Causes of hospitalization included urinary tract infection, anemia, ascites, gastritis and pneumonia. Results: A total of 192 patients were registered for evaluation. The age of the patient ranged from 40 to 80 years. The mean age of the patients was 54.304 ± 12.097 years. The mean duration of diabetes was 13.298 ± 3.650 years while the mean duration for CKD diagnosis was 4.16 ± 0.989 years. Urinary tract infection was the most common cause of recurrent hospitalization recorded in 84 patients (43.7%) followed by anemia (n = 57, 29.7%), ascites (n = 29, 15.1%), pneumonia (n = 13, 6.8%) and gastritis (n = 09, 4.7%) respectively. Conclusion: Infections are the most common cause of recurrent hospitalization in diabetic CKD patients. Male patients taking oral medications for diabetes are more prone to infections and recurrent hospitalization. Keywords: Chronic Kidney Disease, Diabetes Mellitus, Recurrent Hospitalization

Epidemiology and outcomes of post-AKI proteinuria.

Acute kidney injury (AKI) has been associated with increased risks of new-onset and worsening proteinuria. However, epidemiologic data for post-AKI proteinuria was still lacking. This study aimed to determine the incidence, risk factors and clinical correlations of post-AKI proteinuria among hospitalized patients. This study was conducted in a multicenter cohort including patients aged 18-100 years with hospital-acquired AKI (HA-AKI) hospitalized at 19 medical centers throughout China. The primary outcome was the incidence of post-AKI proteinuria. Secondary outcomes included AKI recovery and kidney disease progression. The results of both quantitative and qualitative urinary protein tests were used to define post-AKI proteinuria. Cox proportional hazard model with stepwise regression was used to determine the risk factors for post-AKI proteinuria. Of 6206 HA-AKI patients without proteinuria at baseline, 2102 (33.9%) had new-onset proteinuria, whereas of 5137 HA-AKI with baseline proteinuria, 894 (17.4%) had worsening proteinuria after AKI. Higher AKI stage and preexisting CKD diagnosis were risk factors for new-onset proteinuria and worsening proteinuria, whereas treatment with renin-angiotensin system inhibitors was associated with an 11% lower risk of incident proteinuria. About 60% and 75% of patients with post-AKI new-onset and worsening proteinuria, respectively, recovered within 3 months. Worsening proteinuria was associated with a lower incidence of AKI recovery and a higher risk of kidney disease progression. Post-AKI proteinuria is common and usually transient among hospitalized patients. The risk profiles for new-onset and worsening post-AKI proteinuria differed markedly. Worsening proteinuria after AKI was associated with adverse kidney outcomes, which emphasized the need for close monitoring of proteinuria after AKI.

Symptoms for early diagnosis of chronic kidney disease in children - a machine learning-based score.

In conclusion, a dozen symptoms that are easy to be clinically verified emerged as risk indicators for chronic kidney disease. This information can contribute to increasing awareness of the diagnosis, mainly in primary care settings. Therefore, healthcare professionals can select patients for more detailed investigation, which will reduce the chance of wasting time and improve early disease detection. •Late diagnosis of chronic kidney disease in children is common, increasing morbidity. •Mass screening of the whole population is not cost-effective. •With two machine-learning methods, this study revealed 12 symptoms to aid early CKD diagnosis. •These symptoms are easily obtainable and can be useful mainly in primary care settings.

Contemporary use of cardiovascular risk reduction strategies in type 2 diabetes. Insights from the diabetes collaborative registry

Cardiovascular disease remains the primary source of morbidity and mortality in type 2 diabetes (T2D). We characterized the change over time in the use of evidence-based therapies to reduce cardiovascular risk in US patients with T2D. Data from a longitudinal outpatient diabetes registry were used to calculate the prescription of SGLT2i or GLP-1RA over time and among those with high-risk comorbidities (atherosclerotic cardiovascular disease [ASCVD], heart failure [HF], chronic kidney disease [CKD]) and a diabetes cardiovascular composite score (DCCS; calculated as: #eligible medications prescribed/#eligible medications x 100 for SGLT2i, GLP-1RA, statin, antiplatelet/anticoagulant therapy, ACEi/ARB/ARNI). Scores ranged from 0% to 100% (higher=more optimal care). Among 1,001,542 outpatients from 391 US sites, 51.7% patients had ASVCD, 17.7% HF, and 23.0% CKD. The percentage of patients prescribed an SGLT2i or GLP-1RA increased over time (7.3% in 2013 to 28.8% in 2019), and 18.3% of patients with ASCVD, HF, or CKD were on at least one of these medications at last follow-up vs 25.5% of patients without any of these comorbidities. Mean DCCS was 54±36%; 54±25% in patients with ASCVD, HF, or CKD vs 52±50% in patients without any of these comorbidities (P<0.001 for both). In a hierarchical linear model, male sex, and a diagnosis of CKD were independently associated with higher DCCS whereas a diagnosis of HF or ASCVD was associated with a lower DCCS. In a large, contemporary cohort of patients with T2D, we found improvement in the use of SGLT2i and GLP-1RA but unexpectedly lower use in patients with ASCVD, heart failure, and CKD, highlighting a treatment-risk paradox. Further education is needed to shift the understanding of these medications as tools for glucose-lowering to cardiovascular risk reduction and to improve their implementation in clinical practice.

Design and analysis of a novel hybrid approach for the prediction and diagnosis of CKD by using deep learning and Data mining

Design and analysis of a novel hybrid approach for the prediction and diagnosis of CKD by using deep learning and Data mining

A Metabolomics study of metabolites associated with the glomerular filtration rate

BackgroundChronic kidney disease (CKD) is a global public health issue. The diagnosis of CKD would be considerably enhanced by discovering novel biomarkers used to determine the glomerular filtration rate (GFR). Small molecule metabolites related to kidney filtration function that might be utilized as biomarkers to measure GFR more accurately could be found via a metabolomics analysis of blood samples taken from individuals with varied glomerular filtration rates.MethodsAn untargeted metabolomics study of 145 plasma samples was performed using ultrahigh-performance liquid chromatography tandem mass spectrometry (UPLC–MS/MS). The 145 samples were divided into four groups based on the patient’s measured glomerular filtration rates (mGFRs) determined by the iohexol plasma clearance rate. The data were analyzed using random forest analyses and six other unique statistical analyses. Principal component analysis (PCA) was conducted using R software.ResultsA large number of metabolites involved in various metabolic pathways changed significantly between groups with different GFRs. These included metabolites involved in tryptophan or pyrimidine metabolism. The top 30 metabolites that best distinguished between the four groups in a random forest plot analysis included 13 amino acids, 9 nucleotides, and 3 carbohydrates. A panel of metabolites (including hydroxyaparagine, pseudouridine, C-glycosyltryptophan, erythronate, N-acetylalanine, and 7-methylguanidine) for estimating GFR was selected for future testing in targeted analyses by combining the candidate lists with the six other statistical analyses. Both hydroxyasparagine and N,N-dimethyl-proline-proline are unique biomarkers shown to be inversely associated with kidney function that have not been reported previously. In contrast, 1,5-anhydroglucitol (1,5-AG) decreases with impaired renal function.ConclusionsThis global untargeted metabolomics study of plasma samples from patients with different degrees of renal function identified potential metabolite biomarkers related to kidney filtration. These novel potential metabolites provide more insight into the underlying pathophysiologic processes that may contribute to the progression of CKD, lead to improvements in the estimation of GFR and provide potential therapeutic targets to improve kidney function.