Early Stages Of Chronic Kidney Disease Research Articles

Association of serum 25-hydroxyvitamin D with cardiovascular mortality and kidney outcome in patients with early stages of CKD.

While serum 25-hydroxyvitamin D (25[OH]D) deficiency is prevalent in chronic kidney disease (CKD), the effects of 25(OH)D deficiency on cardiovascular mortality and kidney outcomes in patients with early-stage CKD remain incompletely understood. This multicenter retrospective cohort study included adult patients with stages 1-3 CKD from 19 medical centers across China between January 2000 and May 2021. The primary outcome was cardiovascular mortality. The secondary study outcome included CKD progression (defined as a sustained > 40% eGFR decrease from baseline or progress to end-stage kidney disease), and annual percentage change of eGFR. Of 9229 adults with stages 1-3 CKD, 27.0% and 38.9% had severe (< 10ng/mL) and moderate (10 to < 20ng/mL) serum 25(OH)D deficiency, respectively. Compared with patients having 25(OH)D ≥ 20ng/mL, a significantly higher risk of cardiovascular mortality (hazard ratio [HR] 1.90, 95% CI 1.37-2.63), CKD progression (HR 2.20, 95% CI 1.68-2.88), and a steeper annual decline in eGFR (estimate - 7.87%; 95% CI - 10.24% to - 5.51% per year) was found in those with serum 25(OH)D < 10ng/mL. Similar results were obtained in subgroups and by sensitivity analyses. 25(OH)D deficiency is associated with increased risks of cardiovascular mortality and CKD progression in patients with early-stage CKD. Studies are needed to determine whether early intervention for 25(OH)D deficiency could improve the prognosis of patients with early-stage CKD.

Correlation of serum fibroblast growth factor-23 levels and calcium phosphate products levels in chronic kidney disease; sub analysis of chronic kidney disease-mineral and bone disorder study

&lt;em data-sider-select-id="0e59b1fc-fce5-41b4-b987-316daa778de4"&gt;Introduction: The body produces fibroblast growth factor-23 (FGF-23) to maintain normal phosphate levels when hyperphosphatemia occurs. Production of FGF-23 indirectly causes hypocalcemia. Phosphate and calcium disturbances also occur in chronic kidney disease (CKD), therefore this adaptation mechanism applies. This situation; however, only manifests in the early stages of CKD; if the estimated glomerular filtration rate (eGFR) is less than 30% of normal. This adaptation is no longer adequate and levels of calcium-phosphate (Ca×P) products and FGF-23 still rise. &lt;em data-sider-select-id="f0dc3bf1-1598-419e-9de6-fe837eadc8e6"&gt;Objectives: In this study, the correlation between both the serum levels of FGF-23 and Ca×P products in CKD was analyzed. &lt;em data-sider-select-id="a367eeb1-7c32-4bf0-98ef-e6ae52522dc7"&gt;Patients and Methods: A cross-sectional study including 78 subjects with CKD stages 3 to 5 dialysis was conducted. Serum FGF-23 levels were determined using the enzyme-linked immunosorbent assay (ELISA) method and Ca×P product levels were calculated using the formula calcium (mg/ dL) × phosphate (mg/dL). The Kolmogorov-Smirnov test and Spearman’s test were conducted in the statistical study. If the P value is less than 0.05, the statistical findings are significant. &lt;em data-sider-select-id="e286c166-6c09-432e-b832-c902b1a13b81"&gt;Results: Serum FGF-23 levels and Ca×P product levels were shown to be significantly correlated. This analysis of the two correlations was independent of age and diabetes mellitus (DM). Based on stages of CKD, serum FGF-23 levels and Ca×P product levels were discovered to be significantly correlated only at stage 5 of non-dialysis. &lt;em data-sider-select-id="9b3534d4-deaa-4ccf-8b82-745bb5380661"&gt;Conclusion: Increasing serum FGF-23 levels were correlated with increased Ca×P product levels, particularly in CKD stage 5 non-dialysis subjects. This correlation was independent of age and DM.

