Distribution Of Chronic Kidney Disease Research Articles

Temporal trends in prevalence and disability of chronic kidney disease caused by specific etiologies: an analysis of the Global Burden of Disease Study 2019.

The prevalence of disability in CKD is high. In this context the aim of the present study wasto assess the temporal trends of prevalence and disability progression for chronic kidney disease (CKD) caused by specific etiologies. Using data from the Global Burden of Diseases Study (GBD) 2019, we examined the age-standardized rates of CKD prevalence and disability-adjusted life-years for different etiologies, including Type 1/2 diabetes mellitus (T1DM/T2DM), glomerulonephritis, and hypertension. We also calculated the average annual percentage changes to assess trends. Additionally, we utilized the joinpoint regression model to identify significant shifts over time. From 1990 to 2019, the global prevalence of CKD due to various etiologies exhibited an overall increasing trend, albeit with fluctuations. Notably, CKD due to T1DM, glomerulonephritis, and hypertension consistently demonstrated a significant upward trend across all continents, while the prevalence of CKD due to T2DM varied across continents. In terms of disability-adjusted life-years, CKD due to T2DM and hypertension exhibited a significant rising trend over the past 30 years. However, changes in age standardized disability-adjusted life-years for CKD due to different etiologies were not consistent across continents, with an upward trend observed in The Americasand a contrasting trend in Asia. Furthermore, both age-standardized prevalence rate and age standardized disability-adjusted life-year trends for CKD varied significantly across 204 countries and territories. Additionally, a negative association was observed between the Socio-demographic Index and the disability progression of CKD. The prevalence and disability burden of CKD caused by specific etiologies show substantial heterogeneity worldwide, highlighting significant disparities in the distribution of CKD. It is crucial to implement geographic and personalized strategies in different regions to alleviate the burden of CKD effectively.

#5309 MODELLING LONG-TERM OUTCOMES FOR PATIENTS WITH IMMUNOGLOBULIN A NEPHROPATHY (IGAN) FROM SHORT-TERM PROTEINURIA DATA

Abstract Background and Aims Immunoglobulin A nephropathy (IgAN) is rare kidney disease that leads to glomerular injury, progressive loss of kidney function and progression to kidney failure. Pre-specified interim proteinuria data from ongoing clinical trials is being used as the basis of regulatory approval of new therapies but little is known about the translation of these results to long-term patient outcomes; a topic of particular interest to heath technology assessment (HTA) groups looking to inform decisions on reimbursement before final renal outcome data are available. The objective of this study was to model long-term outcomes for patients with IgAN based on short-term proteinuria data. Method We developed a de novo model including a short-term (36-week) decision tree and a long-term Markov model to capture expected lifetime outcomes associated with treatment for IgAN. We used achievement of proteinuria <1 g/day as a clinically relevant treatment target. The short-term model included data on proteinuria level and distribution of chronic kidney disease (CKD) health states (CKD 1/2, 3, 4, and 5). At the end of 36 weeks of treatment, patients were categorized into groups based on their proteinuria level (<1g/day and ≥1 g/day) and CKD stage before transitioning to the long-term Markov model. In the long-term model, proteinuria level-based, CKD health state transition matrices derived from analysis of UK National Registry of Rare Kidney Disease (RaDaR) data, and transition matrices to dialysis and transplant derived from the US Renal Data System (USRDS) were used. Other included clinical inputs of complications and mortality were derived from extension of US Optum data analyses and literature. Health-related quality of life (HRQoL) was assessed as health state utilities and disutility associated with complications. Hypothetic scenarios of improvement in short-term proteinuria and impact on long term outcomes were tested. Model outputs included life years (LYs) and quality-adjusted life years (QALYs). Effectiveness was discounted at 3% annually. Deterministic sensitivity analysis was conducted. Results Over a lifetime, patients receiving treatment that increased the probability of achieving proteinuria <1 g/day by 10% in the short-term, were modelled to have gained an additional 0.388 LYs from reduced CKD/transplant/dialysis-related mortality and 0.633 QALYs from delaying CKD progression to kidney failure. As expected, results improved when the probability of achieving proteinuria <1 g/day increased; with a 30% increase in the probability of achieving proteinuria <1 g/day, LYs gained were 0.562 (Figure 1) and QALYs 0.968 (Figure 2). Results were most sensitive to time horizon and long-term extrapolation of CKD health state transition matrices. Conclusion Despite challenges inherent in the translation of surrogate endpoints to long-term outcomes, combining short-term proteinuria from clinical trials and long-term CKD data from real-world registry and claims-based data provides a solution. Based on modelling, treatments that increase the probability of achieving <1 g/day in the short-term, are expected to provide benefits to patients with IgAN in the long-term including less time with advanced kidney disease, less time on dialysis and avoiding the need for kidney transplant resulting in improved survival, and better quality of life. Refinement and customization of country-specific model inputs will help ensure outputs are relevant for different jurisdictions and as representative of anticipated real-world outcomes as possible.

