Chronic Kidney Disease Factors Research Articles

Promoting kidney health in people with type 2 diabetes: part 2.

The incidence of chronic kidney disease is increasing internationally with many risk factors for chronic kidney disease also being risk factors for type 2 diabetes. Nurses should use primary, secondary and tertiary prevention to minimise the incidence of chronic kidney disease when caring for individuals with type 2 diabetes. This article is the second in a two-part series on the interrelationship between these long-term conditions. Part 1 addressed the significance of using primary prevention to promote kidney health in adults living with type 2 diabetes; part 2 will discuss the use of secondary and tertiary prevention relevant to these long-term conditions.

Obstructive sleep apnea risk factor for chronic kidney disease: A systematic review and meta-analysis

<b>Introduction: </b>Obstructive sleep apnea (OSA) is related to chronic kidney disease (CKD), but its association is not fully understood.<br /> <b>Objective</b>: To realize a systematic review with meta-analysis to determine the association between OSA and CKD.<br /> <b>Methods:</b> Systematic review with meta-analysis of observational studies. The search was carried out in Embase, PubMed/Medline, Scopus, and Web of Science. The data were calculated by the hazard ratio (HR). The heterogeneity was identified by I squared.<br /> <b>Results:</b> Five studies were included (n=6,710). The meta-analysis found an association between OSA and CKD (HR=2.00; confidence interval 95%=1.68-2.38).<br /> <b>Conclusions:</b> We found an association between OSA and CKD.

Community Knowledge and Self-Awareness on Risk Factors for Chronic Kidney Disease (CKD) in Bali, Indonesia

Introduction: In Indonesia, CKD is among the top 10 most prevalent diseases, with the prevalence increasing sharply from 2013 to 2018. Therefore, prevention should focus on reducing risk factors for people who have not yet suffered from CKD. Based on the above, researchers are interested in examining the relationship between knowledge and community self-awareness of CKD risk factors in Bali.
 Methods: This study used descriptive analysis with a cross-sectional approach. The population in the study was all Balinese people, with a sample size of 209 respondents who met the inclusion criteria. The research was conducted by means of an online survey consisting of demographic data, Self-Awareness Questionnaire and CKD Knowledge Questionnaire through Google Forms. The collected data were analyzed with univariate and bivariate analyses.
 Results: Most of the respondents were from adolescence to early adulthood (17–35 years old)—as many as 78.2%, dominated by women (64.8%). Judging from the level of knowledge, more than half of the respondents fell into the sufficient category, namely 67%. While the level of community self-awareness tends to be high, with a result of 45%, Thus, there was a significant relationship between knowledge and self-awareness of the Balinese community towards CKD risk factors (p<0.01).
 Conclusion: Balinese people have a good level of knowledge and awareness of CKD risk factors. However, preventive measures are still needed to prevent an increase in these cases. It is hoped that health services would continue to provide information.

Study to Assess the Prevalence of Risk Factor of Chronic Kidney Disease among Diabetes Mellitus and Hypertensive Client at Karambakkam

Aim: The present study aims to assess the prevalence of risk factor of chronic kidney disease among diabetes mellitus and hypertensive client at karambakkam. Methods and Materials: A Non-experimental descriptive research design was used for the present study. A total 200 samples were collected using purposive sampling technique. The demographic of diabetes mellitus and level of knowledge of risk factor of chronic kidney diseases was assessed using structured questioner and, followed by that data was gathered and analyzed. Results: The results the study revealed that there is a significant association with the level of knowledge on risk factor of chronic kidney diseases among diabetes mellitus and hypertensive client at p<0.001. Conclusion: Thus, the present study concluded that majority of the clients with diabetes mellitus and hypertension had inadequate knowledge and it is recommended that they should be educated on the risk factors of CKD.

Smokeless tobacco consumption and its association with risk factors of chronic kidney disease in rural and peri-urban Bangladesh.