Urinary angiotensin-converting enzyme 2 and its activity in cats with chronic kidney disease

IntroductionAngiotensin-converting enzyme 2 (ACE2) played an important role in the renin-angiotensin-aldosterone system (RAAS) and it was proved to be renoprotective in renal disease. Urinary angiotensin-converting enzyme 2 (uACE2) has been shown to reflect renal injury in human and experimental studies, but its role in feline kidney disease remains unknown.AimsOur objectives involve comparing uACE2 concentrations and activities in cats across CKD stages with healthy controls, investigating the relationship between uACE2 concentrations, activities, and clinicopathological data in feline CKD patients, and assessing the predictive abilities of both for CKD progression.MethodsA retrospective, case–control study. The concentration and activity of uACE2 were measured by commercial ELISA and fluorometric assay kits, respectively. The concentration was adjusted to give uACE2 concentration-to-creatinine ratios (UACCRs).ResultsIn total, 67 cats consisting of 24 control and 43 chronic kidney disease (CKD), including 24 early-stage CKD and 19 late-stage CKD, were enrolled in this study. UACCR values were significantly higher in both early-stage (2.100 [1.142–4.242] x 10−6) and late-stage feline CKD (4.343 [2.992–5.0.71] x 10−6) compared to healthy controls (0.894 [0.610–1.076] x 10−6; p &amp;lt; 0.001), and there was also significant difference between-early stage group and late-stage group (p = 0.026). Urinary ACE2 activity (UAA) was significantly lower in CKD cats (1.338 [0.644–2.755] x pmol/min/ml) compared to the healthy cats (7.989 [3.711–15.903] x pmol/min/ml; p &amp;lt; 0.001). UACCR demonstrated an independent, positive correlation with BUN (p &amp;lt; 0.001), and UAA exhibited an independent, negative correlation with plasma creatinine (p &amp;lt; 0.001). Both UACCR and UAA did not yield significant results in predicting CKD progression based on the ROC curve analysis.Conclusion and clinical importanceuACE2 concentration and activity exhibit varying changes as renal function declines, particularly in advanced CKD cats.

Specific Gravity Improves Identification of Clinically Significant Quantitative Proteinuria from the Dipstick Urinalysis.

CKD is often underdiagnosed during early stages when GFR is preserved due to underutilization of testing for quantitative urine albumin-to-creatinine ratio (UACR) or protein-to-creatinine ratio (UPCR). Semi-quantitative dipstick proteinuria (DSP) on urinalysis is widely obtained but not accurate for identifying clinically significant proteinuria. We identified all patients with a urinalysis and UACR or UPCR obtained on the same day at a tertiary referral center. The accuracy of DSP alone or in combination with specific gravity against a gold-standard of UACR ≥30 mg/g or UPCR ≥0.15 g/g, characterizing clinically significant proteinuria, was evaluated using logistic regression. Models were internally validated using 10-fold cross validation. The specific gravity for each DSP above which significant proteinuria is unlikely was determined. Of 11,229 patients, clinically significant proteinuria was present in 4,073 (36%). The area under the receiver operating characteristic curve (95% confidence interval) was 0.77 (0.76, 0.77) using DSP alone and 0.82 (0.82, 0.83) in combination with specific gravity (P<0.001), yielding a specificity of 0.93 (standard error, SE=0.02) and positive likelihood ratio of 9.52 (SE=0.85). The optimal specific gravity cut-offs to identify significant proteinuria were ≤1.0012, 1.0238, and 1.0442, for DSP of trace, 30, and 100 mg/dL. At any specific gravity, a DSP ≥300 mg/dL was extremely likely to represent significant proteinuria. Adding specific gravity to DSP improves recognition of clinically significant proteinuria and can be easily used to identify patients with early-stage CKD who may not have otherwise received a quantified proteinuria measurement for both clinical and research purposes.

