Epidemiology Of Chronic Kidney Disease Research Articles

Principles of nutrition in chronic kidney disease in children - a review of the clinical trials and recommendations

Introduction: Children with chronic kidney disease (CKD) require a specialized diet to manage their condition and support healthy growth and development. A proper diet for children with CKD aims to control the intake of certain nutrients, such as protein, lipid, calcium, phosphorus, potassium, sodium, and vitamin D, while ensuring they receive adequate nutrition for growth and development. Aim of the study: This article discusses the epidemiology, causes and pathomechanism of CKD in children. It also presents existing clinical trials and dietary recommendations from societies such as Kidney Disease: Improving Global Outcomes (KDIGO) 2024, Kidney Disease Outcomes Quality Initiative (KDOQI) and Pediatric Renal Nutrition Taskforce (PRNT) and identifies potential sources of selected macronutrients and micronutrients in children's diets. Materials and methods: Comprehensive literature searches were performed across the main electronic databases of PubMed, Google Scholar, KDIGO2024, KDQQI and PRNT recommendations for studies published in the English language about dietary recommendations for children with CKD. Results: The approach to nutrition for children with CKD is still evolving, and specific macronutrient and micronutrient ratios should be established based on the clinical condition, the child's age, and body weight. Care should be taken to ensure that the child's diet is varied, and a healthy eating style should be promoted.

#294 Pragmatic literature reviews to populate a patient-level model to project the future clinical burden of CKD in low-and middle-income countries

Abstract Background and Aims Chronic Kidney Disease (CKD) affects approximately one in ten people around the world and is associated with an increased risk of adverse cardiorenal outcomes and mortality. In low- and middle-income countries (LMICs), the situation is aggravated by the paucity of kidney replacement therapies (KRTs). The objective of this study was to review the literature around CKD prevalence to understand the future epidemiology and economic burden of CKD in four LMICs from different continents. Method Inside CKD is a project designed to perform a microsimulation on a representative patient cohort to simulate renal disease progression into the future, and to model the effects of interventions based on population and disease characteristics. A pragmatic literature review was performed to obtain the inputs required to adapt the Inside CKD model to project the epidemiological and economic burden of CKD in four World Bank (2022) classified LMICs (Bolivia, Kenya, Sri Lanka and Uzbekistan). Using a data quality scoring system designed for the Inside CKD programme, a model input template was created to guide the country-specific literature search, to identify country demographics, epidemiological data including CKD staging data, renal registries, comorbidities (type 2 diabetes and hypertension), complications data (stroke, myocardial infarction, heart failure) and economic data including health costs and quality-of-life measures. Additional needs, challenges or country specific risk factors have also been identified. Results Literature reviews identified the best sources of demographic, epidemiological data as well as the main drivers of CKD in the four countries (e.g. hypertension, type 2 diabetes, heart failure). In addition, the reviews identified the best proxy data to use when country-specific data was not available. The UN World Prospects database was selected to derive the current and future population dynamics in the four countries. For Kenya, data from local sources, sub-Saharan African and Uganda were utilised to estimate the primary drivers of CKD: a 2018 meta-analysis reported a CKD prevalence of 18% in sub-Saharan Africa and was used to derive the eGFR and UACR data required to project CKD prevalence. CKD prevalence by stage was also identified for Bolivia. A large-scale study across 12 countries with consistent methodology estimated a CKD prevalence of around 5.5% in Bolivia. CKD data from Kazakhstan was selected as a proxy for Uzbekistan, which had a low prevalence of 1.3%. Country-specific challenges were also identified: in Kenya, results showed the importance of malnutrition, infection and climate as key drivers of CKD. In Sri Lanka and Uzbekistan, environmental factors (air and water pollution) and agricultural activity may contribute to high CKD prevalence in rural areas alongside more common risk factors such as hypertension. In Sri Lanka, CKD has been estimated at around 8.2% in the general population versus 15.0% in areas where groundwater is consumed. For Bolivia, additional parameters including occupation, altitude, seasonal weather variation and extreme temperatures may exacerbate CKD risk. Conclusion CKD is a major public health problem in LMICs but with diverse drivers. Local capacities and healthcare financing priorities vary between regions and depend upon competing demands of acute conditions, infections and non-communicable diseases. Forecasting future CKD burden is helpful for policy and planning purposes. There is a clear need to tailor policies beyond early screening and proactive management to tackle country-specific challenges such as occupation, infection, seasonal weather variation and genetics.