Prevalence of chronic kidney disease and its association with lifestyle factors in adults from 10 regions of China

Objective: To investigate the distribution of chronic kidney disease (CKD) in participants from the China Kadoorie Biobank (CKB) study and evaluate the association between lifestyle risk factors and CKD. Methods: Based on the baseline survey data and follow-up data (as of December 31, 2018) of the CKB study, the differences in CKD cases' area and population distributions were described. Cox proportional hazards regression model was used to estimate the association between lifestyle risk factors and the risk of CKD. Results: A total of 505 147 participants, 4 920 cases of CKD were recorded in 11.26 year follow up with a incidence rate of 83.43/100 000 person-years. Glomerulonephropathy was the most common type. The incidence of CKD was higher in the urban area, men, and the elderly aged 60 years and above (87.83/100 000 person-years, 86.37/100 000 person-years, and 132.06/100 000 person-years). Current male smokers had an increased risk for CKD compared with non-smokers or occasional smokers (HR=1.18, 95%CI: 1.05-1.31). The non-obese population was used as a control group, both general obesity determined by BMI (HR=1.19, 95%CI: 1.10-1.29) and central obesity determined by waist circumference (HR=1.27, 95%CI: 1.19-1.35) were associated with higher risk for CKD. Conclusion: The risks for CKD varied with area and population in the CKB cohort study, and the risk was influenced by multiple lifestyle factors.

Chronic kidney disease in nonalcoholic fatty liver disease at primary healthcare centers in Korea.

The prevalence rates of nonalcoholic fatty liver disease (NAFLD) and chronic kidney disease (CKD) are expected to increase with the rising trends in diabetes and obesity associated with aging populations. Considering the impacts of coexistent NAFLD and CKD on morbidity and mortality rates, screening strategies for groups at high-risk of CKD are needed in community-dwelling individuals with NAFLD. The aims of this study were to determine the prevalence and distribution of CKD in NAFLD, as well as the risk factors for CKD and the correlation with liver fibrosis in asymptomatic individuals with NAFLD at primary healthcare centers in Korea. This retrospective cross-sectional study used data from 13 health-promotion centers in 10 Korean cities. Liver steatosis and stiffness were assessed using ultrasonography and magnetic resonance elastography (MRE), respectively. CKD was defined as an estimated glomerular filtration rate of <60 mL/min/1.73m2, and urine albumin-to-creatinine ratio or proteinuria. CKD was categorized into four stages: no CKD, mild, moderate, and severe. Comparisons according to the CKD stages in NAFLD were performed using Student's t-test or the chi-square test. Multivariable logistic regression analyses were performed to identify the risk factors for CKD and the correlation with liver fibrosis in NAFLD. The prevalence of CKD was 12.4% in NAFLD. Albuminuria (16.2%) and proteinuria (8.0%) were more prevalent in NAFLD. NAFLD (odd ratio = 1.27, 95% CI = 1.09-1.48, P = 0.003) was independently associated with CKD of at least mild stage. However, there was no significant association between CKD of at least moderate stage and NAFLD after adjusting for age and a metabolically unhealthy status. CKD was associated with significant liver fibrosis as measured by MRE in NAFLD. The presence of NAFLD and liver fibrosis were independent risk factors for CKD, but NAFLD was not an independent risk factor for the later stages of CKD.