Compared to smoking, which has major consequences in chronic kidney disease (CKD) initiation and progression, smokeless tobacco (SLT) consumption is considered to have fewer health consequences. We investigated the prevalence of SLT consumption and its association with risk factors of CKD in a rural and peri-urban Bangladeshi population. Using random sampling we recruited 872 adults in 2020, from the Mirzapur Demographic Surveillance System of Bangladesh, who had resided in the area for at least five years. Interviews using a semi-structured questionnaire, physical examination and anthropometric measurements were done, followed by blood and urine testing. The blood and urine tests were repeated in selected participants after three months as per the CKD Epidemiology Collaboration equation. The prevalence of SLT consumption was 29%. Being aged ≥46 years (OR=7.10; 95% CI: 4.79-10.94), female (OR=1.64; 95% CI: 1.21-2.22), housewife (OR=1.82; 95% CI: 1.35-2.45), farmer (OR=1.71; 95% CI: 1.06-2.76), widow (OR=3.40; 95% CI: 2.24-5.17), and having no formal schooling (OR=4.91; 95% CI: 3.59-6.72), family income of <$100/month (OR=1.66; 95% CI: 1.13-2.43), sleeping duration <7 hours per day (OR=2.33; 95% CI: 1.70-3.19), were associated with a significantly higher odds of SLT consumption. However, being aged 31-45 years (OR=0.25; 95% CI: 0.16-0.38) had significantly lower odds of being an SLT consumer. Among the diseases investigated, undernutrition (OR=1.63; 95% CI: 1.15-2.33), hypertension (OR=1.52; 95% CI: 1.13-2.05), anemia (OR=1.94; 95% CI: 1.39-2.71) and CKD (OR=1.62; 95% CI: 1.15-2.27) were significantly associated with SLT consumption. In the multivariable analysis, being aged 31-45 years (AOR=3.06; 95% CI: 1.91-4.90), ≥46 years (AOR=15.69; 95% CI: 4.64-53.09) and having no formal schooling (AOR=2.47; 95% CI: 1.72-3.55) were found to have a significant association with being an SLT consumer. SLT consumption is associated with most of the established risk factors of CKD within the studied population.

Prevalence and associated risk factors for chronic kidney disease in the elderly physically disabled population in Shanghai, China: a cross-sectional study

BackgroundThe global prevalence of chronic kidney disease (CKD) in the general population is relatively clear. Our previous study showed that elderly individuals who are physically disabled are more likely to experience kidney function impairment, and the main purpose of this study was to determine the prevalence and risk factors associated with CKD in elderly patients with physical disabilities.MethodsA total of 2679 elderly individuals with physical disabilities from the 2018 Shanghai Disability Health Survey were screened to calculate the prevalence of CKD. Multiple logistic regression was performed to identify the factors associated with CKD. Detailed subgroup analyses of disability level were also conducted.ResultsWe confirmed CKD in 287 of 2679 (10.7%) participants. Female sex, age, history of hypertension, red blood cell count, albumin, urea, and uric acid (UA) were independently correlated with CKD. Age and UA abnormalities were common risk factors for different levels of disabilities.ConclusionThe prevalence of CKD is higher in the mild level of older physically handicapped individuals. Age and the level of UA should also be considered in this population. The preventive strategies for patients with two levels of elderly disability should have different focuses.

Obesity as a risk factor for chronic kidney disease: a contemporary view on the problem. Review

The review article is devoted to an actual clinical problem of participation of obesity in development and progression of chronic kidney disease (CKD). Some pathogenic links due to which a negative renal effect of obesity is mediated including in particular, dyslipidemia (DLP), endothelial dysfunction (ED) of renal vessels, activation of renin‑angiotensin‑aldosterone system (RAAS), arterial hypertension (AH), a production of adipose tissue mediators with renal injuring properties such as leptin, tumor necrosis factor‑α, interleukines 1,6,8 are discussed. The data about the main factors of progression of renal damage associated with obesity included insulin resistance (IR), hyperinsulinemia, DLP, systemic and renal hemodynamic disorders caused by activation of RAAS (AH, intraglomerular hypertension) are given. The role of metabolic syndrome and its components in pathogenesis of CKD as well as a role of diabetes mellitus (DM) frequently combined with obesity in development of diabetic kidney disease (diabetic nephropathy) is generalized. Among adipokines a special attention in the present review is paid for pathogenic role of leptin and adiponektin in obesity with its conditions promoted renal damage. The participation of resistance to leptin in the pathogenesis of CKD through such links as IR, ED, oxidative stress and inflammation is discussed. The role of ED and glomerular hyperfiltration in pathogenesis of microalbuminuria is elucidated. The significance of injury of kidney tubular cell structures so called podocytes in pathogenesis of CKD in obesity is uncovered. The clinical significance of early revealing of renal pathology as well as body weight, glycemia level, arterial blood pressure control and following of healthy mode of life in reduction of risk development of CKD associated with obesity, DM and other metabolic disorders is generalized. It’s emphasized that evaluation of lipid and carbohydrate exchange parameters, serum leptin level, IR indices is considered to be perspective for diagnostics of renal damage in obesity.