Rationale and design of the Innsbruck Diabetic Kidney Disease Cohort (IDKDC)—a prospective study investigating etiology and progression of early-stage chronic kidney disease in type 2 diabetes

ABSTRACT Background The development of chronic kidney disease (CKD) in about 20%–40% of patients with type 2 diabetes (T2D) aggravates cardiovascular morbidity and mortality. Pathophysiology is of increasing relevance for individual management and prognosis, though it is largely unknown among T2D patients with CKD as histologic work-up is not routinely performed upon typical clinical presentation. However, as clinical parameters do not appropriately reflect underlying kidney pathology, reluctance regarding timely histologic assessment in T2D patients with CKD should be critically questioned. As the etiology of CKD in T2D is heterogeneous, we aim to assess the prevalence and clinical disease course of typical diabetic vs atypical/non-specific vs non-diabetic vs coexisting kidney pathologies among T2D patients with mild-to-moderate kidney impairment [KDIGO stage G3a/A1–3 or G2/A2–3; i.e. estimated glomerular filtration rate (eGFR) 59–45 mL/min irrespective of albuminuria or eGFR 89–60 mL/min and albuminuria &amp;gt;30 mg/g creatinine]. Methods The Innsbruck Diabetic Kidney Disease Cohort (IDKDC) study aims to enroll at least 65 T2D patients with mild-to-moderate kidney impairment to undergo a diagnostic kidney biopsy. Six-monthly clinical follow-ups for up to 5 years will provide clinical and laboratory data to assess cardio-renal outcomes. Blood, urine and kidney tissue specimen will be biobanked to identify diagnostic and prognostic biomarkers. Conclusions While current risk assessment is primarily based on clinical parameters, our study will provide the scientific background for a potential change of the diagnostic standard towards routine kidney biopsy and clarify its role for individual risk prediction regarding cardio-renal outcome in T2D patients with mild-to-moderate kidney impairment.

252 Novel Circulating Form of Guca2b Accurately Identifies Early-Stage Chronic Kidney Disease on Single Assessment

252 Novel Circulating Form of Guca2b Accurately Identifies Early-Stage Chronic Kidney Disease on Single Assessment

WCN24-2388 Prediction model for early-stage CKD using the Naples prognostic score and plasma indoleamine 2,3-dioxygenase activity

WCN24-2388 Prediction model for early-stage CKD using the Naples prognostic score and plasma indoleamine 2,3-dioxygenase activity

만성 신장 질환 진행 단계 및 신대체요법에 따른 임상적 특성과 의료비 지출 비교

The worsening of chronic kidney disease (CKD) leads to an increase in renal replacement therapies (RRT), which pose significant clinical and economic burdens. The purpose of this study was to estimate clinical characteristics and medical expenditure across CKD stage and RRT initiation. Using the 2018 National Patient Sample claims data, we identified 9,006 patients diagnosed with CKD (N18) were extracted. RRT options included hemodialysis, peritoneal dialysis, and kidney transplantation. Adopting a prevalence-based approach, we compared the clinical characteristics, healthcare resource utilization, and medical expenditures by CKD stage and the use of RRT. The prevalence of CKD increased with age, 41% in those aged 70 and above. Among patients with stage5 CKD, 78.75% underwent RRT. When comparing patients receiving RRT with those not receiving RRT, the annual average number of admissions (2.2 vs. 0.2), length of stay (56.6 vs. 23.1 days), and number of outpatient visits (101.0 vs. 5.2) were higher in the RRT group. Additionally, the average expenditure escalated with advancing CKD stages; the expenditure difference between stage3 and 4 was 2.8 times, and between stage4 and 5 was 15 times. Patients undergoing RRT spent 17.6 times more than those not receiving RRT (29,237,778 vs. 1,660,351 KRW). This study concludes that the aggravation of CKD can lead the financial toxicity due to RRT initiation, highlighting the need of appropriate management in early and moderate stages of CKD.