Clinical risk assessment of chronic kidney disease patients using genetic programming

Chronic kidney disease (CKD) is one of the serious health concerns in the twenty-first century. CKD impacts over 37 million Americans. By applying machine learning (ML) techniques to clinical data, CKD can be diagnosed early. This early detection of CKD can prevent numerous loss of life. In this work, clinical data set of 400 patients, available on the UCI repository, are taken. Unfortunately, this data set doesn’t have an equal distribution of CKD and Non-CKD samples. This imbalanced nature of data highly influences the learning capabilities of classifiers. Genetic Programming (GP) is an ML technique based on the evolution of species. GP with standard fitness function, also impacted by this imbalanced nature of data. A new Euclidean distance-based fitness function in GP is proposed to handle this imbalanced nature of the data set. To compare the robustness of the proposed work, other classification techniques, K-nearest neighborhood (KNN), KNN with particle swarm optimization (PSO), and GP with the standard fitness function, is also applied. For ten-fold cross-validation, the KNN shows an accuracy of 83.54% with an AUC value of 0.69, the PSO-KNN shows an accuracy of 96.79% with an AUC value of 0.94, and the GP, with the newly proposed fitness function, supersedes KNN and PSO-KNN and shows the accuracy of 99.33% with an AUC value of 0.99.

Preparing Pathology Data for Linkage

IntroductionThe Tasmanian Data Linkage Unit (TDLU) undertook a complex data linkage project in 2019 linking public and private pathology data to five disparate health datasets. Having linked pathology data previously, the unit was aware of the challenges it faced linking a large dataset covering a fourteen-year time span. The aim of this study was to use data-linkage to develop a Tasmanian dataset to quantify the burden and distribution of chronic kidney disease, including identifying barriers to dialysis treatment services.&#x0D; Objectives and ApproachA cohort was selected from public and private providers of pathology services in Tasmania from 2004-2017 to support the establishment of a comprehensive researchable dataset. A linkage plan was developed that included detailed processes for cleaning and de-duplicating the pathology data prior to linkage. The larger private pathology dataset comprised 3.9 million records and data cleaning strategies were implemented. De-duplication created extensive clerical review and methods to reduce this work were devised and implemented as part of the linkage process.&#x0D; ResultsDe-duplication based on exact matches reduced the size of the dataset from 3.9 million to just over 520,000 individuals. Internal linkage of the dataset resulted in approximately 47,000 ‘groups’ eligible for review. Structured Query Language (SQL) queries were constructed and the number of groups eligible for review decreased by 42%. Further analysis was conducted, which resulted in an appropriate ‘cut off’ threshold being determined for clerical review and an estimate of false positive links remaining was calculated.&#x0D; Conclusion / ImplicationsMethods of reducing the amount of manual clerical review can be incorporated into a linkage design when there is a thorough understanding of the characteristics and content of the dataset to be linked. The methods used for this linkage project will be utilised for future projects using pathology data.

Experimental rat model for acute tubular injury induced by high water hardness and high water fluoride: efficacy of primary preventive intervention by distilled water administration

BackgroundHigh water hardness associated with high water fluoride and the geographical distribution of Chronic Kidney Disease of unknown etiology (CKDu) in Sri Lanka are well correlated. We undertook this study to observe the effects of high water hardness with high fluoride on kidney and liver in rats and efficacy of distilled water in reducing the effects.MethodsTest water sample with high water hardness and high fluoride was collected from Mihinthale region and normal water samples were collected from Kandy region. Twenty-four rats were randomly divided into 8 groups and water samples were introduced as follows as daily water supply. Four groups received normal water for 60 (N1) and 90 (N2) days and test water for 60 (T1) and 90 (T2) days. Other four groups received normal (N3) and test (T3) water for 60 days and followed by distilled water for additional 60 days and normal (N4) and test (T4) water for 90 days followed by distilled water for another 90 days. The rats were sacrificed following treatment. Serum samples were subjected to biochemical tests; serum creatinine, urea, aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP) and elemental analysis. Histopathological examinations were carried out using kidney and liver samples.ResultsTest water treated groups were associated with acute tubular injury with loss of brush border and test water followed with distilled water treated groups maintained a better morphology with minimal loss of brush border. Serum creatinine levels in T1 and T2 groups and urea level in T2 group were significantly (p < 0.05) increased compared to control groups. After administration of distilled water, both parameters were significantly reduced in T4 group (p < 0.05) compared to T2. Serum AST activity was increased in T4 group (p < 0.05) compared to control group with no histopathological changes in liver tissues. The serum sodium levels were found to be much higher compared to the other electrolytes in test groups.ConclusionHard water with high fluoride content resulted in acute tubular injury with a significant increase in serum levels of creatinine, urea and AST activity. These alterations were minimized by administering distilled water.