Adherence to healthy lifestyle was associated with an attenuation of the risk of chronic kidney disease from metabolic dysfunction–associated fatty liver disease: Results from two prospective cohorts

AimsNon-alcoholic fatty liver disease (NAFLD) and metabolic dysfunction–associated fatty liver disease (MAFLD) are important risk factors of chronic kidney disease (CKD). Whether adherence to a healthy lifestyle can modify these effects remain unknown. This study aimed to evaluate the modification effects of healthy lifestyle on the associations among NAFLD, MAFLD, and the risk of CKD, with taking into the effect of genetic risk. MethodsThe Tianjin Chronic Low-grade Systemic Inflammation and Health Cohort Study (TCLSIH), the UK Biobank Study (UKB). The outcome was incident CKD. The exposures including NAFLD, MAFLD, healthy lifestyle, and a genetic risk score (GRS) for CKD. ResultsAfter 1,135,334 person–year follow-up, we documented 2975 incident CKD cases in the two cohorts. MAFLD and NAFLD were associated with a higher risk of CKD, particularly in patients with MAFLD. In the TCLSIH and UKB, the hazard ratios (95% confidence intervals) of incident CKD for MAFLD were 1.47 (1.30, 1.66) and 1.73 (1.57, 1.91), respectively. Adherence to a healthier lifestyle decreased the risk of CKD from MAFLD with significant interaction effects (TCLSIH: Pinteraction = 0.02; UKB: Pinteraction = 0.04). Participants with a lower CKD–GRS experienced a higher risk of CKD from MAFLD, but achieved two healthy lifestyles can significantly decreased the risk of CKD in patients with MAFLD. ConclusionsMAFLD and NAFLD are associated with a higher CKD risk, particularly MAFLD. Adherence to a healthier lifestyle was associated with a lower risk of CKD from MAFLD. These results highlight the important role of following a healthy lifestyle to prevent CKD.

Risk factors for chronic kidney disease among adults in a tertiary hospital community in north-central, Nigeria.

Background: The prevalence of chronic kidney disease (CKD) is on the increase globally with an attendant heavy disease burden and high morbidity and mortality from end-stage renal disease (ESRD). Data on the prevalence of risk factors for chronic kidney disease from sub-Saharan Africa are scanty, more so in the northern part of Nigeria. There are several risk factors for CKD which include, obesity, hypertension, diabetes mellitus and some nephrotoxic agents. Preventive strategy through early detection and treatment has been advocated for CKD especially in our own setting where majority of patients present late and cannot afford the cost of renal replacement therapy which again is not readily available.&#x0D; Method: This study was conducted among the staff of Bingham University Teaching Hospital (BHUTH), Jos, as part of a screening exercise during the World Kidney Day (WKD) program of 2021, to determine the prevalence of modifiable risk factors for CKD. Adult subjects of 18 years and above, who consented to the study were mobilized after a sensitization talk. The parameters assessed were demographics, body mass index, blood pressures, proteinuria, fasting plasma glucose and plasma creatinine. Glomerular filtration rate (GFR) was estimated using CKD-EPI Creatinine Equation 2021. Data were analyzed using SPSS version 25. The level of statistical significance was set at a p-value of &lt; 0.05.&#x0D; Results: 150 adult volunteers participated in the study. The mean age of the participants was 43.3±11.32 years (18-71 years), with 61.3% being females and 38.7% were males. The frequency of the risk factors of CKD observed were obesity in 45 (30.0%) of the participants and diabetes mellitus found in 44 (29.3%) of the participants, Proteinuria and glycosuria were found in 49 (32.7%) and 9 (6.0%) of the participants respectively while a whopping 37 (24.7%) of the participants had haematuria. The number of participants found with estimated glomerular filtration rate (eGFR) of &lt;60ml/min/1.73m2 were 55 (36.7%). There was an independent association between older age (p = 0.010), being widowed/divorced (p = 0.041), and having diabetes (p = 0.006) with an eGFR &lt;60ml/min/1.73m2.&#x0D; Conclusion The prevalence of CKD risk factors in this study population was high. Therefore, there is the need for adequate and continuous sensitization and routine screening in our various clinics for early detection and early management by lifestyle and risk factor modification to halt or reduce the growing burden of CKD with its attendant morbidity and mortality in Nigeria.

