Mortality In Kidney Disease Research Articles

#6405 PROGRESSION TO END-STAGE RENAL DISEASE AND ONE-YEAR MORTALITY IN ACUTE CARDIORENAL SYNDROME

Abstract Background and Aims Approximately 25% of patients with chronic congestive heart failure (CHF) present a reduction in glomerular filtration rate (GFR) independent of the left ventricular ejection fraction (LVEF). A meta-analysis of 80,000 patients revealed that patients with lower GFR (<53 mL/min) had a higher one-year mortality rate (51% versus 38%). Therefore, this reduction in GFR seems to have an important impact on both morbidity and mortality. The aim of this study was to analyze the factors associated with progression to advanced chronic kidney disease (CKD) and one-year mortality in a retrospective cohort of patients hospitalized due to acute decompensation of cardiorenal syndrome (CRS). Method Patients hospitalized for CRS between September-2013 and June-2020 who presented acute kidney injury (AKI) associated with CHF. Clinical, analytical and echocardiographic data were analyzed. Results The study included 100 patients with a majority of males (64%) and a median age of 79.5 years (72.3-85.0). Around 38% of the patients were dependent, 49% had ischemic heart disease, 51% were diabetic, 27% had left ventricular hypertrophy, 56% had moderate to severe pulmonary hypertension, and 59% had moderate to severe valve disease. In terms of LVEF, 27% showed severe dysfunction while 42% had preserved function. The median baseline creatinine was 1.6 mg/dl (1.3-2.0) with an estimated glomerular filtration rate (eGFR) of 36 ml/min (29.0-46.5). At the time of acute renal failure (ARF), creatinine was 3.3 mg/dl (2.8-4.0) and at hospital discharge the eGFR (CKD-EPI) was 29.5 ml/min (20.1-40.0). After one year of follow-up, 49 patients had died, 7 were admitted?? for chronic hemodialysis, and 6 showed a drop in eGFR greater than 40%. A logistic regression analysis was conducted for the outcome variable of "death or severe progression of CKD (considering entry into CKD grade V or loss of more than 40% of GFR)". Hyperphosphatemia (76% death/progression vs 48%, p=0.004), discharge eGFR less than 30 ml/min (74% vs 50%, p=0.013), and renin-angiotensin system (RAS) blockade (48.1% vs 77.1%) were significantly associated with the outcome. Systolic dysfunction was associated with 70.4% of death/progression (52.2% p=0.06). In the multivariate analysis, variables with a trend in the univariate analysis (p<0.2), such as prolonged hospital stay, non-revascularized coronary disease, hyponatremia, and proteinuria, were included. The analysis showed that five variables were significantly associated with the risk of death/CKD progression: proteinuria (OR 2.8, 95% CI 1.03-7.37, p=0.04), discharge eGFR (OR 2.7, 95% CI 1.05-6.82, p=0.04), LVEF (OR 0.97, 95% CI 0.94-1.00, p=0.06), hyponatremia (OR 0.89, 95% CI 0.80-0.99, p=0.04), and RAS blockade (OR 0.19, 95% CI 0.07-0.53, p=0.001). The predictive model had an area under the curve of 0.79 (95% CI 0.70-0.88) with a p-value of 0.047 and a global accuracy of 77%. Conclusion In conclusion, our study found that hyponatremia and proteinuria were significantly associated with a poorer outcome in terms of CKD progression and mortality in patients with cardiorenal syndrome. Conversely, higher left ventricular ejection fraction and a higher estimated glomerular filtration rate at discharge from the decompensation episode were linked to a lower risk. Our findings support the use of RAS-blocking drugs as beneficial in this population.

#4914 LOW LEAN BODY TISSUE IS AN INDEPENDENT RISK FACTOR FOR KIDNEY DISEASE PROGRESSION AND MORTALITY IN PATIENTS WITH ADVANCED CHRONIC KIDNEY DISEASE

