Early Recognition Of Chronic Kidney Disease Research Articles

Renal Survival of Chronic Kidney Disease Patients in a Tertiary Referral Hospital in Malaysia.

Chronic kidney disease (CKD) represents a major public health issue, which then progresses to end-stage renal disease (ESRD) sooner or later. This retrospective cohort study aimed to determine the renal survival time of CKD patients. In total, 247 CKD patients in one of the tertiary referral hospitals in Malaysia between January 2005 and December 2015 were enrolled. All CKD patients were included if they were dependent on dialysis. Patients who were transferred out and those with incomplete records were excluded from the study. The renal survival time was calculated from the time of the first diagnosis of CKD to a confirmed ESRD diagnosis or the use of dialysis. In total, 193 (78.1%) CKD patients progressed to ESRD. The mean age of the ESRD patients was 53 years old. The majority of ESRD patients were male (57.0%) and of Malay ethnicity (89.6%). The most common comorbidities among ESRD patients were hypertension (92.2%) and diabetes mellitus (85.5%). The majority of patients were in Stage IV and V (97.9%). The overall renal survival time of CKD patients who develop ESRD was 26 months (95% confidence interval: 20.41, 31.59). Patients who smoked (P = 0.001), had hyperlipidemia (P <0.001) and consumed lipid-lowering agents (P = 0.004) had a significant P-value in the log-rank test. The progression of CKD from diagnosis to ESRD was within 2 years. Therefore, early recognition of CKD is important to improve patients' outcomes and prolong their renal survival time.

Need for chronic kidney disease prevention programs in disadvantaged populations.

Chronic kidney disease (CKD) is a key determinant of the poor health outcomes for major non-communicable diseases that are the leading cause of death in the world. CKD is a worldwide threat to public health, but the size of the problem is not fully appreciated. Early recognition of CKD and concomitant co-morbid conditions, can potentially slow progression to renal failure, increase longevity, improve quality of life, and reduce healthcare costs. Although screening programmes are attractive, there is no consensus yet on which individuals should be prioritized (high-risk group for CKD, or general population) especially in resourcepoor regions. In these settings there is not a unique blueprint of screening strategy, so that the approaches should be adapted on single-nation conditions and socioeconomic status. Effective multimodal tools are available to prevent CKD by managing its risk factors, and to slow or even halt disease progression to end-stage renal failure, as well as reduce the associated risk of cardiovascular morbidity and mortality. They can be adapted even to the poorest populations who are at the highest risk of CKD. Where management strategies have been implemented, the incidence of end-stage renal disease (ESRD) has been reduced. The hope is that all these efforts will assist to make major advances in addressing the neglected aspect of renal health, especially of poor and disadvantaged populations worldwide. Beside saving young lives, such action would minimize the present health inequity that arises mainly from the unaffordable cost of renal replacement therapy if ESRD is not prevented.

Prevalence, associated factors and impact on mortality of chronic kidney disease in nursing home residents: A single-center experience.

We carried out the present study to determine the prevalence, associated comorbidities and impact on mortality of chronic kidney disease (CKD) in nursing home residents. This was an 8-year prospective single-center, longitudinal cohort study consisting of 612 patients living in a nursing home from 2005-2013. The glomerular filtration rate (GFR) was estimated from a prediction equation, the Chronic Kidney Disease Epidemiology Collaboration equation, based on the serum creatinine concentration, age, race, sex and body size. The demographic and clinical characteristics of the residents were collected. CKD, defined as abnormalities of kidney structure or function, present for >3 months, with implications for health, was present in 197 (39.9%) residents. Specifically, 109 (21.5%) residents had an estimated GFR of 45-59 mL/min, and 64 (12.6%) had an estimated GFR of 30-44 mL/min. Multivariate logistic regression identified older age (OR 0.97, 95% CI 0.95-0.99), female sex (OR 2.99, 95% CI 1.99-4.49) and hypertension (OR 1.55, 95%, CI 1.00-2.40) as the only independent predictors of CKD. After a follow up of 8 years, 208 (41.1%) of the 506 residents died. Of these residents, 104 (52.8%) had CKD and 104 (33.4%) did not have CKD. The Kaplan-Meier survival curves showed that residents with CKD had a significantly higher mortality than those without CKD. CKD is prevalent in nursing home residents. A decline in renal function is associated with cardiovascular disease and mortality. Early recognition of CKD might improve drug dosage, renal management and outcomes in this particular group of patients.

Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers for adults with early (stage 1 to 3) non-diabetic chronic kidney disease.