#853 Kidney-protective medication and risk of adverse clinical outcomes in patients with chronic kidney disease: preliminary findings from DISCOVER CKD

Abstract Background and Aims Renin-angiotensin-system inhibitors (RASi) have been a foundational therapy in chronic kidney disease (CKD) for several decades. Sodium-glucose co-transporter-2 inhibitors (SGLT2i) have also emerged as a critical disease-modifying therapy in CKD, with contemporary data from trials showing SGLT2i to significantly improve kidney and cardiovascular (CV) outcomes in patients with or without diabetes. Nonetheless, several studies have revealed sub-optimal prescribing of RASi and/or SGLT2i therapy (both herein referred to as kidney-protective medication) in patients with CKD. Using prospective data from the DISCOVER CKD study, we conducted an exploratory analysis to assess the association of kidney-protective medication real-world use with mortality risk, CV events (fatal and non-fatal), and hospitalisation in patients with CKD. Method DISCOVER CKD (NCT04034992) is a multi-country, non-interventional cohort study designed to characterise the epidemiology of CKD, including describing patient characteristics, disease progression, clinical outcomes, patient journey, practice patterns, and clinical management. In the prospective phase, patients with CKD were recruited from the UK, USA, Spain, Italy, Sweden and Japan between September 2019 and June 2022. Clinical data were extracted manually from patients’ health records into a standardised case report form. The current analysis includes 12 months’ follow-up data. A Cox proportional hazards model was used to compare the risk of all-cause mortality and CV events and a negative binomial regression model was used to compare the risk of all-cause hospitalisation between patients receiving and not receiving kidney-protective medication at baseline, with adjustments for age, sex, CKD stage, diabetes mellitus, hyperkalaemia, and heart failure. DISCOVER CKD received research ethics board approval, and informed consent was obtained from all patients. Results Of the 1052 patients enrolled in DISCOVER CKD, 643 (61.1%) were receiving kidney-protective medication in the form of RASi (n = 618) and SGLT2i (n = 147) at baseline. The mean age of participants receiving and not receiving kidney-protective medication was 62.4 years and 62.7 years, respectively; 34.4% and 40.8%, respectively, were female. Most patients had CKD stage 3A (n = 332, 31.6%) or 3B (n = 308, 29.3%), and 8.4% (n = 88) had ongoing dialysis. Body mass index (30.4 vs 29.4 kg/m2) and blood pressure were similar for those receiving kidney-protective medication versus those who were not. Laboratory assessments were also generally similar, although estimated glomerular filtration rate (eGFR; 40.9 vs 33.7 mL/min/1.73 m2) and haemoglobin (132.0 g/L vs 124.0 g/L) were higher in patients receiving kidney-protective medication versus those not. During the follow-up, patients receiving kidney-protective medication had a 67% lower risk of all-cause mortality (hazard ratio [HR] 0.33; 95% confidence interval [CI] 0.12–0.80, p = 0.019), and a 20% lower risk of all-cause hospitalisation (HR, 0.80; 95% CI 0.64–0.99, p = 0.042) compared with patients not receiving kidney-protective medication. In the population without pre-existing CV disease, a trend towards a lower rate of CV events was observed in patients with kidney-protective medication (CV events rates: 2.2 vs 3.2 per 100 person-years; HR, 0.38; 95% CI 0.12–1.08, p = 0.074 (Figure). Conclusion In this multinational CKD cohort, preliminary analysis indicates that using kidney-protective medication was associated with lower risks of adverse outcomes including death. Further analysis to mitigate potential confounding will be performed to confirm these preliminary findings.

#837 Information needs and emotional impact when receiving a diagnosis of chronic kidney disease: insights from DISCOVER CKD

Abstract Background and Aims Chronic kidney disease (CKD) is often a silent condition, with symptoms typically not appearing until a large proportion of kidney function has been lost. Therapeutic interventions, e.g., disease-modifying medications, blood pressure and diabetes control, and lifestyle changes, can delay CKD progression, particularly if instigated early. However, psychological distress can reduce adherence to interventions. It is important patients are adequately informed about their diagnosis to improve adherence and reduce the impact of distress. Multinational, real-world data on patient experiences with CKD, particularly about clinical management, treatment patterns and quality of life, are limited. This DISCOVER CKD sub-study aimed to capture the emotions elicited by patients at CKD diagnosis and their perceptions of the information received. Method DISCOVER CKD (NCT04034992) is a multinational cohort study that aims tocharacterise the epidemiology of CKD and describe patient characteristics, CKD progression, clinical outcomes, the patient journey, practice patterns, and clinical management. The current analysis includes a subset of patients from the USA, UK, Japan, and Spain, who participated in 1-2-1 telephone interviews about their CKD experience, including their disease journey and interactions with the healthcare system. Interview topics in DISCOVER CKD were informed by a pilot study that utilised data from PatientsLikeMe, an online network for patients to share personal stories and health data. Qualitative interviews, conducted in the local language by trained interviewers, January–June 2023, lasted ∼60–90 minutes. Transcribed interviews were translated into English for coding (MAXQDA Plus 2022 v22.3.0) and analysis. The study received research ethics board approval and all participants provided written informed consent. Results 103 patients (mean age 63.1 years; 42.7% female; 51.5% with type 2 diabetes) were interviewed. Most had CKD stage 3A (22.3%) or 3B (28.2%); 26.2% had stage 4 or 5 no dialysis and 9.7% were stage 4 (n = 1) or 5 on dialysis. Average time since diagnosis was 9.5 years. Over one-third (38.8%; n = 40/103) of participants did not recall any specific symptoms or signs of CKD prior to diagnosis. Of the pre-diagnosis symptoms reported, the most common was fatigue (21.4%; n = 22/103), then high blood pressure (15.5%; n = 16/103) and swelling (11.7%; n = 12/103). With respect to patient experiences, 55.2% (n = 32/58) said they did not feel sufficient information about CKD was provided at diagnosis and 59.2% (n = 45/76) said no information about their CKD stage was shared. Participants felt overwhelmed and confused about the diagnostic process and struggled to understand the information provided to them, including information about kidney function and symptoms. To supplement their understanding, participants reported using additional sources of information, including the internet (52.9%; n = 36/68), other healthcare professionals (HCPs) (19.1%; n = 13/68), books/printed information (11.8%; n = 8/68) and patient support groups (8.8%; n = 6/68). The most common emotions experienced at the time of diagnosis were worry and fear (28.2%; n = 29/103), then shock/surprise (25.2%; n = 26/103) (Figure). For those reporting no reaction (27.2%; n = 28/103), many stated the condition had no discernible effect on their daily lives. Reasons for fear or worry were related to the potential for disease progression. Conclusion Many patients expressed dissatisfaction with the information they received at their CKD diagnosis. This suggests that HCPs could dedicate more time to explaining the diagnosis, the characteristics and severity of CKD, likelihood of progression, and the benefits of self-management and adherence to intervention. This could be particularly important for those without symptoms at the time of diagnosis, and patients who rely on HCPs as their primary source of information. Patients should be asked what information they want to receive and be directed to trusted sources. The diagnostic process was a highly emotional experience for many patients and counselling or psychological therapy should be considered.