Association between a high triglyceride–glucose index and chronic kidney disease in adult patients with latent autoimmune diabetes

BackgroundInsulin resistance (IR) is one of the risk factors for chronic kidney disease (CKD) and diabetes. The triglyceride–glucose (TyG) index is considered a reliable alternative marker of IR. We investigated the correlation between the TyG index and the severity of CKD in patients with latent autoimmune diabetes in adults (LADA).MethodsThis cross-sectional study included 288 patients with LADA in the department of endocrinology at our hospital between January 2018 and January 2022. The TyG index was calculated as Ln [TG (mg/dl) × fasting blood glucose (FBG) (mg/dl) / 2]. All individuals were divided into either a LADA + CKD group or a LADA + non-CKD group according to the presence or absence of CKD. A correlation analysis, logistic regression analysis and receiver operating characteristics curve analysis were performed.ResultsA total of 130 (45.1%) participants were identified as having CKD. Compared with the non-CKD group, the CKD group had a longer disease duration and a higher proportion of smokers; patients were more likely to have hypertension and higher serum creatinine, triglyceride, cholesterol, low-density lipoprotein cholesterol, FBG, uric acid estimated glomerular filtration rates (eGFR) and TyG levels as well as lower high-density lipoprotein cholesterol levels (all P < 0.05). The positive relationship between the TyG index and the urinary albumin/creatinine ratio was significant (r = 0.249, P = 0.010). There was also a significant correlation between the TyG index and the eGFR (r = − 0.211, P = 0.034) after adjusting for confounding factors. The area-under-the-curve value of the TyG index was 0.708 (95% confidence interval: 0.61–0.81, P < 0.001).ConclusionsThe TyG index is significantly associated with the severity of CKD in patients with LADA. This conclusion supports the clinical application of the TyG index for the assessment of kidney disease in patients with LADA.

Acceptability, Adherence, Safety and Experiences of Low Energy Diets in People With Obesity and Chronic Kidney Disease: A Mixed Methods Study

Obesity is a modifiable risk factor for chronic kidney disease (CKD) progression. Low energy diets (LEDs) have not been adequately studied in people with CKD. This study aimed to explore acceptability, adherence, safety, and experiences of two LED prescriptions in adults living with obesity and CKD. In a mixed-methods study, obese adults with CKD were prescribed two LEDs (∼800 to 1000kcal/day each), in a randomised order for 2weeks each. One diet consisted of four meal replacement products daily (Optifast®, Nestlé Health Science) and the other two pre-prepared frozen meals (Lite n' Easy®, Mitchell's Quality Foods). Participants received weekly dietitian support, completed daily adherence checklists (converted to % of provided meals/replacements consumed) and participated in post-intervention semi-structured interviews to capture their experience. Nine participants were included (mean age 46.5±14.3years, estimated glomerular filtration rate 64±26mL/min/1.73m2, 4/9 male). Mean self-reported adherence was 88±11% and mean 4-week weight change was -7.3±5.6kg. Two participants withdrew at week two. Most frequently reported side effects were hunger and headaches. Adverse events of interest included one episode each of hyperkalaemia and hypoglycaemia. No serious adverse events occurred. Four overarching themes of patient experiences were identified: strategies used to adapt, disruption to the norm, individual preferences, and influences on acceptability. LEDs were found to be acceptable and safe with high self-reported adherence rates. Future LED trials should include specialist diabetes management, close monitoring for hyperkalaemia and adequate support to assist with managing side effects and dietary and social adjustments.