Frequency of Chronic Kidney Disease in Type 2 Diabetic Patients Presenting with Diabetic Foot Ulcer

Background: Recent evidence states that about a quarter of all diabetic patients will experience an ulcer on foot at some point in their lifetime and 15-25% of these will require foot amputation. In the present study, we aimed to evaluate the incidence of chronic kidney disease (CKD) in Type 2 diabetes mellitus (T2DM) patients presenting with Diabetic foot ulcer. Methods: The present study was carried out at Jinnah Postgraduate Medical Center (JPMC), Sindh from February-August 2017. Over 100 Type 2 - DM patients, aged between 35-60 years who presented with diabetic foot ulcer took part in this study. Data was collected and documented in pre-approved pro-forma, subsequently, entered and analyzed via SPSS version 19. Chi-square was applied to test any significant difference between the categories with a p-value of ≤0.05 considered as significant. Results: The mean serum creatinine (mg/dl) value was reported to be 1.17 ± 0.45. Frequency of CKD in Type 2 - DM patients presenting with diabetic foot ulcer was 31%. Male gender was affected more from CKD. Frequency distribution of chronic kidney disease among duration of DM groups 10-15 years = 35.5% and &gt;15 years = 64.5%. The characteristics of HbA1c (g/dl) of study population was 8.34 ± 0.59. Conclusion: Occurrence of CKD in Type 2 - DM patients presenting with diabetic foot ulcer was much higher as compared to national and international studies. Therefore, special attention should be given on regular screening of diabetic patients with a complaint of a foot ulcer.

Linking Pathology Datasets – Trials and Triumphs

Background with rationaleThe burden of chronic kidney disease (CKD) has increased rapidly in Australia over recent years. The financial cost of treating people with end-stage kidney failure by conventional models of dialysis or transplantation represents a substantial healthcare cost and is likely to continue to increase in coming years. Tasmania, the smallest state of Australia and its only island state, has the highest burden of chronic disease nationally, including kidney disease. The aim of this study was to use data-linkage to develop a state-wide dataset to quantify the burden and distribution of CKD, including identifying barriers to dialysis treatment services.&#x0D; Methods/ApproachThe Tasmanian Data Linkage Unit (TDLU) used a complex data linkage design comprising seven disparate datasets representing public and private pathology, public hospital admitted patient and emergency department data, cancer records, dialysis and transplant records and death notifications. A cohort was selected from public and private providers of pathology services in the state to support the establishment of a comprehensive researchable dataset. The datasets spanned the period 2004-2017 and included linkage of both state and national data.&#x0D; ResultsThe study cohort comprised just under 490,000 individuals in the Tasmanian population from the two pathology datasets, with a combined total of 1,347,00 total links made across all datasets. Individual unit records were geocoded according to the Australian Statistical Geographic Standard (2011) with over 92% of the 374,000 unique addresses identified in the public pathology dataset geocoded to address level.&#x0D; ConclusionThe final researchable dataset compiled by the research team following linkage is providing an enormously powerful asset to help answer questions specific to CKD in Tasmania, and that in turn is anticipated to result in greater access to services, improved care and better patient outcomes.

Ca2+ and SO42− interactions with dissolved organic matter: Implications of groundwater quality for CKDu incidence in Sri Lanka