Early identification of thyroid illness and its intricate relationship to renal function may be crucial for therapy planning

An epidemiological shift has occurred in India, where the burden of chronic illnesses is increasing, and communicable diseases are declining. Chronic diseases such as diabetes mellitus, cancer, and chronic respiratory disorders are on the rise, and this trend has been attributed to unhealthy lifestyles, increased urbanization, and changes in society and the environment. Such a category did not include chronic kidney disease (CKD). End-stage renal disease (ESRD) is defined as glomerular filtration rate (GFR) <15 ml/min/1.73 m2, while chronic kidney disease (CKD) is defined as a sustained eGFR of <60 ml per minute per 1.73 m2 of body-surface area for more than three months irrespective of the underlying cause while glomerular filtration rate (GFR) <15 ml/min/1.73 m2 is considered as end-stage renal disease (ESRD). CKD is classified into five stages ranging from mild dysfunction to complete failure. Globally, CKD is a significant cause of morbidity and death and there is a 38% increase in mortality linked to renal failure in developing nations like India. It has been shown that the epidemiology of CKD in India differs from that in the West; patients in India were, on average, five to twenty years younger Pregnancy-related malnutrition, environmental variables, genetics, or postponed medical care that accelerates the course of CKD are among the likely reasons and birth weight.The present hospital-based, cross-sectional, observational study was conducted in the a tertiary care teaching hospital in South India from December 2020 to January 2024. The study comprised 50 patients of CKD between 30 and 70 years of age of both sexes with no previous history of any thyroid dysfunction, while 50 apparently healthy age and sex-matched individuals from the same ethnic population with normal renal function and no past history of thyroid disorders served as a control group.The results of this study and most others, there is a possibility that abnormal thyroid hormone activity may result in a decline in renal function. Early identification of thyroid illness and its intricate relationship to renal function may be crucial for therapy planning.The current cross-sectional hospital-based observational study discovered that uremic patients had considerably lower mean TT3 and TT4 and higher mean TSH when compared to healthy controls, regardless of the kind of medication or duration of the disease. Based on the results of this study and most others, there is a possibility that abnormal thyroid hormone activity may result in a decline in renal function. Early identification of thyroid illness and its intricate relationship to renal function may be crucial for therapy planning.

From Sugar Spikes to Pressure Peaks: Navigating the World of Diabetes, Hypertension, Obesity, and Kidney Health.

Diabetes, hypertension, obesity, and chronic kidney disease (CKD) are major public health challenges globally, contributing significantly to morbidity and mortality. The co-occurrence and interplay among these conditions exacerbate health outcomes, highlighting the need for an integrated understanding and approach to management. This narrative review aims to explore the complex relationships between diabetes, hypertension, obesity, and CKD, elucidating their collective impact on health. It discusses the epidemiological trends, underlying pathophysiological mechanisms, genetic predispositions, current treatment strategies, and the future direction of research and therapy. An extensive review of current literature was conducted, focusing on the epidemiology, pathophysiology, risk factors, diagnosis, and treatment of diabetes, hypertension, obesity, and CKD. Additionally, the review delves into the genetic and molecular biology underlying these conditions, the potential for personalized medicine, and the importance of a multidisciplinary approach to care. The review identifies key areas where these conditions intersect, enhancing disease progression and complicating management. It highlights the role of genetic and environmental factors in disease etiology, the critical need for personalized treatment strategies, and the gaps in current management approaches. Innovations in pharmacotherapy, monitoring technologies, and the potential of pharmacogenomics are discussed as avenues for advancing patient care. Diabetes, hypertension, obesity, and CKD are intricately linked, necessitating an integrated, patient-centered approach to care that goes beyond traditional treatment modalities. Future research should focus on collaborative models and interdisciplinary strategies to address the multifaceted challenges posed by these conditions. Emphasizing personalized medicine and leveraging technological advancements offer promising pathways to improve outcomes and reduce the global health burden of these metabolic disorders.