Causal Model of Autonomous Motivation to Modify Dietary Behavior among People with Early-stage Chronic Kidney Disease

Dietary behavior is significant for delaying chronic kidney disease progression but is difficult to modify. Autonomous motivation is one of the key concepts that seem to be useful for behavior modification. Thus, this descriptive cross-sectional study was purposed to develop and test a causal model of autonomous motivation to modify dietary behavior among people with early-stage chronic kidney disease. Participants comprised 308 people with early-stage chronic kidney disease from ten tertiary hospitals in Thailand. Data collection employed a demographic and health information form, the Regulation of Eating Behaviour Scale: Autonomous Motivation Subscale, the General Causality Orientation Scale: Autonomy Orientation Subscale, the Health Care Climate Questionnaire Short-Form, the Importance Domain of the Aspiration Index: Intrinsic Life Aspiration Subscale, the Importance Domain of the Aspiration Index: Extrinsic Life Aspiration Subscale, and the Basic Need Satisfaction in General Scale. Data were analyzed through descriptive statistics and structural equation modeling using M-plus.The results showed the final model explained 57% of the variance in autonomous motivation to modify dietary behavior. Intrinsic life aspiration, autonomy support from healthcare providers, and autonomy orientation had a positive direct effect on autonomous motivation and an indirect effect through basic psychological need satisfaction. Basic psychological need satisfaction had a positive direct effect on autonomous motivation. On the other hand, extrinsic life aspiration had neither a direct nor an indirect effect on autonomous motivation. Nurses can use these findings to design and test nursing interventions by integrating autonomy orientation, autonomy support from healthcare providers, and intrinsic life aspirations for enhancing autonomous motivation to modify the dietary behavior of this population.

Smoking status, cadmium, and chronic kidney disease

Abstract Background Chronic kidney disease (CKD) affects 10% of the general population in Western countries. Currently, CKD cannot be cured and there are only few strategies to prevent the onset of CKD, to reverse early stages of CKD, and to prevent the progression of established CKD to end-stage kidney disease. Cigarette smoking is a preventable cause of CKD. Methods This narrative review analyses the cause–effect relationship between cigarette smoking and CKD and discusses the association of inhaled cadmium and smoking-induced kidney damage. Results Cigarette smoking places individuals at risk for incident CKD. It accelerates the progression (decline in glomerular filtration rate, aggravation of proteinuria) of CKD to end-stage kidney disease (ESKD), and is associated with shortened kidney transplant graft survival. These harmful effects on kidney function/structure are dependent on the dose and duration of cigarette smoking. Smoking abstinence decreases the higher risk for proteinuria and CKD progression. Inhaled cadmium may be the biologic link between cigarette smoking and kidney dysfunction. Recent studies indicate that accumulation of cadmium in the blood mediates progression of CKD and places smokers at higher risk for all-cause mortality. Conclusions Smoking cessation is an effective intervention to reduce the risk of onset and progression of CKD as well as to reduce smoking-attributable morbidity and mortality.

Cost-effectiveness of screening for chronic kidney disease using a cumulative eGFR-based statistic.

Routine screening for chronic kidney disease (CKD) could enable timely interventions to slow down disease progression, but currently there are no clinical guidelines for screening. We aim to evaluate the cost-effectiveness of screening for CKD using a novel analytical tool based on a cumulative sum statistic of estimated glomerular filtration rate (CUSUMGFR). We developed a microsimulation model that captured CKD disease progression, major complications, patients' awareness, and treatment adherence for a nationally representative synthetic cohort of age ≥ 30 years in the United States. In addition to the status quo with no screening, we considered four CUSUMGFR-based universal screening policies by frequency (annual or biennial) and starting age (30 or 60 years), and two targeted annual screening policies for patients with hypertension and diabetes, respectively. For each policy, we evaluated the total discounted disability-adjusted life years (DALYs) and direct health costs over a lifetime horizon and estimated the incremental cost-effectiveness ratio (ICER). We further performed one-way and probabilistic sensitivity analyses to assess the impact of parameter uncertainty. Compared with the status quo, all the CUSUMGFR-based screening policies were cost-effective under the willingness-to-pay (WTP) range of $50,000 -$100,000, with the estimated incremental cost-effectiveness ratios (ICERs) ranging from $15,614/DALYs averted to $54,373/DALYs averted. Universal annual screening with starting age of 30 was the non-dominated policy on the cost-effectiveness frontier under the WTP of approximately $25,000. Adding more recent treatment option of sodium-glucose cotransporter-2 (SGLT2) inhibitors to the treatment regimen was found to be cost-saving. Among the most influential model parameters, variation in the CKD progression rate, adherence, and testing cost resulted in the highest variability in model outcomes. CUSUMGFR-based screening policies for CKD are highly cost-effective in identifying patients at risk of end stage kidney disease in early stages of CKD. Given its simple requirement of a basic blood test, the CUSUMGFR-based screening can be easily incorporated into clinical workflow for disease monitoring and prevention.