A Comparative Analysis of Supervised Classification Algorithms and Missing Data Handling for Enhancing Chronic Kidney Disease Prediction

Chronic kidney disease (CKD), which is becoming a more significant public health concern, is characterized by a gradual but concerning increase in morbidity and death, particularly in its early, asymptomatic stages. Risk factors for chronic kidney disease (CKD), including genetic predisposition, obesity, diabetes, and hypertension, affect the illness's prevalence. When there are no outward signs of an illness, it is challenging to diagnose and treat it in its early stages. To tackle this pressing issue, our research does a comprehensive investigation through a comparative comparison of supervised classification techniques. In particular, we examine the prediction performance of CKD using the Random Forest, Decision Tree, and Support Vector Machine (SVM) techniques. We also look into a number of approaches to handling missing data. Our research presents a thorough evaluation of these algorithms' performance under different data cleaning methods, pointing out both their benefits and drawbacks. Ultimately, our research aims to clarify the early detection and treatment of chronic kidney disease (CKD) and pave the way for larger-scale public health initiatives to tackle this quickly escalating health emergency.

Single-cell transcriptomic analysis reveals transcript enrichment in oxidative phosphorylation, fluid sheer stress, and inflammatory pathways in obesity-related glomerulopathy

Obesity-related glomerulopathy (ORG) is an independent risk factor for chronic kidney disease and even progression to end-stage renal disease. Efforts have been undertaken to elucidate the mechanisms underlying the development of ORG and substantial advances have been made in the treatment of ORG, but relatively little is known about cell-specific changes in gene expression. To define the transcriptomic landscape at single-cell resolution, we analyzed kidney samples from four patients with ORG and three obese control subjects without kidney disease using single-cell RNA sequencing. We report for the first time that immune cells, including T cells and B cells, are decreased in ORG patients. Further analysis indicated that SPP1 was significantly up-regulated in T cells and B cells. This gene is related to inflammation and cell proliferation. Analysis of differential gene expression in glomerular cells (endothelial cells, mesangial cells, and podocytes) showed that these cell types were mainly enriched in genes related to oxidative phosphorylation, cell adhesion, thermogenesis, and inflammatory pathways (PI3K-Akt signaling, MAPK signaling). Furthermore, we found that the podocytes of ORG patients were enriched in genes related to the fluid shear stress pathway. Moreover, an evaluation of cell-cell communications revealed that there were interactions between glomerular parietal epithelial cells and other cells in ORG patients, with major interactions between parietal epithelial cells and podocytes. Altogether, our identification of molecular events, cell types, and differentially expressed genes may facilitate the development of new preventive or therapeutic approaches for ORG.

The Triglyceride-Glucose Index is Independently Associated with Chronic Kidney Disease in the Geriatric Population, Regardless of Obesity and Sex.

Insulin resistance (IR) negatively affects several risk factors of chronic kidney disease (CKD). This cross-sectional study investigated whether the triglyceride-glucose (TyG) index, which reflects IR, was independently associated with CKD in a geriatric population, regardless of obesity and sex. The analysis included 7,326 individuals (2,864 males and 4,462 females) aged ≥60 years. Non-obesity or obesity was evaluated using a body mass index cutoff of 25 kg/m2. The TyG index was calculated as ln [triglyceride concentration (mg/dL)×fasting plasma glucose concentration (mg/dL)]/2. All participants were categorized into three groups according to TyG tertiles. Moderate-to-severe CKD (MSCKD) was defined as an estimated glomerular filtration rate (eGFR) of <45.0 mL/min/1.73 m2. In males and females with or without obesity, a trend test showed a decreasing tendency in the eGFR from the lowest to highest TyG tertiles. Males without obesity and females with obesity in the middle and highest tertiles of the TyG index were 2.342 and 2.393, and were 2.313 and 3.516 times more likely to have MSCKD, respectively. Those with or without obesity in the highest tertile of the TyG index were 1.736 and 2.374 times more likely to have MSCKD, respectively. Geriatric populations with an increased TyG index have a high risk of MSCKD regardless of obesity and sex. Our findings suggest that increased IR is associated with CKD in the geriatric population independent of obesity and sex.

The Impact of Sedentary Behavior on Renal Function Decline in 132,123 Middle Aged and Older Adults: A Nationwide Cohort Study.