Analysis of chronic kidney disease epidemiology in Kazakhstan using nationwide data for 2014–2020 and forecasting future trends of prevalence and mortality for 2030

According to the Global Burden of Disease (GBD) study, chronic kidney disease (CKD) was prevalent in 697.5 million individuals worldwide in 2017. By 2040, it is anticipated that CKD will rank as the fifth most common cause of death. This study aims to examine the epidemiology of CKD in Kazakhstan and to project future trends in CKD prevalence and mortality by 2030. The retrospective analysis was performed on a database acquired from the Unified National Electronic Health System for 703,122 patients with CKD between 2014 and 2020. During the observation period, 444,404 women and 258,718 men were registered with CKD, 459,900 (66%) were Kazakhs and 47% were older than 50. The incidence rate notably decreased: 6365 people per million population (PMP) in 2014 and 4040 people PMP in 2020. The prevalence changed from 10,346 to 38,287 people PMP, and the mortality rate increased dramatically from 279 PMP to 916 PMP. Kazakhstan’s central regions, Turkestan and Kyzylorda were identified as the most burdensome ones. The ARIMA model projected 1,504,694 expected prevalent cases in 2030. The predicted mortality climbed from 17,068 cases in 2020 to 37,305 deaths in 2030. By 2030, the prevalence and mortality of CKD will significantly increase, according to the predicted model. A thorough action plan with effective risk factor management, enhanced screening among risk populations, and prompt treatment are required to lessen the burden of disease in Kazakhstan.

Sex-specific differences in a large cohort of Brazilian incident dialysis patients over 12 years: A retrospective study.

Sex-specific differences in the epidemiology of chronic kidney disease, such as higher prevalence of women on pre-dialysis and men on chronic dialysis treatment, have been reported worldwide. In this regard, data from non-high-income countries are scarce. We aimed to compare the demographic, clinical, and dialysis characteristics of incident dialysis patients, both men and women, in a large cohort of Brazilian patients over a 12-year period. This was a multicentric retrospective cohort study coordinated by the Brazilian Society of Nephrology. The study included all adult incident dialysis patients in the Brazilian Dialysis Registry from January 2011 to December 2022. The variables studied encompassed age, skin color, education, CKD etiology, predialysis nephrologist care, dialysis characteristics, and geographic region. Additionally, the sample was analyzed for each of the three 4-year periods over the 12 years of data collection. A total of 24,632 incident dialysis patients were included. Men were 59.1% of the dialysis population, remaining stable over the three 4-year periods. Besides other differences, women started dialysis younger (58.5 ± 16.2 years vs 59.5 ± 14.4 years; p < 0.001), had a lower educational level (less than 8 years at school: 54% vs 44%; p < 0.001), received more predialysis nephrologist care (46.2% vs 44.2%; p = 0.04), and had a higher prevalence of peritoneal dialysis (4.4% vs 3.5%; p = 0.03). We consistently observed a higher prevalence of men on dialysis and differences in demographic, clinical, and dialysis characteristics. The underlying reasons for these sex differences still necessitate further clarification.

Trends in the epidemiology of chronic kidney disease in patients with diabetes in Russian Federation according to the Federal diabetes register (2010–2022)