Impact of dietary habits on renal function in Saku, a rural Japanese town: a cohort study.

High protein intake leads to a decline in renal function in the advanced stages of chronic kidney disease (CKD). An effective diet for maintaining renal function in healthy individuals or patients in the early stages of CKD has not been established. This cohort study was conducted in Saku, Nagano Prefecture, Japan, to investigate the impact of dietary habits on renal function. In this cross-sectional cohort study, we used the Saku Control Obesity Program (UMIN000016892), including 4,446 participants who submitted a brief-type self-administered diet history questionnaire and underwent routine physical examination. The amount of food intake was divided into quartiles. After adjusting for age and sex, multivariate logistic regression analysis was used to calculate the odds ratio (OR) for the risk of developing CKD (estimated glomerular filtration rate [eGFR] < 60mL/min/1.73 m2). In total, 3,899 participants were analyzed. The overall prevalence of patients with eGFR < 60mL/min/1.73 m2 was 11% (n = 434, male; 7.1%, female; 4.1%). The groups with a high intake of chicken (approximately 63.4g/day, adjusted OR: 0.632, P = 0.003), natto (fermented bean; approximately 21.7g/day, adjusted OR: 0.679, P = 0.01), and plant protein (approximately 0.8g/ideal body weight/day, adjusted OR: 0.695, P = 0.042) showed a low risk of developing CKD compared to the group with the lowest intake. Our cross-sectional study showed that the intake of chicken meat, natto, and plant protein was associated with high eGFR levels. This information can be of value for preventing CKD incidence in healthy Japanese individuals.

The Importance of Early Diagnosis and Intervention in Chronic Kidney Disease: Calls-to-Action from Nephrologists Based Mainly in Central/Eastern Europe.

Chronic kidney disease (CKD) has a global prevalence of 9.1-13.4%. Comorbidities are abundant and may cause and affect CKD. Cardiovascular disease strongly correlates with CKD, increasing the burden of both diseases. As a group of 15 clinical nephrologists primarily practicing in 12 Central/Eastern European countries, as well as Israel and Kazakhstan, herein we review the significant unmet needs for patients with CKD and recommend several key calls-to-action. Early diagnosis and treatment are imperative to ensure optimal outcomes for patients with CKD, with the potential to greatly reduce both morbidity and mortality. Lack of awareness of CKD, substandard indicators of kidney function, suboptimal screening rates, and geographical disparities in reimbursement often hamper access to effective care. Our key calls-to-action to address these unmet needs, thus improving the standard of care for patients with CKD, are the following: increase disease awareness, such as through education; encourage provision of financial support for patients; develop screening algorithms; revisit primary care physician referral practices; and create epidemiological databases that rectify the paucity of data on early-stage disease. By focusing attention on early detection, diagnosis, and treatment of high-risk and early-stage CKD populations, we aim to reduce the burdens, progression, and mortality of CKD.

