Epidemiology Of Chronic Kidney Disease Research Articles

The 50th anniversary of haemodialysis in Krakow, Poland.

The 50th anniversary of haemodialysis in Krakow, Poland.

Creatinine-or cystatin C-based equations to estimate glomerular filtration in the general population: impact on the epidemiology of chronic kidney disease

BackgroundChronic kidney disease (CKD) is a major issue in public health. Its prevalence has been calculated using estimation of glomerular filtration rate (GFR) by the creatinine-based equations developed in the Modified Diet in Renal Disease (MDRD) and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) study. Recently, new equations based either on cystatin C (CKD-EPI Cys) or both cystatin and creatinine (CKD-EPI mix) have been proposed by the CKD-EPI consortium. The aim of this study was to measure the difference in the prevalence of stage 3 CKD, defined as an estimated GFR less than 60 mL/min/1.73 m2, in a population using these four equations.MethodsCKD screening was performed in the Province of Liège, Belgium. On a voluntary basis, people aged over 50 years have been screened. GFR was estimated by the four equations. Stage 3 CKD was defined as a GFR less than 60 mL/min/1.73 m2.ResultsThe population screened consisted of 4189 people (47% were men, mean age 63 ± 7y). Their mean serum creatinine and plasma cystatin C levels were 0.88 ± 0.21 mg/dL and 0.85 ± 0.17 mg/L, respectively. The prevalence of CKD in this population using the MDRD, the CKD-EPI, the CKD-EPI Cys and the CKD-EPI mix equations was 13%, 9.8%, 4.7% and 5%, respectively. The prevalence of CKD was significantly higher with the creatinine-based (MDRD and the CKD-EPI) equations compared to the new cystatin C-based equations.ConclusionsPrevalence of CKD varies strongly depending on the method used to estimate GFR. Such discrepancies are of importance and must be confirmed and explained by additional studies, notably by studies using GFR measured with a reference method.Trial registrationB70720071509

Chronic kidney disease: a new look at pathogenetic mechanisms and treatment options

The concept of renoprotection has evolved significantly, driven by improved understanding of the pathophysiology of chronic kidney disease (CKD) and the advent of novel treatment options. Glomerular hyperfiltration, hypertension and proteinuria represent key mediators of CKD progression. It is increasingly recognized that proteinuria may actually be pathological and etiological in CKD progression and not just symptomatic. It initiates a sequence of events involving activation of proinflammatory and profibrotic signaling pathways in proximal tubular epithelial cells with transmission of the disease to the tubulointerstitium and progression to end-stage kidney disease (ESKD). Although the etiology and epidemiology of pediatric CKD differs to that in adults, studies in the various animal models of kidney disease, from obstructive uropathy to glomerulonephritis, have revealed that many common proinflammatory and profibrotic pathways are induced in progressive proteinuric CKD, irrespective of the primary disease. This pathomechanistic overlap therefore translates into the potential for common treatment targets for a wide spectrum of kidney diseases. In this review we therefore discuss the experimental and clinical evidence for an array of prospective future drug treatments of CKD progression. While conceptually promising, clear definitive evidence beyond preclinical data does not exist for many of these treatments, and others are limited by serious adverse effects. More studies are needed before general recommendations can be given.

GRP-060 Evaluation of a Pharmaceutical Care Program to Patients with Impaired Renal Function

BackgroundAccording to EPIRCE study results (Epidemiology of Chronic Kidney Disease in Spain), approximately 11% of the adult Spanish population suffers from some degree of Cronic Kidney Disease (CKD).Purpose Evaluate a...

Chronic renal disease in children aged 5-18 years: a population-based survey in Turkey, the CREDIT-C study