BACKGROUND: Chronic kidney disease (CKD) in diabetes mellitus (DM) is a supranosological concept that characterizes multifactorial kidney damage associated with increased cardiovascular and mortality risk, which determines the high medical and social significance of this problem in diabetic patients.AIMS: To assess the clinical and epidemiological characteristics of CKD in adult DM patients with type 1(T1) and type 2 (T2) in Russian Federation (RF) in 2010–2022 according to the Federal Register of Diabetes Mellitus (FDR) and to present the capabilities of the register’s analytical tools for assessing organ-protective therapy and predicting the risk of pathology.MATERIALS AND METHODS: We have used the database of FRD (http://diaregistry.ru), 85 regions of the RF. The data are presented as of 01.01.2023 and in dynamics for the period 2010–2022.RESULTS: The CKD prevalence in adult DM patients in RF in dynamics 2010→2022 showed in an increase in the rate for T1 from 21.5 to 27.1% (1.3 times), for T2 from 5.2 to 19.1% (3.7 times). The incidence of new CKD cases was 153.3→106.3/10 000 adult patients in T1, and 64.3→212.8/10 000 adult patients in T2. The analysis of the distribution by CKD stage indicates improved diagnosis of the complication. In the structure of new cases of CKD in the dynamics of 2010→2022. The proportions of patients with low and moderate combined risk of cardiovascular events and end-stage renal failure according to KDIGO criteria increased for T1 63.7→82.4%, for T2 64.5→77.4%. The proportions of patients with very high risk progressively decreased for T1 12.3→4.0%, for T2 13.1→1.6%. The average age of onset of CKD increased by an average of 6 years in persons with type 1 and type 2 diabetes (35.6→42 years, 63.3→69.3 years, respectively), with the dynamics of the average DM duration at the time of CKD development: in T1 11.5→14.8 years, in T2 7.4→7.8 years. The cause of terminal CKD in the structure of mortality in DM patients took only in T1 patients 5.6% and in T2D — 2.0%. A retrospective analysis of factors influencing the fatal outcome of DM patients with COVID-19 showed the significance of a history of CKD in T2DM patients, which increases the risk of death by 1.49 times (95% CI 1.01–2.04). Analysis of the structure of glucose-lowering therapy in T2DM patients and CKD indicates a more frequent prescription of drugs from the group of SGLT-2 inhibitors, DPP-4 inhibitors, and GLP-1 receptor antagonists compared to the general cohort of T2DM. There is the CKD prognosis calculator in the FRD, which allows assessing the risk of developing of pathology within 5 years in a particular patient based on a set of the most significant predictors, which included 6 factors for T1 and 11 factors for T2. CONCLUSIONS: Epidemiological trends in the prevalence of CKD over a 13-year period indicate the growing importance of this problem in DM patients who are at risk. Along with the positive trends in the development of pathology with a longer duration of diabetes, in clinical practice the problem remains of untimely detection of CKD with impaired renal function at advanced stages. The progressive nature of the course and the negative impact of kidney damage on the risks of premature mortality in patients determine the priority of preventive diagnostic and therapeutic strategies aimed at compliance with the standard of examination, detection of pathology in the early stages and a multifactorial approach to nephroprotection, according to clinical recommendations.

Kidney function decline associated with proton pump inhibitors: results from the ELSA-Brasil cohort

ObjectiveInvestigate the longitudinal association of use and time of use of proton pump inhibitors (PPI) with incidence of chronic kidney disease (CKD) and kidney function change.MethodsProspective study with 13,909 participants from baseline (2008–2010) and second wave (2012–2014) of the ELSA-Brasil (mean interval between visits = 3.9 years (1.7–6.0)). Participants answered about use and time use of the PPI in the two weeks prior the interview. Renal function was assessed by glomerular filtration rate estimated by the Collaboration Equation for the Epidemiology of Chronic Kidney Disease. Values below 60ml/min/1.73 m² in wave 2 were considered incident CKD. Associations between PPI use and time of use at baseline and incident CKD and decline in renal function were estimated, respectively, by logistic regression and linear models with mixed effects, after adjusting for confounders.ResultsAfter adjustments, PPI users for more than six months had an increased risk of CKD compared to non-users. Compared to non-users, users PPIs for up to six months and above six months had greater decline in kidney function over time.ConclusionThis cohort of adults and elderly, after a mean interval of 3.9 years, PPI use and initial duration were associated with kidney function change between visits.

Chronic Kidney Disease Among Agricultural Workers in Taiwan: A Nationwide Population-Based Study

Chronic kidney disease (CKD) in agricultural communities is a significant public health issue. We aimed to investigate the epidemiology of CKD among Taiwanese farmers and its association with outdoor heat exposure. A nested case-control study was conducted on participants in the National Adult Health Examination (NAHE) from 2012 to 2018. The farming occupation was identified through National Health Insurance data. The primary outcomes of interest were the development of CKD, defined as a decreased estimated glomerular filtration rate (eGFR) with diagnosis by physicians, and CKD of undetermined etiology (CKDu), defined as CKD excluding common traditional etiologies. We calculated the county-wide average ambient temperature from a climate reanalysis dataset (ERA5-Land). All CKD cases were matched 1:2 to non-CKD participants by age and biological sex. We estimated the odds ratios (ORs) of CKD and CKDu for farmers and changes in mean ambient temperature (°C) before the examination. We identified 844,412 farmers and 3,750,273 nonfarmers. Among 24.9% of farmers and 7.4% of nonfarmers with reduced kidney function, only 1 in 7 received a diagnosis of CKD. The farming occupation was independently predictive of CKDu (OR= 1.09, 95% confidence interval [CI]= 1.001-1.18) but not CKD. Increased ambient temperature (°C) was associated with a higher risk of CKD (OR= 1.023, 95% CI= 1.017-1.029), with particularly strong associations observed among middle-aged participants and diabetics. Taiwanese farmers might have a higher risk of developing CKDu. Outdoor heat exposure is associated with the development of CKD, and middle-aged participants and those with diabetes are more vulnerable than the general population.

Epidemiology of chronic kidney disease in older indigenous peoples of Brazil: findings from a cross-sectional survey.