Pain and Health-Related Quality of Life in Autosomal Dominant Polycystic Kidney Disease: Results from a National Patient-Powered Registry

Rationale and ObjectiveADPKD impacts health-related quality of life (HRQoL) including pain, discomfort, fatigue, emotional distress, and impaired mobility. Stakeholders prioritized kidney cyst-related pain as an important core outcome domain in clinical trials, leading to development of disease-specific assessment tools. Study DesignThe ADPKD Registry is hosted online with multiple disease-specific patient reported outcomes modules to characterize the patient experience in the United States. Setting and ParticipantsThe ADPKD Registry allows consented participants access to a Core Questionnaire which includes demographics, comorbid conditions, current symptoms, and kidney function. Participants complete subsequent modules on a 3-month schedule, including two validated HRQoL tools, the ADPKD Pain and Discomfort Scale (ADPKD-PDS), the ADPKD Impact Scale (ADPKD-IS) and a Healthcare Access and Utilization module. ExposuresPatient-reported latest eGFR or creatinine used to calculate stage of chronic kidney disease. OutcomesHealth-related quality of life, measured using validated ADPKD-specific tools; access to PKD-specific healthcare. Analytical ApproachFor the two HRQoL tools, scores were calculated for physical, emotional, and fatigue domains, pain severity, and pain interference (based on the licensed user manuals). Associations to health care access were also assessed. ResultsBy July 2022, 1,086 individuals with ADPKD completed at least one of the HRQoL modules, 319 completed four over a year. Participants were an average age of 53, 71% women and 91% white, with all CKD stages represented. 2.5% reported being on dialysis and 23% had a kidney transplant. CKD Stage 4/5 participants reported the most dull kidney pain, while sharp kidney pain was evenly distributed across early CKD stages. Dull kidney pain had an impact on sleep regardless of CKD stage. There was a strong positive correlation between the ADPKD-PDS and ADPKD-IS. Patients with a neutral or positive HRQoL were less likely to have been denied access to imaging or other care. LimitationsCurrently all the information collected is patient-reported without health record validation of clinical variables. ConclusionsUse of the HRQoL tools in the ADPKD Registry provided a broad cross-sectional assessment in the U.S. and provided granular information on the burden of pain across the CKD spectrum in ADPKD. The ADPKD Registry allowed assessment of ADPKD impact in a community that experiences decline in health and kidney function over decades.

A comprehensive analysis of albuminuria in canine chronic kidney disease.

Albuminuria, an important marker of decreased kidney function in chronic kidney disease (CKD), is not routinely used for CKD detection or proteinuria appearance. Its relationships with biochemical parameters and blood pressure in dogs are poorly understood. This study aimed to evaluate the relationship of albuminuria with various CKD markers, its correlation with the urinary protein to creatinine ratio (UPC), and hypertension in dogs with early stages of CKD. It also sought to determine the usability of the urinary albumin to creatinine ratio (UAC) for CKD screening. The study reviewed records of 102 dogs, categorising them into four groups based on disease status. UAC and UPC ratio, biochemistry and haematology variables, age, and systolic blood pressure were determined. The Pearson's correlation coefficient between log-transformed values of UPC and UAC was r = 0.902 (95% CI: 0.87 to 0.93). Median UAC ratio values were 2.1mg/g for the Healthy control group (n = 17), 54.2mg/g for early stages CKD (n = 42), 5.8mg/g for Acute sick control (n = 30), and 104mg/g for Chronic sick control (n = 13). Thresholding UAC ratio as an indicator for impaired kidney function with the threshold of 10mg/g (established based on the receiver operating characteristic curve) had a sensitivity 81.8%, specificity of 89.4%, positive predictive value (PPV) 90%, and negative predictive value (NPV) 80.1%. The correlation of UAC with biochemistry and haematology variables was statistically significant; for SDMA (μg/L), it was r = 0.566 and for other variables, it was weak to moderate. UAC was markedly elevated in cases of severe hypertension. UAC ratio was significantly different among dogs with impaired and not impaired kidney function. The correlation strength for the UAC and UPC ratios was high. UAC ratio may be a promising marker for proteinuria analysis in dogs with CKD or other kidney function alterations.