Chronic kidney disease (CKD) is a long term condition that occurs as a result of damage to the kidneys. Early recognition of CKD is becoming increasingly common due to widespread laboratory estimated glomerular filtration rate (eGFR) reporting, raised clinical awareness, and international adoption of Kidney Disease Outcomes Quality Initiative (K/DOQI) classification. Early recognition and management of CKD affords the opportunity not only to prepare for progressive kidney impairment and impending renal replacement therapy, but also for intervening to reduce the risk of progression and cardiovascular disease. Angiotensin-converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARB) are two classes of antihypertensive drugs that act on the renin-angiotensin-aldosterone system. Beneficial effects of ACEi and ARB on renal outcomes and survival in people with a wide range of severity of renal impairment have been reported; however, their effectiveness in the subgroup of people with early CKD (stage 1 to 3) is less certain. This review aimed to evaluate the benefits and harms of ACEi and ARB or both in the management of people with early (stage 1 to 3) CKD who do not have diabetes mellitus. In March 2010 we searched The Cochrane Library, including The Cochrane Renal Group's specialised register and The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE. Reference lists of review articles and relevant studies were also checked. The search was conducted using the optimally sensitive strategy developed by the Cochrane Collaboration for the identification of randomised controlled trials (RCTs) with input from an expert in trial search strategy. All RCTs reporting the effect of ACEi or ARB in people with early (stage 1 to 3) CKD who did not have diabetes mellitus were selected for inclusion. Only studies of at least four weeks duration were selected. Authors, working in teams of two, independently assessed the retrieved titles and abstracts, and whenever necessary the full text of these studies were screened to determine which studies satisfied the inclusion criteria. Data extraction was carried out by two authors, independently, using a standard data extraction form and cross checked by two other authors. Methodological quality of included studies was assessed using the Cochrane risk of bias tool. Data entry was carried out by one author and cross checked by another author. When more than one study reported similar outcomes, data were pooled using the random-effects model, but a fixed-effect model was also analysed to ensure the robustness of the model chosen and to check susceptibility to outliers. Heterogeneity was analysed using a Chi² test on N-1 degrees of freedom, with an alpha of 0.05 used for statistical significance and with the I² test. Where data permitted, subgroup analysis was used to explore possible sources of heterogeneity. The quality of the evidence was analysed. Four RCTs enrolling 2177 participants met our inclusion criteria. Of these, three compared ACEi with placebo and one compared ACEi with ARB. Two studies had an overall low risk of bias, and the other two were considered to be at moderate to high risk of bias. Low to moderate quality of evidence (from two studies representing 1906 patients) suggested that ACEi had no impact on all-cause mortality (RR 1.80, 95% CI 0.17 to 19.27, P = 0.63) or cardiovascular events (RR 0.87, 95% CI 0.66 to 1.14, P = 0.31) in people with stage 3 CKD. For all-cause mortality, there was substantial heterogeneity in the results. One study (quality assessment: low risk of bias) reported no difference in the risk of end-stage kidney disease in those with an eGFR >45mL/min/1.74m² treated with ACEi versus placebo (RR 1.00, 95% CI 0.09 to 1.11, P = 0.99). The (high risk of bias) study that compared ACEi with ARB reported little difference in effect between the treatments when urinary protein, blood pressure or creatinine clearance were compared. No published studies comparing ARB with placebo or ACEi and ARB with placebo were identified. Our review demonstrated that there is currently insufficient evidence to determine the effectiveness of ACEi or ARB in patients with stage 1 to 3 CKD who do not have diabetes mellitus. We have identified an area of significant uncertainty for a group of patients who account for most of those labelled as having CKD.

The Role of the Primary Care Physician in Managing Early Stages of Chronic Kidney Disease

Recent increases in obesity, diabetes, and hypertension, along with the aging of the US population, are driving a dramatic rise in the prevalence of chronic kidney disease (CKD). Despite this increase, the majority of Americans with early-stage CKD remain unaware of their disease. Primary care physicians are at the forefront of efforts for early recognition of CKD and management to control its progression. Patients with CKD should be referred to nephrologists no later than the point at which their estimated glomerular filtration rate reaches 30 mL/min. Nephrology evaluation at this point is essential to facilitate timely preparation for care of end-stage renal disease through preemptive transplantation or planned transition to dialysis. In addition to stringent control of underlying hypertension and/or diabetes, mineral metabolic parameters (serum parathyroid hormone, phosphorus, calcium, and bicarbonate) in patients with advancing CKD should be managed closely to avoid adverse effects on the cardiovascular and skeletal systems.