Chronic kidney disease (CKD) is a prevalent disease worldwide, with increasing incidence particularly in low- and middle-income countries. Indigenous communities have poorer CKD outcomes due to limited access to healthcare. They are also experiencing a shift toward a sedentary lifestyle and urbanization-related dietary changes, increasing the risk of CKD-related risk factors. To determine the prevalence of CKD in older Brazilian indigenous and identify the main associated risk factors. This cross-sectional study analyzed demographic and clinical data of 229 older indigenous individuals aged 60years and above in 2022-2023. CKD was defined as an estimated glomerular filtration rate < 60mL/min/1.73m2 or a urinary albumin-creatinine ratio > 30mg/g. Data were presented categorically and analyzed using the Chi-square test or Fisher's exact test. The prevalence of CKD in the population was 26.6%, with higher prevalence in women and increasing with age. The prevalence of hypertension and diabetes was 67.7% and 24.0%, respectively, and these comorbidities were associated with CKD: hypertension (OR = 5.12; 95% CI 2.2-11.9) and diabetes (OR = 5.5; 95% CI 3.7-8.2). No association was found between the prevalence of CKD and obesity, dyslipidemia, cardiovascular disease, or smoking. The study found a higher prevalence of CKD among older indigenous populations in Brazil compared to non-indigenous populations, which is exacerbated by risk factors, such as aging, hypertension, diabetes, and lifestyle changes, emphasizing the importance of early detection and intervention in these communities. Older persons' indigenous individuals have a high prevalence of CKD, which is correlated with factors, such as sex, age, diabetes mellitus, and hypertension.

Epidemiology And Risk Factors Of Chronic Kidney Disease In Rural Areas 4 (Badin) Of Sind, Pakistan.

To evaluate the epidemiology of chronic kidney disease in a rural setting. The retrospective study was conducted at Indus Hospital, Badin, Sindh, Pakistan, and comprised data of patients of either gender regardless of age who visited the nephrology clinic between July 2019 and July 2020. Data was retrieved from the institutional health management information system. Data was analysed using SPSS 21. Of the 348 patients, 184(52.9%) were males and 164(47.1%) were females. The overall mean age was 40.4±19 years. Obstructive nephropathy was the most frequent cause of chronic kidney disease 108(31%), followed by chronic kidney disease of unknown aetiology 79(22.7%). The most prevalent comorbid was hypertension in 106(30.5%) patients, while 56(16.1%) were diabetic. The stone disease was found in 90(24.6%) patients. Age was strongly associated with chronic kidney disease (p<0.001). Among those with chronic kidney disease of unknown aetiology, 35(44.3%) patients were aged 31-50 years 35. The expected glomerular filtration rate in such patients was significantly associated with the cause of chronic kidney disease (p<0.001). Unknown aetiology and kidney stones were the leading causes of chronic kidney disease among the rural population studied.

#5817 EPIDEMIOLOGY OF CHRONIC KIDNEY DISEASE AND COMORBID ILLNESS IN OLDER HOSPITALIZED PATIENTS

Abstract Background and Aims The number of older people in Europe is expanding. Although chronic kidney disease (CKD) becomes more common with increasing age, data concerning epidemiology of CKD in older people are scarce, especially in Eastern Europe countries. These patients have multiple chronic conditions that must be correctly quantified for guiding risk stratification and subsequent management. Previously, European Renal Best Practice (ERBP) guidelines shed some light on managing older patients with advanced CKD, by stimulating the implementation of validated tools for predicting the most critical risks (death and progression to end-stage renal disease). Risk stratification can further inform decisions about the intensity of care (dialysis versus conservative treatment). In the current analysis, we aimed to fill the gap in CKD epidemiology in older people from Romania by describing a large population of hospitalized geriatric patients. Method In this retrospective cohort study, we included all patients aged ≥ 65 years hospitalized in the Geriatric Department of “Dr. C. I. Parhon” Hospital from Iași, Romania, between 2012 – 2022. This Geriatric Unit covers the entire North-East region of the country, so patients are representative of a population of almost 4 million people. CKD was identified as decreased estimated glomerular filtration rate (&amp;lt;60 ml/min/1.73 m2) according to CKD-EPI equation. We investigated comorbid conditions including diabetes mellitus, hypertension/hypertensive heart disease, coronary artery disease, congestive heart failure, atrial fibrillation, chronic respiratory failure and anemia. Results 3563 geriatric patients (59,2% females) were hospitalized between 2012–2022, totalling 5124 hospital admissions. The most common diagnosis was congestive heart failure (1958 cases, 38,2%) frequently due to hypertensive heart disease (877 patients, 44.8% of CHF cases). 3116 patients (87,4% of the total population) had a serum creatinine assay. Among these patients, the prevalence of CKD using the CKD-EPI equation was 32%. The mean age of CKD patients was 79 years, gender distribution was unequal (63,4% females) and almost half of them (49,1%) had stage 3a CKD. The most frequent comorbidities in patients with CKD were congestive heart failure (33%), diabetes (19%) and hypertension (17%), followed by atrial fibrillation (11%), chronic respiratory failure (9%), coronary artery disease (6%) and anemia (3%). The distribution of CKD patients stratified by the number of comorbidities showed that 86,7% had ≥ 2 comorbidities. The largest CKD subgroup was the one that associated three comorbidities (315 patients, 31.5%), followed by two subgroups that had two comorbidities (249 patients, 24,9%), respectively four comorbidities (189 patients, 18.9%). Only a minority of CKD patients (24 adults, 2,4%) had no other chronic condition. Conclusion With the ageing of the population, cardiovascular disease is becoming more common. In our population of geriatric patients, heart failure was the leading cause of hospitalization and the most frequent comorbid condition in CKD patients. One in three adults ≥ 65 years had CKD, a finding similar to other literature data. We emphasized that in older adults, CKD is not an isolated entity, which makes caring for these patients challenging, especially if we add the negative impact of other superimposed geriatric syndromes like frailty and cognitive decline.