BACKGROUND Prior studies suggest that sedentary behavior is a well-known risk factor for cardiometabolic diseases. However, the longitudinal association between overall siting time and kidney function decline is not known. MATERIAL AND METHODS We performed a nationwide prospective cohort study in individuals aged more than 40 years enrolled in the China Cardiometabolic Disease and Cancer Cohort (4C) study. A total of 132 123 individuals were included in this study. Sitting time was measured with the short version of the International Physical Activity Questionnaire (IPAQ). Kidney function decline was defined as an eGFR <60 mL/min/1.73 m² or more than a 30% decrease in eGFR from baseline. Multivariate Cox proportional hazards regression analyses were conducted to estimate the adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) of the relation between kidney function decline and sitting time. RESULTS During a mean follow-up of 3.8 years, 3890 (2.9%) participants experienced kidney function decline. Longer sitting time was significantly associated with the risk of kidney function decline (aHR, 1.136; 95% CI, 1.036-1.247, P=0.007, comparing participants with baseline sitting time in the lowest quartile with those in the highest quartile) after adjustment for potential confounders. CONCLUSIONS Longer sitting time was independently and prospectively associated with a higher risk of kidney function decline. Sedentary behavior might represent a modifiable risk factor for chronic kidney disease (CKD) prevention.

Tricuspid Annular Plane Systolic Excursion/Systolic Pulmonary Artery Pressure Ratio and Cardiorenal Syndrome Type 2 in the Systemic Sclerosis EUSTAR Cohort.

The aim of the study was to evaluate the association between the tricuspid annular plane systolic excursion (TAPSE)/systolic pulmonary artery pressure (sPAP) ratio and estimated glomerular filtration rate (eGFR) and their association with mortality in the European Scleroderma Trials and Research (EUSTAR) cohort. Patients with systemic sclerosis (SSc) from the EUSTAR database with TAPSE, sPAP, and parameters required to calculate eGFR were included. Logistic regression and Cox regression analysis were performed to evaluate TAPSE/sPAP as a risk factor for chronic kidney disease (CKD) and overall survival. A total of 2,370 patients with SSc were included; 284 (12%) patients had CKD stage 3a-5. TAPSE/sPAP (odds ratio [OR] 0.479; 95% CI 0.310-0.743; P < 0.001), arterial hypertension (OR 3.118; 95% CI 2.173-4.475; P < 0.001), diastolic dysfunction (OR 1.670; 95% CI 1.148-2.428; P < 0.01), and N-terminal pro-B-type natriuretic peptide (OR 1.165; 95% CI 1.041-1.304; P < 0.01) were associated with CKD stage 3a-5. TAPSE/sPAP ≤0.32 mm/mm Hg (hazard ratio [HR] 3.589; 95% CI 2.236-5.761; P < 0.001), eGFR <60 mL/min per 1.73 m2 (HR 2.818; 95% CI 1.777-4.468; P < 0.001), and age (HR 1.782; 95% CI 1.348-2.356; P < 0.001) were the most significant predictive factors for all-cause mortality. A total of 276 patients with SSc had pulmonary hypertension (PH) confirmed by right heart catheterization, with 69 (25%) having CKD stage 3a-5. No difference was found in eGFR between patients with PH with reduced or normal cardiac index. Reduced TAPSE/sPAP ratio is independently associated with CKD. TAPSE/sPAP ratio ≤0.32 mm/mm Hg and eGFR <60 mL/min per 1.73 m2 are prognostic factors for all-cause mortality. In patients with SSc with PH, eGFR is independent by reduced cardiac output.