It has recently been proposed that recalcitrant dissolved organic carbon (DOC) in groundwater plays a potent etiological role in the peculiar distribution of chronic kidney disease of unknown etiology (CKDu). This study aims to elucidate the interactions of Ca2+ and SO42− with a model organic fraction of humic acid (SHA) to determine the possible relationship of CKDu incidence with the DOC in drinking water. XPS and FT-IR methods respectively determined the surface functional groups and chemical composition of protonated dissolved organic carbon (HDOC) in a CKDu high-risk zone (HR) of Sri Lanka and in SHA. Higher surface C composition (87.9%) and lower O (11.4%) were observed for HDOC from the HR region than for SHA (C: 73.8%, O: 24.7%). Aromatic C with less O-containing functional groups was observed in HDOC. The IR band at 1170 cm−1 confirms the formation of organic sulfonate (C–SO3-) on SHA. A band at 1213 cm−1 due to organic sulfonate in HDOC from the CKDu HR region was also identified. The IR band at 866 cm−1 evidenced the formation of CaCO3 on SHA above pH 7.4. XPS data confirmed the presence of sulfur oxidation states corresponding to SO32− and SO42− at 168.9 eV and 170.1 eV binding energies, respectively. The binding energies at 347 eV and 351 eV for Ca 2p3/2 and Ca 2p1/2 eV, respectively, confirmed the bidentate complexation of Ca2+ with COO− and sulfonate groups on SHA. The organic sulfonate formed is postulated as a uremic toxicant.

Chronic kidney disease in HIV patients

Chronic kidney disease (CKD) is a health problem in human immunodeficiency virus (HIV) population. Prediction of CKD in HIV patients needsto have done. This study aimis to identify the prevalence of CKD in HIV patients.Thisis a cross-sectional studyofmale and female, age 18-60 years old, diagnosedHIVat Wahidin Sudirohusodo & Hasanuddin University Hospital Makassar. Diagnosed as CKD if estimated glomerular filtration rate (eGFR) <60ml/min/L73m2 and/or microalbuminuria (MA) is found. Total of 86 HIV patients included in the analyses. Distribution of CKD, showed 3 (3.5%) subjects with eGFR<60mL/min/1.73m2. Based on CKD stage, 2 (2.3%) subjects in stage 3a and 1 (1.2%) subjectin stage 4. If all of the subjects were grouped according to MA criteria only, eGFR<60mL/min/1.73m2 only and MA with eGFR<60mL/min/1.73m2, we found 2 (2.3%) subjects with eGFR<60mL/min/1.73m2 & NA, 1 (1.2%) subject with eGFR<60mL/min/1.73m2 & MA, and 32 (37.2%) subjects with eGFR ≥60mL/mm/L73m2 & MA. We concluded that the prevalence of CKD in HIV populations in Makassar is still quite low.

Role of socioeconomic disparities in incidence and mortality of chronic kidney disease

Chronic kidney disease (CKD) is a public health problem known as one of the most important factors for premature death (Coresh et al., 2007; Martins et al., 2012). The disparity in the distribution of CKD is due to the socio-economic factors, gender, ethnicity and race at the global level (Norris and Nissenson, 2008; Norris and Agodoa, 2005). Roles of socio-economic conditions have been recently taken into account as a key factor in the pathway of CKD creation and expansion (Bruce et al., 2009; Nicholas et al., 2015). Several studies worldwide investigated a strong relationship between socioeconomic status and incidence of CKD complications (Crews et al., 2012; Jurkovitz et al., 2012; Saab et al., 2012).

Insuficienţa cardiacă cronică şi boala cronică de rinichi

Introduction. Renal dysfunction is one of the most common comorbidity of heart failure and may complicate its evolution. Aim. To analyze the frequency of chronic kidney disease in patients with decompensated chronic heart failure hospitalized in the Internal Medicine Clinic of the Clinical Emergency Hospital of Bucharest over a period of one year. Material and method. We retrospectively analyzed the data registered in hospital’s database between June 1st, 2014 – June 1st, 2015. Between 01.06.2014-01.06.2015, 609 patients with the diagnosis of chronic heart failure were hospitalized. Of these, 109 (17.89%) were diagnosed with chronic kidney disease (CKD) and represented our group of study. Distribution of chronic kidney disease in patients with chronic heart failure, depending on the stage of chronic kidney disease, was: no patient with stage 1, 26.61% with stage 2, 33.94% with stage 3A, 28.44% in stage 3B, 8.26% with stage 4 and 2.75% with stage 5. Distribution of NYHA class in the study group was: 20.18% NYHA class II, 40.37% NYHA class III, 39, 45% NYHA IV. 37 of the 109 patients (33.94%) with chronic heart failure and CKD had type 2 diabetes. Other important comorbidities in the group of study have been hypertension and anemia. Conclusions. Most patients with chronic heart failure admitted to our clinic were men, had heart failure NYHA class III and presented CKD class 3. A significant proportion of patients had risk factors for both BRC and heart failure: essential hypertension, diabetes and anemia.