Abstract Background and Aims Lean tissue mass is a marker of good health and is associated with a lower risk of death in patients without chronic kidney disease (CKD). A potentially underestimated risk factor for impaired renal function is low serum albumin concentration. Previous studies have shown that even small decreases in serum albumin concentration levels are strongly associated with cardiovascular disease, heart failure, impaired kidney function, and mortality in vulnerable populations. An association between low lean body tissue with mortality in patients with stage 4 and 5 CKD has recently been demonstrated. The aim of this study was to evaluate the effect of lean body tissue index (LTI) measured by multifrequency bioelectrical impedance analysis (BIA) on kidney disease progression and mortality in a cohort of patients with stage 4 and 5 CKD. Method We performed a retrospective observational cohort study that included patients with stage 4 and 5 CKD who were referred to the Advanced Chronic Kidney Disease outpatient clinic at our centre between January 2014 and December 2020, in whom a baseline measurement of body composition by using BIA was performed in the first 6 months of follow-up. Baseline clinical and laboratory parameters (serum creatinine, glomerular filtration rate, serum albumin, hemoglobin, cholesterol, triglycerides, calcium, phosphorus, PTH and CRP) were defined as those observed at the time of BIA measurement. Low lean tissue was defined as having LTI values below the 10th centile adjusted by age and sex. Renal survival was defined as the absence of need of renal replacement therapy (RRT) at the end of follow-up. Results The study included 145 patients who had a mean age of 72 ± 11.8 years, 69.7% were males, with a mean GFR measured by CKD-EPI of 20.4 ± 4.7 ml/min, mean albumin of 4.1 ± 0.3 g/dl and median urine albumin-creatinine ratio (uACR)of 413 mg/g (IQR 98-1341). The mean body mass index of the population was 30.1 ± 6.1 kg/m2, and BIA showed a mean LTI of 15.4 ± 3.9 kg/m2 and fat tissue index (FTI) of 14.1 ± 6.8 kg/m2. Nineteen patients (13.1%) had low LTI. Patients with low LTI were younger (65.9 ± 12.8 vs 73 ± 11.4 years, p = 0.013) and had higher uACR (1444 [484-1815] vs 318 [68-1188] mg/g, p = 0.002) with no differences in sex, GFR, and other laboratory parameters. After a mean follow-up of 27.7 months (IQR 15.3-45.4), 72 (49.7%) showed CKD progression to RRT and 55 patients (37.9%) died. The Kaplan-Meier survival analysis showed that patients with low LTI had a worse renal survival (log-rank 5.5, p = 0.019) and overall survival (log-rank 7.6, p = 0.006). The multivariate Cox regression analysis showed that low LTI (HR 2.28, 95% CI 1.12-4.62), lower GFR (HR 0.86, 95% CI 0.81-0.92) and higher uACR (HR 1.001, CI 95% 1-1.001) were independent risk factors for CKD progression to ESKD, while low LTI (HR 3.16, 95% CI 1.42-7.05), age (HR 1.09, CI 95% 1.05-1.13) and serum albumin (HR 0.31, CI 95% 0.13-0.77) were the factors that were independently associated with mortality. Conclusion Low lean body tissue index measured by multifrequency bioelectrical impedance analysis is and independent risk factor for CKD progression and mortality in stage 4-5 CKD. Close monitoring of nutritional status by BIA should be followed in these patients to provide timely and adequate nutritional interventions that might help in improving patient outcomes.

Trends in incidence and mortality of acute kidney disease following coronary angiography in Chinese population: 2008–2017

AbstractBackgroundAcute kidney disease (AKD) has received increasing attention owing to its poor prognosis. However, few studies have investigated the trends in AKD incidence and prognosis among patients undergoing coronary angiography (CAG). Therefore, this study was designed to explore trends in the incidence and mortality of AKD following CAG in China.MethodsWe enrolled patients undergoing CAG using data of the Cardiorenal Improvement (CIN) cohort registry of Guangdong Provincial People's Hospital. Univariate and multivariate logistic regression analyses were applied to examine the incidence of AKD from 2008 to 2017. Mortality rates are presented as deaths per 1000 person‐years and were evaluated in univariate and multivariate Cox regression analyses.ResultsA total of 9665 patients (mean age: 61.6 ± 9.6 years, 40% women) were enrolled in the final analysis. From 2008 to 2017, the overall incidence and mortality of AKD were 19% and 323.0 per 1000 person‐years, respectively. The incidence of AKD decreased from 25% to 13% during 2008–2017 (adjusted odds ratio, 0.40; 95% confidence interval [CI], 0.31–0.51; p < 0.01; p for trend <0.01). However, the mortality of AKD increased significantly from 138.2 to 544.1 per 1000 person‐years (adjusted hazard ratio, 2.85; 95% CI, 1.20–6.73; p = 0.02, p for trend = 0.02). The above trends were observed consistently in patients stratified by sex and age.ConclusionsOur findings suggest a significant decrease in incidence and an increase in mortality of AKD following CAG from 2008 to 2017 in China. We advocate for more proactive measures to prevent AKD and improve the prognosis of patients with AKD.

Relationship of serum albumin at initiation of incident peritoneal dialysis with cardiovascular and overall survival.