Data on the epidemiology of chronic kidney disease (CKD), which is a serious health problem and refers to a condition related to irreversible kidney damage that further progress to end-stage renal disease in children, are insufficient and data that are available were based on hospital records. The aim of this nationwide, population-based field study was to determine the prevalence of CKD in children in Turkey and to evaluate the association between CKD and possible risk factors such as obesity and hypertension. The study was the paediatric stratum (3622 children aged 5-18 years) of the previously published population-based survey of Chronic REnal Disease In Turkey (CREDIT study). Medical data were collected through home visits and interviews between November 2007 and July 2008; height, weight and blood pressure were also measured. Serum creatinine, total cholesterol, uric acid and complete blood count were determined from 12-h fasting blood samples, and spot urine tests were performed for subjects who gave consent to laboratory evaluation. Following adjustment according to gender, residence, age groups and geographical regions, the prevalence of children with estimated glomerular filtration rate (eGFR) <75 mL/min/1.73 m(2) was 0.94 [95% confidence interval (CI): 0.63-1.35], and the prevalence of children with CKD Stages 3-5 [National Kidney Foundation-Kidney Disease Outcomes Quality Initiative (K/DOQI)] was 2600 (95% CI 1100-5100) per million age related population. The mean eGFR was found to increase with age; the ratios of children with eGFR <90 and <75 mL/min/1.73 m(2) were higher in younger age groups. The frequencies of overweight and obese children were 9.3 and 8.9%, respectively, and the mean eGFR was lower in patients with higher body mass index. The prevalence of hypertension and hypercholesterolaemia was 6.1 and 5.8%, respectively; the mean eGFR was lower in children with hypercholesterolaemia. This is the first population-based CKD study performed in children aged 5-18 years. The prevalence of CKD in our study was 25-100 times greater than that found in previous hospital-based studies. Our data suggest that approaches focusing on patients in tertiary centres are likely to lead to patients being missed at early stages of CKD and that a vast majority of these children will never develop symptomatic CKD during childhood.

Epidemiology of chronic kidney disease in children

The data available from developing countries, about chronic kidney disease (CKD) in children is limited (1). Gheissari et al reported higher incidence of CKD (16.8 per million children population), mostly of advanced stage (75% in stage 5) (2), which is higher than the median reported incidence of renal replacement therapy (RRT) in children aged 0–19 years across the world in 2008 (9 per million of the age related population) (1). They also observed that, the commonest underlying etiology was glomerular diseases (35.2%) followed by congenital anomaly of kidney and urinary tract (CAKUT) (34.5%). This observation is different from that of most other countries where the predominant obstructive are uropathy and congenital anomalies (3). On the other hand, in less developed countries, infections related glomerulopathies are the main cause of CKD in children (3). Most of the reported children were in advanced CKD, with anemia, acidosis and evidence of renal bone disease. It is interesting that most of those transplanted children had received kidneys from non-related living donor and that the majority received renal replacement therapy in form of hemodialysis or peritoneal dialysis. This observational study is important to add to the universal picture of the epidemiology of CKD in children.

Epidemiology of Chronic Kidney Disease Among Older Adults: A Focus on the Oldest Old

The National Kidney Foundation (NKF), Kidney Disease Outcomes Quality Initiative (KDOQI) Clinical Practice Guidelines for Chronic Kidney Disease: Evaluation, Classification, and Stratification expanded the focus of chronic kidney disease (CKD) management from end-stage renal disease (ESRD) to the entire spectrum of kidney disease including early kidney damage through the stages of kidney disease to kidney failure. A consequence of these guidelines is that a large number of older adults are being identified as having CKD, many of whom will not progress to ESRD. Concerns have been raised that reduced estimated glomerular filtration rate (eGFR) among older adults may not represent "disease" and using age-specific cut-points for staging CKD has been proposed. This implies that among older adults, CKD, as currently defined, may be benign. Several recent studies have shown that among people greater than or equal to 80 years old, CKD is associated with an increased risk for concurrent complications of CKD (eg, anemia, acidosis) and adverse outcomes including mortality and cardiovascular disease (CVD). Further, among older adults, CKD is associated with problems not traditionally thought to be associated with kidney disease. These nondisease-specific outcomes include functional decline, cognitive impairment, and frailty. Future research studies are necessary to determine the impact of concurrent complications of CKD and nondisease-specific problems on mortality and functional decline, the longitudinal trajectories of CKD progression, and patient preferences among the oldest old with CKD.

Diabetes and hypertension have become leading causes of CKD in Chinese elderly patients: a comparison between 1990–1991 and 2009–2010

It is unclear whether any significant changes in the epidemiology of chronic kidney disease (CKD), possibly resulting from the exceedingly rapid economic development and the aggressive prevention and treatment of kidney diseases in the Chinese population, have occurred over the past two decades. The medical records of 173 CKD patients from 1990-1991 and 956 patients from 2009-2010 were retrospectively analyzed. In patients from 1990-1991, CKD occurred at an earlier age, with severely decreased kidney function. On average, these patients progressed to end-stage renal disease 4.5 years faster. Diabetes and hypertension have become the most common causes of CKD in elderly patients in 2009-2010 period, representing 39.5 % and 24.2 % of all CKD causes, respectively. In the 1990-1991 period, CKD was characterized by a high frequency of severe anemia in stage 4 and 5 patients. The mean arterial pressure in patients with CKD stage 4 and stage 5 decreased significantly in. Although the number of dyslipidemia patients in stage 4 and 5 was significantly higher in the 2009-2010 period, there were no substantial differences in the average levels of serum triglycerides and total cholesterol in the two cohorts. Hypoproteinemia also became less common than before. The occurrence of cardiovascular events was significantly reduced in stage 4 and stage 5 patients in 2009-2010. Diabetes and hypertension have increased and become the leading causes of CKD in elderly Chinese patients. Improvement in the control of CKD complications has been significant, mainly regarding anemia, hypertension, dyslipidemia, and hypoproteinemia.