Prevalence of self-reported chronic kidney disease in Brazil: National Health Survey of 2013.

To describe the profile of adults who reported medical diagnosis of chronic kidney disease (CKD), according to selected variables. In a cross-sectional study with individuals included in the National Health Survey of 2013, a household population-based study was conducted in rural and urban areas of Brazil. A total of 60,202 individuals aged ≥ 18 years who self-reported a medical diagnosis of chronic renal failure or kidney disease were evaluated. Descriptive statistics, including calculations of prevalence and 95% confidence intervals (95%CI), were calculated. The prevalence of CKD was 1.4% (95%CI 1.3 - 1.6). It was similar between sexes: male, 1.4% (95%CI 1.1 - 1.6); and female, 1.5% ((95%CI 1.3 - 1.7). southern Brazil showed the highest frequency of this indicator (2.1%; 95%CI 1.6 - 2.7). The prevalence of dialysis among people with medical diagnosis of end stage renal disease was 7.4% (95%CI 4.4 - 10.3), being greater in males (12.4%; 95%CI 6.5 - 18.3). There was no difference between the age groups and schooling levels. CKD was referenced by 8.9% (95%CI 3.5 - 14.3) of the individuals with brown skin, with no difference among races/skin color. These results reveal various aspects of CKD in Brazil. The distribution of CKD was unequal, burdening especially individuals with poor education, demanding greater investments in health programs for the confrontation of CKD. Thus, these data allow the planning of public policies aimed at the prevention of this disease and health promotion.

Distribution of CKD and Hypertension in 13 Towns in Hail Region, KSA

Article History Background: Identification of individuals with early chronic kidney disease (CKD) and impaired blood pressure at community base provides opportunities for successful interventions that decrease burden renal failure and hypertension. Therefore, the aim of present study was to screen for CKD and hypertension in 13 towns around Hail city. Methodology: Screening for CKD is performed involving 2800 Saudi volunteers with age ranges from 14 to 100 years. Participants fulfilled a questionnaire, underwent blood pressure measurement and were then sent for laboratory investigations for CKD. Results: Of the 2800 individuals, CKD was Identified in 217/2800 (7.8%), of whom 95/217 (43.8%) were males and 122/217 (56.2%) were females. Hypertension was identified in 939/2800 (33.4%), of whom 477/939 (50.9%) were males and 462/939 (49.1%) were females. Conclusion: The prevalence of CKD and hypertension are high in Hail Region and differ from town to another. An intervention at the community base is high required to identify individuals at risk for follow up and early treatment.

Chronic kidney disease epidemic in Central America: urgent public health action is needed amid causal uncertainty.

Chronic kidney disease epidemic in Central America: urgent public health action is needed amid causal uncertainty.

Staging and risk factors of chronic kidney disease of outpatients in Shanghai

Purpose: We conducted a survey to determine the stages distribution of chronic kidney disease (CKD) using estimated glomerular filtration rate (eGFR) Study Equation and evaluate the risk factors for these patients. Methods: All participants completed a questionnaire documenting their social demographic status, personal and family medical history and lifestyle behaviors. Blood and urine samples were collected for laboratory testing. The Chi-square test/analysis of variance and multiple/logistic regression were applied for data analysis. There were 530 CKD patients enrolled in this survey. Results: The Chi-square analysis showed that there was significant difference among different CKD stages in age, gender, BMI (body mass index), medical insurance and education status. Five factors (age, gender, BMI, hypertension, and hyperuricemia) were associated with decreased kidney function (eGFR < 60 mL/min/1.73 m2). Five factors (age ≥ 65 years, hypertension, proteinuria, hematuria, and hyperuricemia) were associated with abnormal kidney function (eGFR < 90 mL/min/1.73 m2). Three factors (low education status, hypertension, and proteinuria) were associated with kidney failure (eGFR < 15 mL/min/1.73 m2). Conclusions: Older patients, female with higher BMI, proteinuria and hyperuricemia, complicating with hypertension and diabetes tend to be easier for CKD progression. However, patients with higher education have the lower risk of progressing to end-stage renal disease.