We retrospectively reviewed the records of ESKD patients on continuous ambulatory PD during 2015-2021. Patients with initial albumin ≥3mg/dL were placed in the high albumin group and those with albumin <3mg/dL in the low albumin group. A Cox proportional hazards model was used to identify variables influencing survival. Among 77 patients, 46 were in the high albumin group and 31 in the low albumin group. The high albumin group had significantly increased cardiovascular (1-, 3-, and 5-year cumulative survival rates of 93 vs. 83%, 81 vs. 64%, and 81 vs. 47%, respectively; log-rank p=0.016) and overall survival (1-, 3-, and 5-year cumulative survival rates of 84 vs. 77%, 67 vs. 50%, and 60 vs. 29%, respectively; log-rank p=0.017). Serum albumin <3g/dL was an independent predictor of cardiovascular (hazard ratio (HR) 4.401; 95% confidence interval (CI), 1.584-12.228; p=0.004) and overall survival (HR 2.927; 95% CI 1.443-5.934, p=0.003). Low albumin levels at PD initiation are an independent risk factor for decreased cardiovascular and overall survival. Further research is required to know whether increasing albumin levels before PD would decrease mortality.

PRETERM BIRTH IS ASSOCIATED WITH INCREASED CENTRAL SYSTOLIC PRESSURE IN PRIMARY HYPERTENSION - SINGLE CENTER EXPERIENCE

Objective: Preterm birth (PB) and lower birth weight (LBW) are associated with higher risk for hyprtension, chronic kidney disease and cardiovascular (CV) morbidity and mortality in adulthood. Our aim In this study was to analyze the association of PB and LBW with the parameters of arterial stiffness obtained during 24h measurement, with special focus on parameters of central hemodynamic (central aortic pressure). Design and method: In this study we included 154 adult patients (mean age 32, predominantly women (69.5%) with primary hypertension. In all of them we collected the data about term of birth and birth weight, and different antropological paramaters were measured. We determined various different laboratory data. Parameters of arterial stifness were measured in the office using Sphygmocor, and during the 24h using Mobil-o-Graph and Arteriograph. Results: In the whole group, 39 patients (25.5%) were born before the term. The corellation between pulse wave velocity (measured in office ambulatory during 24h) and term of birth was not found. The term of birth had low negative and statistically significant correlations with systolic central aortic pressure measured by Arteriograph during the night (r = -0.164, p &lt; 0.05), as well as measured by Mobil-o-Graph during 24h (r = -0.167, p &lt; 0.05), day (r = -0.172, p &lt; 0.05) and night (r = -0.186, p &lt; 0.05). Conclusions: Our findings suggest that preterm born is associated with increased systolic aortic pressure. We found this association fot the night time using two different devices. It could be speculated that this association might contribute to the global CV and kidney risk in subjects born before term. Further results are needed to answer whether ambulatory measurement of central hemodynamics have clinical importance.

Hospital overcrowding caused by covid-19 and chronic kidney disease mortality

The coronavirus disease (COVID-19) pandemic has been the largest public health emergency in recent decades. While there have been many epidemiology studies on this pandemic, less research has been done to examine its indirect impact on mortality. This paper utilizes Kolmogorov-Zurbenko (KZ) filter to examine chronic kidney disease (CKD) mortality trend in Florida hospitals and finds an indirect impact of the pandemic, namely the excess Florida CKD deaths due to pandemic-period hospital over-crowding. The results show that kidney disease patients suffer higher mortality from hospital overcrowding, thus prompting the need to allocate healthcare resource to more vulnerable patients. This paper also proposes a measurement method of hospital overcrowding with KZ filter. The strong correlation between CKD mortality and hospital overcrowding confirms that the level of healthcare has a significant influence on the wellness of CKD patients.

Associations Between Frailty and the Increased Risk of Adverse Outcomes Among 38,950 UK Biobank Participants With Prediabetes: Prospective Cohort Study.

Compared with adults with normal glucose metabolism, those with prediabetes tend to be frail. However, it remains poorly understood whether frailty could identify adults who are most at risk of adverse outcomes related to prediabetes. We aimed to systematically evaluate the associations between frailty, a simple health indicator, and risks of multiple adverse outcomes including incident type 2 diabetes mellitus (T2DM), diabetes-related microvascular disease, cardiovascular disease (CVD), chronic kidney disease (CKD), eye disease, dementia, depression, and all-cause mortality in late life among middle-aged adults with prediabetes. We evaluated 38,950 adults aged 40 years to 64 years with prediabetes using the baseline survey from the UK Biobank. Frailty was assessed using the frailty phenotype (FP; range 0-5), and participants were grouped into nonfrail (FP=0), prefrail (1≤FP≤2), and frail (FP≥3). Multiple adverse outcomes (ie, T2DM, diabetes-related microvascular disease, CVD, CKD, eye disease, dementia, depression, and all-cause mortality) were ascertained during a median follow-up of 12 years. Cox proportional hazards regression models were used to estimate the associations. Several sensitivity analyses were performed to test the robustness of the results. At baseline, 49.1% (19,122/38,950) and 5.9% (2289/38,950) of adults with prediabetes were identified as prefrail and frail, respectively. Both prefrailty and frailty were associated with higher risks of multiple adverse outcomes in adults with prediabetes (P for trend <.001). For instance, compared with their nonfrail counterparts, frail participants with prediabetes had a significantly higher risk (P<.001) of T2DM (hazard ratio [HR]=1.73, 95% CI 1.55-1.92), diabetes-related microvascular disease (HR=1.89, 95% CI 1.64-2.18), CVD (HR=1.66, 95% CI 1.44-1.91), CKD (HR=1.76, 95% CI 1.45-2.13), eye disease (HR=1.31, 95% CI 1.14-1.51), dementia (HR=2.03, 95% CI 1.33-3.09), depression (HR=3.01, 95% CI 2.47-3.67), and all-cause mortality (HR=1.81, 95% CI 1.51-2.16) in the multivariable-adjusted models. Furthermore, with each 1-point increase in FP score, the risk of these adverse outcomes increased by 10% to 42%. Robust results were generally observed in sensitivity analyses. In UK Biobank participants with prediabetes, both prefrailty and frailty are significantly associated with higher risks of multiple adverse outcomes, including T2DM, diabetes-related diseases, and all-cause mortality. Our findings suggest that frailty assessment should be incorporated into routine care for middle-aged adults with prediabetes, to improve the allocation of health care resources and reduce diabetes-related burden.