Antithrombotic Therapy in Patients With Chronic Kidney Disease

Chronic kidney disease (CKD) is a pandemic public health problem, with >500 million people worldwide estimated to have some form of kidney injury.1 Survey data suggest that the prevalence of CKD in the United States has increased between 1988 to 1994 and 1999 to 2004 from 10% to 13%, reaching a rate of 14% in 2010.2,3 Overlapping conditions such as acute kidney injury play an important role in the growing epidemiology of CKD, and underlying CKD is in turn an important risk factor for acute kidney injury and end-stage renal disease. Key factors contributing to the increased prevalence of CKD include the aging population and the growing burden of diabetes mellitus.4 The prevalence of stage 3 or 4 CKD has been reported to be ≈38% for adults ≥70 years old versus ≈1% in adults 20 to 39 years of age.2,5 Patients with diabetes mellitus are found to present with CKD in about one third of cases, with diabetic nephropathy as the most common cause of renal impairment.6 Notably, numerous epidemiological studies have shown that patients with all stages of CKD experience higher rates of atherothrombotic disease manifestations and processes with thromboembolic potential such as atrial fibrillation than the general population.7–10 This underscores the importance of antithrombotic treatment strategies in these patients. However, the risk-to-benefit ratio with antithrombotic therapies may be altered in CKD. In fact, patients with CKD also have an increased risk of bleeding complications.11–13 Importantly, bleeding has emerged as an independent predictor of adverse outcomes, including mortality.14–17 Moreover, patients with severe CKD are less likely to receive medications of proven benefit.18,19 Overall, these findings contribute to explain why patients with reduced renal function have poorer prognosis compared …

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How to manage HIV-infected patients with chronic kidney disease in the HAART era

As human immunodeficiency virus (HIV)-infected patients now live longer while receiving highly active antiretroviral therapy (HAART), chronic kidney disease (CKD) has emerged as a significant cause of morbidity and mortality among urban HIV population. Risk factors associated with CKD in such HIV-infected population include aging, hypertension, diabetes mellitus, co-infection with hepatitis C virus, low CD4 cell count, and high HIV viral load. Clinical experience has shown that HIV-infected individuals often have one or more concurrent risk factors for CKD. The cumulative effect of multiple risk factors on the development of CKD should be noted in this population. Glomerular disease directly related to HIV infection, so-called HIV-associated nephropathy, remains an important cause of CKD among limited HIV population of African descent. The impact of exposure to nephrotoxic antiretroviral agents on the development of kidney disease is both an old and a new concern. In particular, the association of tenofovir with kidney disease has been an area of great interest. The findings regarding tenofovir's adverse effect on long-term kidney function vary among studies. Early identification and treatment of kidney disease is imperative for reducing the burden of patients requiring dialysis in HIV-infected populations. Periodic monitoring of urinary albumin excretion, tubular parameters such as low-molecular-weight proteinuria, and the estimated glomerular filtration rate may be useful for early diagnosis of patients at risk for incident CKD. This review focuses on recent developments in epidemiology, risk factors, identification, estimation, and management of CKD in HIV-infected population in the HAART era.

Prevalence of risk factors for chronic kidney disease among civil servants in Kano

Background: Data on the epidemiology of chronic kidney disease (CKD) from sub-Saharan Africa are still sparse. Preventive strategy through early detection and treatment has been advocated for CKD, especially in our environment where majority of patients present late and cannot afford the cost of renal replacement therapy which is not widely available. We investigated the prevalence of risk factors for CKD among the civil servants who volunteered after a public enlightenment campaign in Kano, northern Nigeria. Materials and Methods: We studied 225 apparently healthy civil servants who availed themselves of the opportunity to be screened for risk factors for CKD during the 2011 World Kidney Day activities. Relevant demographic and clinical data were obtained using a questionnaire. Weight, height, Body Mass Index (BMI), and blood pressure were measured. Spot urine samples were collected and tested for protein, sugar, and other parameters using a dipstick. Random blood sugar was measured with a glucometer. Results: The mean age of the study participants was 41.5 ± 9.68 years. Males constituted 83.6% of the respondents. Majority had a positive history of use of traditional medications, followed by the use of analgesic drugs, while very few (less than 5% each) admitted to alcohol ingestion or use of bleaching creams. While there was a significant family history of hypertension and diabetes, only about 3% had positive family history of kidney disease. Proteinuria was found to be present in 19.4%. Other risk factors found include hypertension (29.8%), obesity (11%), and diabetes mellitus (3.6%). Conclusion: Risk factors for CKD are common among civil servants in Kano. The most frequent CKD risk factors found among the study subjects were use of traditional medication, cigarette smoking, obesity, hypertension, and proteinuria.