Untargeted metabolomic profiling of serum from client-owned cats with early and late-stage chronic kidney disease

Evaluation of the metabolome could discover novel biomarkers of disease. To date, characterization of the serum metabolome of client-owned cats with chronic kidney disease (CKD), which shares numerous pathophysiological similarities to human CKD, has not been reported. CKD is a leading cause of feline morbidity and mortality, which can be lessened with early detection and appropriate treatment. Consequently, there is an urgent need for early-CKD biomarkers. The goal of this cross-sectional, prospective study was to characterize the global, non-targeted serum metabolome of cats with early versus late-stage CKD compared to healthy cats. Analysis revealed distinct separation of the serum metabolome between healthy cats, early-stage and late-stage CKD. Differentially abundant lipid and amino acid metabolites were the primary contributors to these differences and included metabolites central to the metabolism of fatty acids, essential amino acids and uremic toxins. Correlation of multiple lipid and amino acid metabolites with clinical metadata important to CKD monitoring and patient treatment (e.g. creatinine, muscle condition score) further illustrates the relevance of exploring these metabolite classes further for their capacity to serve as biomarkers of early CKD detection in both feline and human populations.

Optimizing Care Delivery in Patients with Chronic Kidney Disease in the United States: Proceedings of a Multidisciplinary Roundtable Discussion and Literature Review.

Approximately 37 million individuals in the United States (US) have chronic kidney disease (CKD). Patients with CKD have a substantial morbidity and mortality, which contributes to a huge economic burden to the healthcare system. A limited number of clinical pathways or defined workflows exist for CKD care delivery in the US, primarily due to a lower prioritization of CKD care within health systems compared with other areas (e.g., cardiovascular disease [CVD], cancer screening). CKD is a public health crisis and by the year 2040, CKD will become the fifth leading cause of years of life lost. It is therefore critical to address these challenges to improve outcomes in patients with CKD. The CKD Leaders Network conducted a virtual, 3 h, multidisciplinary roundtable discussion with eight subject-matter experts to better understand key factors impacting CKD care delivery and barriers across the US. A premeeting survey identified topics for discussion covering the screening, diagnosis, risk stratification, and management of CKD across the care continuum. Findings from this roundtable are summarized and presented herein. Universal challenges exist across health systems, including a lack of awareness amongst providers and patients, constrained care team bandwidth, inadequate financial incentives for early CKD identification, non-standardized diagnostic classification and triage processes, and non-centralized patient information. Proposed solutions include highlighting immediate and long-term financial implications linked with failure to identify and address at-risk individuals, identifying and managing early-stage CKD, enhancing efforts to support guideline-based education for providers and patients, and capitalizing on next-generation solutions. Payers and other industry stakeholders have opportunities to contribute to optimal CKD care delivery. Beyond addressing the inadequacies that currently exist, actionable tactics can be implemented into clinical practice to improve clinical outcomes in patients at risk for or diagnosed with CKD in the US.

Investigation on explainable machine learning models to predict chronic kidney diseases

Chronic kidney disease (CKD) is a major worldwide health problem, affecting a large proportion of the world’s population and leading to higher morbidity and death rates. The early stages of CKD sometimes present without visible symptoms, causing patients to be unaware. Early detection and treatments are critical in reducing complications and improving the overall quality of life for people afflicted. In this work, we investigate the use of an explainable artificial intelligence (XAI)-based strategy, leveraging clinical characteristics, to predict CKD. This study collected clinical data from 491 patients, comprising 56 with CKD and 435 without CKD, encompassing clinical, laboratory, and demographic variables. To develop the predictive model, five machine learning (ML) methods, namely logistic regression (LR), random forest (RF), decision tree (DT), Naïve Bayes (NB), and extreme gradient boosting (XGBoost), were employed. The optimal model was selected based on accuracy and area under the curve (AUC). Additionally, the SHAP (SHapley Additive exPlanations) and LIME (Local Interpretable Model-agnostic Explanations) algorithms were utilized to demonstrate the influence of the features on the optimal model. Among the five models developed, the XGBoost model achieved the best performance with an AUC of 0.9689 and an accuracy of 93.29%. The analysis of feature importance revealed that creatinine, glycosylated hemoglobin type A1C (HgbA1C), and age were the three most influential features in the XGBoost model. The SHAP force analysis further illustrated the model’s visualization of individualized CKD predictions. For further insights into individual predictions, we also utilized the LIME algorithm. This study presents an interpretable ML-based approach for the early prediction of CKD. The SHAP and LIME methods enhance the interpretability of ML models and help clinicians better understand the rationale behind the predicted outcomes more effectively.