Renal Disease Burden Following Liver Transplantation

Significant chronic kidney disease (CKD) occurs following orthotopic liver transplant (OLT). Since CKD is associated with increased cardiovascular events, mortality, and hepatic allograft dysfunction, early recognition of CKD and implementation of changes may improve the long-term outcome. The purpose of this study was to determine the burden of renal disease following OLT. Patients and Methods We retrospectively reviewed our OLT recipients from 1997 until 2004. We calculated glomerular filtration rates (GFR) using the Modification of Diet in Renal Disease study (MDRD) method. The GFRs were further subdivided into pre-MELD and post-MELD eras. Results During the study period, we performed 407 OLTs. We censored data from living donor liver transplants ( n = 14), combined liver-kidney transplants ( n = 12), and from patients whom we did not have complete data for 6 months after transplant ( n = 40). Mean MELD score at the time of transplant was 18 ± 7 (mean ± standard deviation). The mean GFR at 6 months following OLT was 63.7 ± 30.2 mL/min per 1.73 m 2. Only 14% ( n = 47) of our patients had normal renal function at 6 months, while 78% ( n = 266) of our patients had mild to moderate risk for renal failure. Eight percent ( n = 28) had stage 4 or 5 CKD. There were no differences between the pre-MELD and post-MELD GFRs. Conclusions The burden of renal disease is significant in our patient population at 6 months posttransplantation. It may be important to introduce CKD management as early as 6 months after transplant to impact the outcomes of OLT recipients.

Peritoneal Dialysis: A Primary Care Perspective

As the population of chronic kidney disease (CKD) and end-stage renal disease (ESRD) grows at an alarming rate, primary care physicians will increasingly be involved in the management of these patients. Early recognition of CKD and timely referral to a nephrologist when glomerular filtration rate approaches 30 mL/min/1.73 m(2) is extremely important to improve ESRD outcome and appropriate selection of dialysis modality. Peritoneal dialysis (PD) remains a viable treatment option for ESRD patients. PD is less expensive dialysis modality and may provide a survival advantages over hemodialysis in first 2 to 4 years of treatment. Preserving residual renal function (RRF) is of paramount importance to prolong the survival outcomes in PD patients. Thus preservation of RRF is an important goal in the management of PD patients. Every effort should be made to avoid nephrotoxic drugs like aminoglycosides and nonsteroidal anti-inflammatory drugs, and limit the use of radiocontrast agents in PD patients with RRF. Judicious use of prophylactic antibiotics to prevent peritonitis would further help to reduce morbidity from PD. Protecting peritoneal membrane from long-term toxic and metabolic effects of the conventional glucose-based solutions is another objective to further improve PD outcome. Development of new, more biocompatible PD solutions holds promise for the future. One such solution, icodextrin, is now approved for use in the United States. Although extremely safe to use, it is associated with unique metabolic effects that may concern primary care physicians. They include false elevation of blood glucose, a reversible increase in serum alkaline phosphatase and a false decline in serum amylase. Monitoring of glycemia by assays that use glucose dehydrogenase pyrroloquinoline quinone enzymes should be avoided and serum amylase alone should not be relied on in diagnosing pancreatitis in patients on icodextrin.

Chronic kidney disease in Nigeria: primary care physicians must intervene earlier

Chronic Kidney disease (CKD) is one of the world's major public health problems and the prevalence of Kidney failure is rising steadily. Patients with early stages of CKD are primarily silent with long latent period, and may in fact be masked by other conditions. Progressive damage is invariable and progression to ESRD is the rule. Failure to recognize CKD early is a missed opportunity to prevent or delay the development of ESRD or other cardiovascular events complicating CKD. To evaluate the present practice of Medical officers within the primary and secondary health care centres in Kaduna State to see how this could help in early detection of CKD. Cross sectional descriptive study. Medical doctors working within Kaduna State of Nigeria both in the private and public sector excluding specialists and those in the university teaching hospital. Interview using self administered questionnaire. Percentage of patients tested for symptomless urinary abnormalities when seen by the doctor. A total of 96 completed and returned questionnaires were analysed. Sixty five percent (65%) of the doctors tested less than ten percent (10%) of their patients for proteinuria and eighty five percent (85%) of the doctors tested less than ten percent (10%) of their patients for haematuria. Only thirty percent (30%) of the doctors tested for proteinuria in thirty nine percent (39%) of those they were treating for Diabetes Mellitus and only thirty five percent (35%) of the doctors tested for proteinuria in twenty nine percent (29%) of those with hypertension. Screening for CKD is hardly considered in the routine practice of the primary and secondary care medical officers who have the first contact with patients and are in the best position to screen for CKD and provide opportunity for early detection, evaluation and prevention of progression to ESRD. Failure to recognize CKD early is a missed opportunity to improve patient outcome therefore the primary care physicians must intervene earlier to ensure early recognition of CKD. Nigerian Medical Practitioner Vol. 49(1&2) 2006: 18-23

SHAPE UP-a management program for chronic kidney disease

Chronic kidney disease (CKD) is a disease of epidemic proportions, affecting 11% of the population and having far-reaching consequences in quality of life, mortality, and overall cost of health. So far, CKD care has been suboptimal. Evidence-based guidelines for management of patients with CKD have been established by the National Kidney Foundation. Early recognition of CKD and its associated complications and timely referral to a nephrologist are the key components of management. Coordinated care and effective communication between the primary care physician, the nephrologist, and other providers are critical to improve the outcome. Using a simple mnemonic, SHAPE UP, we outline a program for comprehensive care of patients with CKD. We believe that implementing this program in medical and renal clinics will enhance the care of CKD patients.