Distribution of and factors contributing to chronic kidney disease in a middle-aged working population.

To clarify the distribution of chronic kidney disease (CKD) and the factors contributing to its development and progression in middle-aged Japanese workers/employees. This was a retrospective study involving 3,964 men and 2,698 women aged 35-64 years in 2009 who had been followed-up until 2003. Data on proteinuria determined with a dipstick and glomerular filtration rate estimated from serum creatinine concentration (eGFR) were collected in the annual health check-ups. Proteinuria was detected in 2.9 and 1.1 % of the men and women, respectively, and total CKD was detected in 16.0 and 16.1 % of the men and women respectively. Moderate or severe CKD associated a high risk of cardiovascular diseases and end-stage kidney disease was found mostly in the male subjects [2.0 (men) vs. 0.6 % (women)]. High-risk CKD was found in 3.3 % of the men aged 55-64 years. A body mass index (BMI) of ≥30, hypertension, diabetes mellitus (DM), current smoking and some job types were independently related to the development of proteinuria, while age, BMI, hypertriglyceridemia, and job types were related to total CKD. The development of high-risk CKD was related to preceding mild CKD signs of reduced eGFR and proteinuria as well as to hypertension, DM, smoking, and job type. Chronic kidney disease was found in 16 % of middle-aged workers with an equal prevalence in both sexes, while high-risk CKD was found mostly in men, of whom 3.3 % were aged 55-64 years. Obesity, hypertension, DM, smoking and some job types were related to the development and progression of CKD.

Geographical distribution of chronic kidney disease of unknown origin in North Central Region of Sri Lanka

In early nineties investigators noticed an alarmingly high incidence of an apparently new form of chronic kidney disease of unknown aetiology (CKD-U) in some parts of Sri Lanka. The aim of the study was to investigate the geographical distribution of CKD-U using GIS and GPS mapping. Community based information was collected from 11,630 patients for GIS mapping using ARC 9.2 software. Based on GIS mapping, two locations were selected for GPS mapping to locate the households of 863 CKD-U patients with reference to reservoirs, irrigation canals and the topography of the areas. GIS mapping indicated five high prevalence areas of CKD-U. Communities who consumed water from natural springs showed a low prevalence of the disease. GPS mapping showed that most of the affected villages were located below the reservoirs and canals with stagnant irrigated water. Epidemiological data on geographical distribution infers that while older foci of CKD-U are persisting, there is an emergence of new foci with time. The location of the affected villages below the level of the reservoirs/canals may indicate the possibility of draining of irrigated water to the shallow wells of the households, which is the source of drinking water.

Implementation and first results of a German Chronic Kidney Disease Registry

Advanced chronic kidney disease (CKD) is gaining increasing medical and economical importance, but little information exists about treatment variation and the impact of routine clinical treatments on survival, quality of life, and cost. We demonstrate the first results of a national electronic registry of nephrology clinic data that will serve as a resource for the prospective observation of CKD patients in Germany. A large network of German nephrologist practices is currently joining the project. Routinely obtained clinical data for non-dialysis dependent CKD patients are documented in health records electronically, and elements from these data are extracted using QuaNT (Qualitätssicherung Nephrologie und Transplantation) to create a centralized database. Here, we report cross-sectional data from 59 participating nephrology clinics and 6,187 patients with CKD Stage 3 - 5 in 2011. Mean age ± standard deviation (SD) was 72 ± 12 years. The distribution of CKD 3, 4, and 5 (non-dialysis) was 60%, 33%, and 8%, respectively. The major renal diseases were hypertension/vascular nephropathy (47%) and diabetic nephropathy (26%). Reninangiotensin-system inhibitor prescription was 78%. Vitamin D prescription was 50%, phosphate binders 6%, iron (oral or i.v.) 19%, and erythropoietin-stimulating agents 14%. This electronic registry follows clinical nephrology care and outcomes for CKD patients in Germany, and increased participation is anticipated. As a component of the initiative, variation in patient care will be studied to identify best treatment practices in analyses integrated into the international CKD Outcomes and Practice Patterns Study (CKDopps).