Unmet Needs of CKD in Latin America: A Review from Expert Virtual Working Group

Chronic kidney disease (CKD) represents a major challenge for Latin American (LatAm) because of its epidemic proportions. Therefore, the current status and knowledge of CKD in Latin America is not clearly understood. Moreover, there is a paucity of epidemiologic studies that makes the comparison across the countries even more difficult. To address these gaps, a virtual kidney expert opinion meeting of 14 key opinion leaders from Argentina, Chile, Colombia, Costa Rica, Dominican Republic, Ecuador, Guatemala, Mexico, and Panama was held in January 2022 to review and discuss the status of CKD in various LatAm regions. The meeting discussed the following: (i) epidemiology, diagnosis, and treatment of CKD, (ii) detection and prevention programs, (iii) clinical guidelines, (iv) state of public policies about diagnosis and management of chronic kidney disease, and (v) role of innovative therapies in the management of CKD. The expert panel emphasized that efforts should be made to implement timely detection programs and early evaluation of kidney function parameters to prevent the development or progression of CKD. Furthermore, the panel discussed the importance of raising awareness among health care professionals; disseminating knowledge to the authorities, the medical community, and the general population about the kidney and cardiovascular benefits of novel therapies; and the need for timely updating of clinical practice guidelines, regulatory policies, and protocols across the region.

Clinical implications and guidelines for CKD in type 2 diabetes.

Chronic kidney disease (CKD) is a complication of type 2 diabetes (T2D) with high morbidity and mortality. The prevalence of CKD in T2D is increasing due to rising numbers of persons with T2D. Multiple clinical trials have been conducted testing novel therapies to reduce the progression of CKD, cardiovascular morbidity, in particular hospitalization for heart failure, and mortality. Results of these clinical trials have informed guidelines for the management of CKD in T2D. The epidemiology of CKD in T2D and the process of guideline writing, including data gathering, grading and consensus development, were reviewed. Recent guidelines for the management of CKD in T2D that include recent renal outcome clinical trials are reported, along with supporting evidence. All current guidelines recommend annual screening for CKD, control of blood pressure and glucose, although the target levels and background therapy recommendations vary. Renin-angiotensin system (RAS) inhibition is uniformly recommended. Sodium-glucose cotransporter-2 (SGLT2) inhibition with proven agents is recommended by all guidelines, with minor variations in suggested estimated glomerular filtration rate and albuminuria levels. Finerenone, the first nonsteroidal mineralocorticoid receptor antagonist with renal outcome data, is recommended by the most recent guideline available. Current guidelines continue to recommend screening for CKD, blood pressure control using RAS inhibition as first-line therapy, and glucose control. SGLT2 inhibition and finerenone are recent additions to current guidelines to improve CKD outcomes in T2D, based on robust clinical trial data.

Developing a common data model approach for DISCOVER CKD: A retrospective, global cohort of real-world patients with chronic kidney disease.

ObjectivesTo describe a flexible common data model (CDM) approach that can be efficiently tailored to study-specific needs to facilitate pooled patient-level analysis and aggregated/meta-analysis of routinely collected retrospective patient data from disparate data sources; and to detail the application of this CDM approach to the DISCOVER CKD retrospective cohort, a longitudinal database of routinely collected (secondary) patient data of individuals with chronic kidney disease (CKD).MethodsThe flexible CDM approach incorporated three independent, exchangeable components that preceded data mapping and data model implementation: (1) standardized code lists (unifying medical events from different coding systems); (2) laboratory unit harmonization tables; and (3) base cohort definitions. Events between different coding vocabularies were not mapped code-to-code; for each data source, code lists of labels were curated at the entity/event level. A study team of epidemiologists, clinicians, informaticists, and data scientists were included within the validation of each component.ResultsApplying the CDM to the DISCOVER CKD retrospective cohort, secondary data from 1,857,593 patients with CKD were harmonized from five data sources, across three countries, into a discrete database for rapid real-world evidence generation.ConclusionsThis flexible CDM approach facilitates evidence generation from real-world data within the DISCOVER CKD retrospective cohort, providing novel insights into the epidemiology of CKD that may expedite improvements in diagnosis, prognosis, early intervention, and disease management. The adaptable architecture of this CDM approach ensures scalable, fast, and efficient application within other therapy areas to facilitate the combined analysis of different types of secondary data from multiple, heterogeneous sources.