Identification of novel serum metabolic signatures to predict chronic kidney disease among Chinese elders using UPLC-Orbitrap-MS

BackgroundChronic kidney disease (CKD) is a major public health concern. However, validated and broadly applicable biomarkers for early CKD diagnosis are currently not available. We aimed to identify serum metabolic signatures at an early stage of CKD to provide a reference for future investigations into the early diagnostic biomarkers. MethodsSerum metabolites were extracted from 65 renal dysfunction (RD) patients and 121 healthy controls (discovery cohort: 12 RD patients and 55 health participants; validation cohort: 53 RD patients and 66 health participants). Metabolite extracts were analyzed by ultraperformance liquid chromatography coupled with quadrupole-electrostatic field orbital trap mass spectrometry (UPLC-QE-Orbitrap MS) for untargeted metabolomics. Orthogonal partial least squares-discriminant analysis (OPLS-DA) was performed to detect different compounds between groups. Receiver operating characteristic (ROC) curve analysis was carried out to determine the diagnostic value of the validated differential metabolites between groups. We referred to the Kyoto Encyclopedia of Gene and Genomes (KEGG) to elucidate the metabolic pathways of the validated differential metabolites. ResultsA total of 22 and 23 metabolites had significantly different abundances in the discovery and validation cohort, respectively. Six of them (creatinine, L-proline, citrulline, butyrylcarnitine, 1-methylhistidine, and valerylcarnitine) in the RD group was more abundant than that of the health group in both cohorts. The combination of the six validated differential metabolites were able to accurately detect RD (AUC 0.86). Three of the six metabolites are involved in the metabolism of arginine and proline. ConclusionsThe present study highlights that creatinine, L-proline, citrulline, butyrylcarnitine, 1-methylhistidine, and valerylcarnitine are metabolite indicators with potential predictive value for CKD.

Long-term safety of total knee arthroplasty in patients with chronic kidney disease in Taiwan: a retrospective cohort study

Background: Chronic kidney disease (CKD) is a prevalent condition in Taiwan, and the incidence of total knee arthroplasty (TKA) is on the rise. This study aimed to evaluate the postoperative results of patients with different degrees of CKD after TKA, using data from the Taiwan National Health Insurance Research Database.Methods: The study analyzed 3,078 patients who received TKA from 2012 to 2017, equally divided into three groups: none-CKD, mild CKD (without dialysis), and severe CKD (with dialysis). Propensity score matching was used to minimize selection bias.Results: After TKA, there was no significant difference in the risk of debridement surgery for infection between the three groups (adjusted HR of mild CKD 0.71 95% CI = 0.36 - 1.38, P = 0.3073; adjusted HR of severe CKD: 1.14, 95% CI = 0.63 - 2.06, P = 0.6616). However, CKD patients requiring dialysis had a significantly higher risk of mortality (adjusted HR 1.98, 95% CI = 1.57 - 2.50, P < 0.001) and readmission within 90 days of any causes (adjusted HR 1.83, 95% CI = 1.48 - 2.26, P < 0.001) than non-CKD and mild CKD patients.Conclusion: Severe CKD patients needing dialysis after TKA have a higher risk of mortality and readmission rates than that of the non-CKD or mild CKD patients. If the patient is in the early stage of CKD, their prognosis after receiving TKA is expected to be as good as non-CKD patients.Level of evidence : IV; well-designed cohort study.