Clinical assessment of etiological risk factors of chronic kidney disease in patients admitted for dialysis to a tertiary care hospital

Background: Chronic kidney disease (CKD) is defined as a reduced glomerular filtration rate, increased urinary albumin excretion, or both, and it is an increasing public health problem with a prevalence of 8–16%. However, there is a paucity of such studies evaluating risk factors among dialysis patients in India and also there could be associated setting specific varied contributory factors. Hence, we have undertaken this study to assess common risk factors in CKD patients admitted for dialysis to a Tertiary Care Hospital. Aims and Objectives: To assess the clinical presentation and the common risk factors in CKD patients admitted for dialysis to tertiary care hospital. Materials and Methods: The present study was cross-sectional study in which 100 CKD patients admitted to the dialysis unit of tertiary care hospital were included on the basis of predefined inclusion and exclusion criteria and were analyzed as regards the history of illness, environment, and physical behavior was collected based on various pre-validated questionnaires (The WHO STEP wise approach to chronic disease risk factor Surveillance questionnaire for NCDs, dietary questionnaire, environmental/occupational questionnaire, and patient history questionnaire) in a face-to-face interview with participants and their family members. Etiological Risk Factors and clinical assessment of patients were studied. P&lt;0.05 was taken as statistically significant. Results: 49 (49%) of the study participants were from the age group of 41 to 60 years with the mean age of the 51.9±12.3 years. There was a male ponderance with M: F ratio being 1:0.61. The most common underlying condition responsible for end-stage renal disease (ESRD) was hypertension (25%) followed by diabetes mellitus (21%), glomerulonephritis (18%), analgesic nephropathy (15%), and renal stones (8%). CKD of unknown etiology was present among 7% and polycystic kidney 6%. Common clinical presentation in studied cases was anorexia (61%) followed by easy fatigability (58%) patients, Facial puffiness (49%), weakness (45%), and oliguria (44%). Conclusion: Male gender, advancing age, and occupational exposure to nephrotoxic metals were the baseline risk factors. Hypertension and diabetes mellitus were the two most common comorbidities among ESRD patients which are the important risk factors for progression to ESRD.

Abstract 127: Time Restricted Feeding In Diet Induced Obesity Reduces Kidney Cd8 + T Cells

Diet induced obesity (DIO) is one of the leading risk factors for chronic kidney disease. Previous studies identified a role for pro-inflammatory T cells in mediating DIO-driven renal damage. We found that time restricted feeding (TRF; food available only in 12-hr dark phase) during the final 2 weeks of a 20-week DIO model (45% fat) significantly improves renal damage compared to DIO ad libitum fed male mice. DIO+TRF also significantly reduced total T cells in the kidney adjacent to vasa recta in the outer medulla compared to DIO ad libitum mice assessed at the start of the dark phase or Zeitgeber Time (ZT) 12. We hypothesized that DIO+TRF decreases renal and circulating pro-inflammatory CD4 + and CD8 + T cells compared to DIO ad libitum in a time-of-day dependent manner . Using flow cytometry, we found that DIO significantly increases total renal T cells compared to normal diet (ND; 10% fat) at ZT13-15 (dark phase) only. DIO+TRF significantly decreases total renal T cells compared to DIO in the dark phase (n=7-14; 2-way ANOVA, Interaction: p=0.016, Effect of Time of Day: p=0.010, Effect of Diet: p=0.001). Our data showed no significant changes in renal T cell numbers in the light phase. Compared to ND, DIO increased renal CD8 + T cells at ZT13-15 and DIO+TRF normalized renal CD8 + T cells (n=7-14; 2-way ANOVA, Interaction: p=0.007, Effect of Diet: p=0.004). DIO and DIO+TRF did not alter renal CD4 + T cells at either ZT1-3 or ZT13-15 compared to ND. We further examined the kidney CD8 + T cell phenotype with DIO and TRF. We also found no significant changes in CD8 + T cell activation markers, perforin and granzyme B, CD8 + T cell development marker EOMES, or CD8 + T cell pro-inflammatory cytokines, IFNγ and TNFα. We assessed circulating CD8 + and CD4 + T cells via flow cytometry to analyze systemic effects of TRF. DIO+TRF led to a diurnal rhythm of CD8 + T cells with increased circulating CD8 + T cells in the dark phase compared to the light phase that was not observed in the ND or DIO groups (n=7-17; 2-way ANOVA, Interaction: p=0.012). No significant changes were observed in circulating CD8 + T cell activation markers or cytokines. DIO and TRF had no significant effect on numbers of circulating CD4 + T cells. We conclude that DIO+TRF influences rhythms of circulating and renal CD8 + T cells, but not CD4 + T cells.