Unlocking Potential within Health Systems Using Privacy-Preserving Record Linkage: Exploring Chronic Kidney Disease Outcomes through Linked Data Modelling

Background Chronic kidney disease (CKD) is a major global health problem that affects approximately one in 10 adults. Up to 90% of individuals with CKD go undetected until its progression to advanced stages, invariably leading to death in the absence of treatment. The project aims to fill information gaps around the burden of CKD in the Western Australian (WA) population, including incidence, prevalence, rate of progression, and economic cost to the health system. Methods Given the sensitivity of the information involved, the project employed a privacy preserving record linkage methodology to link data from four major pathology providers in WA to hospital records, to establish a CKD registry with continuous medical record for individuals with biochemical specification for CKD. This method uses encrypted personal identifying information in a probability-based linkage framework (Bloom filters) to help mitigate risk while maximizing linkage quality. Results The project developed interoperable technology to create a transparent CKD data catalogue which is linkable to other datasets. This technology has been designed to support the aspirations of the research program to provide linked de-identified pathology, morbidity, and mortality data that can be used to derive insights to enable better CKD patient outcomes. The cohort includes over 1 million individuals with creatinine results over the period 2002 to 2021. Conclusion Using linked data from across the care continuum, researchers are able to evaluate the effectiveness of service delivery and provide evidence for policy and program development. The CKD registry will enable an innovative review of the epidemiology of CKD in WA. Linking pathology records can identify cases of CKD that are missed in the early stages due to disaggregation of results, enabling identification of at-risk populations that represent targets for early intervention and management.

MO393: Kidney Echogenicity and Kidney Length as Surrogate Markers of Kidney Function With an Increased Echogenic Pattern Being the Most Predictive of Renal Dysfunction, Particularly in HIV

Abstract BACKGROUND AND AIMS Non-communicable diseases (NCDs) are rapidly emerging as a major cause of chronic kidney disease (CKD) in Africa with a reported prevalence of 10.7% locally. At current, few high-quality studies assessing the epidemiology of CKD in South Africa have been published. Alarmingly, CKD is now at epidemic proportions and is a leading cause of mortality with significant cost implications. This study aims to investigate economic means of predicting renal function in CKD by exploring the association between estimated glomerular filtration rate (eGFR) and renal morphology evaluated by ultrasound (US). METHOD This is a retrospective descriptive chart review conducted at the Department of Nephrology, Inkosi Albert Luthuli Central Hospital (IALCH), Cato Manor, Kwa-Zulu Natal from January 2016 to December 2016. A total of 455 patients who had met the Kidney Disease Improving Global Outcomes (KDIGO) definition of CKD with eGFR (MDRD) and kidney US performed were included. Demographic, clinical, laboratory and kidney morphological data [kidney length (KL), increased echogenicity (IE) and loss of corticomedullary differentiation (LCMD)] on US were collected and analyzed with SPSS software (v. 27). Associations between eGFR, parameters on US and CKD risk factors were determined using logistic regression analysis. RESULTS Black Africans (75.2%; n = 342) and females (56.9%; n = 259) predominated the sample. Whilst, Indians, Whites and Coloreds comprised of 20.4%, 2.42% and 1.98% of the study respectively. The median age was 45.8 ± 14.3 years. Hypertension (34.9%), diabetes (26.8%), HIV (27.5%) and glomerulonephritis 9.89% were the four most frequently reported risk factors, of which Black Africans comprised more than 50% of cases (P &amp;lt; 0.001). A significant proportion of patients 65.7% (n = 307) had end-stage renal disease with a median eGFR of 14.4 ± 12.8mL/min/1.73m2 (P &amp;lt; 0.001). The median right and left KL were short at 8.49 ± 2.16 cm and 8.60 ± 2.20 cm respectively. Black Africans were also found to have significantly shorter KLs and lower eGFRs (P &amp;lt; 0.001). The dual effect of IE and LCMD predisposed to significantly shorter KLs and lower eGFRs than in the presence of one or no abnormality on US (P &amp;lt; 0.001). IE [−9.29 odds ratio (OR); 95% confidence interval (CI) (−13.8 to −4.77); P &amp;lt; 0.001] and KL [right: 5.02 OR; 95% CI (3.44–6.60); P = 0.04; left: 5.11 OR; 95% CI (3.56–6.66); P = 0.04] were found to be significant predictors of eGFR. HIV was the only risk factor found to be negatively associated with all determined measures of renal function, as well as the sole predictor of IE [2.31 OR; 95% CI (0.17–3.15); P = 0.02]. CONCLUSION The CKD epidemic is driven by the complex interplay between communicable (HIV) and NCDs (HPT/DM) and has emerged as important public health and economic threat in Southern Africa. Africans are most vulnerable presenting with an advanced and accelerated disease course. GFR determination and US are inexpensive means of determining renal function, particularly in resource-limited settings. IE and KL are surrogate markers of kidney function with an increased echogenic pattern being most predictive of kidney dysfunction in CKD, particularly in HIV.

Results of a community-based screening programme for chronic kidney disease and associated risk factors, (obesity, diabetes and hypertension) in a Samoan cohort

ObjectivesIn 2019, under the World Kidney Day theme of ‘Kidney health for everyone everywhere’, the National Kidney Foundation of Samoa undertook an extensive community screening campaign to detect the estimated...