Epidemiology of chronic kidney disease in children in Serbia

The epidemiological information from well-defined populations regarding childhood chronic kidney disease (CKD), particularly those concerning non-terminal stages, are scanty. The epidemiology of CKD in children is often based on renal replacement therapy (RRT) data, which means that a considerable number of children in earlier stages of CKD are missed as they will reach end-stage renal disease (ESRD) in adulthood. Here, we report the basic epidemiological data on childhood CKD in Serbia, gathered over the 10-year period of activity of the Serbian Pediatric Registry of Chronic Kidney Disease. Since 2000-09, data on incidence, prevalence, aetiology, treatment modalities and outcome of children aged 0-18 years, with CKD Stages 2-4 and CKD Stage 5, were collected by reporting index cases from paediatric centres. Three hundred and thirty-six children were registered (211 boys, 125 girls, male/female ratio 1.7). The median age at registration was 9.0 years [interquartile range (IQR) 3-13]. Median follow-up was 4.0 years (IQR, 1-9). The median glomerular filtration rate (GFR) at the time of the registration was 39.6 mL/min/1.73m(2) (IQR, 13.8-65.4). Median annual incidence of CKD 2-5 stages was 14.3 per million age-related population (p.m.a.r.p.), while those of CKD 2-4 or CKD 5 were 9.1 and 5.7 p.m.a.r.p., respectively. The median prevalence of CKD 2-5 was 96.1 p.m.a.r.p., 52.8 p.m.a.r.p. in CKD 2-4 and 62.2 p.m.a.r.p. in CKD 5. The main causes of CKD were congenital anomalies of kidney and urinary tract and hereditary nephropathies. Kidney survival was the worst in children with glomerular diseases and in those with advanced CKD. Haemodialysis was the most common first modality of RRT. Mortality rate was 4.5%, mainly due to cardiovascular and infectious complications. Epidemiology of paediatric CKD in Serbia is similar to that reported from developed European countries. The knowledge of the epidemiology of earlier stages of CKD is essential for both institution of renoprotective therapy and planning of RRT, a fact of paramount importance in countries with limited resources.

Erratum to: Epidemiology of chronic kidney disease in children

Erratum to: Pediatr Nephrol DOI 10.1007/s00467-011-1939-1 There was an error in the Abstract of the article The correct sentence is: The median reported incidence of renal replacement therapy (RRT) in children aged 0–19 years across the world in 2008 was 9 (range: 4–18) per million of the age-related population.

Handbook of Chronic Kidney Disease Management

Journal of Renal NursingVol. 3, No. 4 Book ReviewsHandbook of Chronic Kidney Disease ManagementChris JonesChris JonesSearch for more papers by this authorChris JonesPublished Online:29 Sep 2013https://doi.org/10.12968/jorn.2011.3.4.204AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article FiguresReferencesRelatedDetails 1 July 2011Volume 3Issue 4ISSN (print): 2041-1448ISSN (online): 2052-2894 Metrics History Published online 29 September 2013 Published in print 1 July 2011 Information© MA Healthcare LimitedPDF download

Epidemiology of chronic kidney disease in children

In the past 30 years there have been major improvements in the care of children with chronic kidney disease (CKD). However, most of the available epidemiological data stem from end-stage renal disease (ESRD) registries and information on the earlier stages of pediatric CKD is still limited. The median reported incidence of renal replacement therapy (RRT) in children aged 0–19 years across the world in 2008 was 9 per million of the age-related population (4–18 years). The prevalence of RRT in 2008 ranged from 18 to 100 per million of the age-related population. Congenital disorders, including congenital anomalies of the kidney and urinary tract (CAKUT) and hereditary nephropathies, are responsible for about two thirds of all cases of CKD in developed countries, while acquired causes predominate in developing countries. Children with congenital disorders experience a slower progression of CKD than those with glomerulonephritis, resulting in a lower proportion of CAKUT in the ESRD population compared with less advanced stages of CKD. Most children with ESRD start on dialysis and then receive a transplant. While the survival rate of children with ERSD has improved, it remains about 30 times lower than that of healthy peers. Children now mainly die of cardiovascular causes and infection rather than from renal failure.Electronic supplementary materialThe online version of this article (doi:10.1007/s00467-011-1939-1) contains supplementary material, which is available to authorized users