Association of the rs5186 polymorphism of the AGTR1 gene with decreased eGFR in patients with type 2 diabetes from Mexico City

BackgroundEarly biomarkers search for Diabetic Kidney Disease (DKD) in patients with Type 2 Diabetes Mellitus (T2DM), as genetic markers to identify vulnerable carriers of the disease even before Glomerular Filtration Rate (GFR) decline or microalbuminuria development, has been relevant during the last few years.The rs5186 (A116C) polymorphism of the Angiotensin II Receptor Type I gene (AGTR1), has been associated to multiple effects of renal injury risk, commonly detected in patients with Diabetes Mellitus (DM). It has been described that rs5186 could have an effect in stability proteins that assemble Angiotensin II Receptor Type I (AT1), modifying its action, which is why it should be considered as a risk factor for Chronic Kidney Disease (CKD), characterized by a GFR progressive reduction. Even though, the association between rs5186 AGTR1 gene polymorphism and DKD in patients with T2DM has been controversial, inconclusive, and even absent. This disputable issue might be as a result of association studies in which many and varied clinical phenotypes included are contemplated as CKD inductors and enhancers. Although, the sample sizes studied in patients with T2DM are undersized and did not have a strict inclusion criteria, lacking of biochemical markers or KDOQI classification, which have hindered its examination. ObjectiveThe aim of our study was to establish an association between rs5186 AGTR1 gene polymorphism and GFR depletion, assessed as a risk factor to DKD development in patients with T2DM. MethodsWe analyzed 297 not related patients with T2DM, divided into 221 controls (KDOQI 1) and 76 cases (KDOQI 2). Arterial pressure, anthropometric and biochemical parameters were measured. rs5186 of AGTR1 genotyping was performed by TaqMan assay real-time PCR method. Allele and genotype frequencies, and Hardy-Weinberg equilibrium were measured. Normality test for data distribution was analyzed by Shapiro-Wilk test, variable comparison by Student’s t-test for continuous variables, and Chi-squared test for categorical variables; ANOVA test was used for mean comparison of more than two groups. Effect of rs5186 to DKD was estimated by multiple heritability adjustment models for risk variables of DKD. Statistical significance was indicated by p<0.05. Data was analyzed using Statistical Package STATA v11 software. ResultsDominant and Over-dominant models showed a likelihood ratio to GFR depletion of 1.89 (1.05−3.39, p=0.031) and 2.01 (1.08−3.73, p=0.023) in patients with T2DM. Risk factor increased to 2.54 (1.10−5.89) in women in Over-dominant model. ConclusionIn clinical practice, most of nephropathies progress at a slow pace into a total breakdown of renal function, even asymptomatic. This is the first study, reporting that rs5186 polymorphism of AGTR1 gene contribution to GFR depletion, and this could be evaluated as a predisposing factor for DKD in patients with T2DM.

Hepatic Fibrosis Evaluated in Patients with Type 2 Diabetes with and without Chronic Kidney Disease

Background: Non-alcoholic fatty liver disease (NAFLD), and particularly liver fibrosis, has been suggested as a risk factor of chronic kidney disease (CKD). Given that NAFLD affects every fourth person globally, better insight is needed. Our aim was to investigate the association between hepatic fibrosis and CKD in patients with type 2 diabetes and to compare different methods for diagnosing liver fibrosis in this study population. Methods: Cross-sectional study including patients with type 2 diabetes with CKD stages 3–5 (N = 50) or without CKD (N = 50). CKD was defined as estimated glomerular filtration rate <60 mL/min/1.73 m² with or without proteinuria. Three methods were used to detect significant liver fibrosis defined as either ≥8 kilopascal measured by transient elastography (FibroScan®), fibrosis-4 (FIB-4) score ≥2.67, or NAFLD fibrosis score (NFS) >0.675. Results: Significant liver fibrosis was found in 38% and 28% of the patients with and without CKD, respectively, using at least one of the three methods. Both FIB-4 score and NFS were significantly higher in patients with CKD (p < 0.0009 and p < 0.0001, respectively), although insignificant after adjustments for age, sex, body mass index, and duration of diabetes. In patients without CKD, a significant association between steatosis and fibrosis was observed (p = 0.0007). Conclusion: Our data do not support any strong independent association between liver fibrosis and established CKD as assessed by FibroScan, FIB-4 score, and NFS, respectively.