Glomerulonephritis in disadvantaged populations

Glomerulonephritis (GN) still enjoys a high rank as a cause of chronic kidney disease (CKD) worldwide. Its burden is particularly manifest in disadvantaged populations, with a proportional contribution up to 6-folds compared to that in the USA. There are several overlapping risk factors that render a particular population "disadvantaged" in this respect. It is envisaged that these may be categorized into a triad of genetic, climatic and socioeconomic factors. An attempt is made to dissect the impact of each of these factors, which combine in different proportions in different populations thereby explaining regional disparity in the epidemiology, clinical manifestations and outcomes of CKD. The genetic impact is manifest in racial variations in the incidence of GN as a whole, the predominance of FSGS mainly in blacks and IgA nephropathy in Asians, the increased susceptibility to SLE and decreased incidence of IgAN and vasculitis in blacks, with similar trends in other "subraces" as Indians, Afro-Caribbean's, Martinique and other indigenous populations. The climatic impact is mainly displayed in the tropics, where the "rich bioecological environment" increases the incidence of infection-associated GN, usually proliferative with a few exceptions. The socioeconomic impact, reflecting low national economy in the developing world, modifies the two other arms of the triad according to the level of primary care, efficiency of the referral system and adequate management of primary infections as well as associated glomerular injury.

Manejo del potasio en hemodiálisis

The present article analyzes the epidemiology of chronic kidney disease (CKD), with emphasis on stage 5 CKD treated with periodic hemodialysis schedules. The physiopathology of potassium in renal patients under hemodialysis, as well as diagnosis of hyperpotassemia, whether acute or toxic, and the therapeutic approach to this disorder are discussed. We describe the acute therapeutic management of hyperpotassemia in chronic patients included in a dialysis program and discuss the particular features of the prescription of hemodialysis, insulin, albuterol, bicarbonate solution, intravenous calcium and resin therapy.

What is CKD?

Chronic kidney disease (CKD) is a term that describes any form of chronic kidney damage and also the circumstance where a patient's estimated glomerular filtration rate (eGFR) is less than 60 ml/min/1.73 m2. The aims of this article are to explain this definition, including its limitations, describe the epidemiology of CKD and discuss the pros and cons of labelling patients as having CKD.

Epidemiology of chronic kidney disease in Spanish pediatric population. REPIR II Project

A national registry of children with Chronic Kidney Disease (CKD) was started in 2007. We analize it to know the incidence, prevalence, demography, etiology, clinical and metabolic state of the children with CKD, in stages 2-5 pre-dialysis, and complying with the K/DOQI guidelines. In the REPIR II 46 centers distributed throughout the Spanish geography are involved. To classify and evaluate comorbidity of the disease, the Clinical Practice Guidelines K/DOQI criteria are used. Each center provides an annual developmental data of each patient which is recorded in a On-line database. patients with CKD who are between stage 2 and 5 in predialysis and which are 18 years old or less. In 2008 there were 605 patients with CKD, the incidence was 8.66 per million of pediatric population (pmpp) and the prevalence was 71.06 pmpp. Structural anomalies was the primary cause of CKD (59% of the cases). The percentage of glomerular diseases was very low (3%). There was a clear predominance of males (66%) and Caucasian race (88%). Mean GFR was 52 ± 2 ml/min/1.73 m(2) with 82% of them in stage 2 and 3. The prevalence of anaemia was 30%. Only 19% of our patients had hypertension and only 17% of them fulfilled the 4 recommendations for calcium-phosphorus metabolism of K/DOQI Guidelines. Mean height Z-Score was -1.03 ± 2. There were 136 patients (25%) who had a mean height Z-Score of size < or = -1.88. In a multivariate logistic regression analysis only a meaningful relationship between age and height was identified. All the children under 2 years old had a 40% higher probability of having a short height (OR = 1.40; P < 0.01). The percentage of malnutrition (BMI Z-Score < or = 1.88) was 7%, mostly in the 0-2 years old group. We report the first study that performs a prospective analysis of incidence, prevalence, etiology and comorbidity of CKD in the pediatric population of the Spanish State. Given the short life of this record the data presented is provisional and may suffer meaningful changes in coming years.