Prospective association between physical activity and mortality in patients with chronic kidney disease

Objective: To investigate the prospective association of physical activity with all-cause, cardiovascular disease (CVD), and chronic kidney disease (CKD) mortality in CKD patients in China. Methods: Cox proportional hazard models were used to evaluate the association of total, domain-specific, and intensity-specific physical activity with the risk of all-cause, CVD, and CKD mortality based on data from the baseline survey of China Kadoorie Biobank. Results: During a median follow-up of 11.99 (11.13, 13.03) years, there were 698 deaths in 6 676 CKD patients. Compared with the bottom tertile of total physical activity, participants in the top tertile had a lower risk of all-cause, CVD, and CKD mortality, with hazard ratios (HRs) (95%CIs) of 0.61 (0.47-0.80), 0.40 (0.25-0.65), and 0.25 (0.07-0.85), respectively. Occupational, commuting, and household physical activity were negatively associated with the risk of all-cause and CVD mortality to varying degrees. Participants in the top tertile of occupational physical activity had a lower risk of all-cause (HR=0.56, 95%CI: 0.38-0.82) and CVD (HR=0.39, 95%CI: 0.20-0.74) mortality, those in the top tertile of commuting physical activity had a lower risk of CVD mortality (HR=0.43, 95%CI: 0.22-0.84), and those in the top tertile of household physical activity had a lower risk of all-cause (HR=0.61, 95%CI: 0.45-0.82), CVD (HR=0.44, 95%CI: 0.26-0.76) and CKD (HR=0.03, 95%CI: 0.01-0.17) mortality, compared with the bottom tertile of corresponding physical activity. No association of leisure-time physical activity with mortality was observed. Both low and moderate-vigorous intensity physical activity were negatively associated with the risk of all-cause, CVD and CKD mortality. The corresponding HRs (95%CIs) were 0.64 (0.50-0.82), 0.42 (0.26-0.66) and 0.29 (0.10-0.83) in the top tertile of low intensity physical activity, and the corresponding HRs (95%CIs) were 0.63 (0.48-0.82), 0.39 (0.24-0.64) and 0.23 (0.07-0.73) in the top tertile of moderate-vigorous intensity physical activity. Conclusion: Physical activity can reduce the risk of all-cause, CVD, and CKD mortality in CKD patients.

CE-452778-2 LONG-TERM MORBIDITY AND MORTALITY ASSOCIATED WITH POSTOPERATIVE ATRIAL FIBRILLATION: AN ANALYSIS FROM THE SWEDEHEART SWEDISH CARDIAC SURGERY REGISTRY

Postoperative atrial fibrillation (POAF) following cardiac surgery is a common complication associated with longer hospital stays and higher healthcare resource utilization. Much of the current literature focuses on the short-term consequences of POAF while long-term morbidity and mortality are not as well described. To assess long-term morbidity and mortality associated with POAF following open-heart surgery. A retrospective study was conducted using the SWEDEHEART Swedish Cardiac Surgery Registry and several other Swedish national health registries. The study sample consisted of patients aged 55 to 90 years who underwent open-chest coronary artery bypass and/or valvular surgery between 2010 and 2019. Patients with a preoperative history of permanent or persistent AF were excluded. Patients who experienced POAF were compared with those who did not. Risk of recurrent AF, heart failure, chronic kidney disease, ischemic stroke, major bleed and mortality were compared between the cohorts. Outcomes were adjusted for differences in baseline demographics and clinical history using multivariable Cox regression. Data extraction was conducted by the Uppsala Clinical Research Center and the Swedish National Board of Health and Welfare. A total of 30,870 patients with a mean age of 69.9 years were included in the study, of which 10,136 (32.8%) patients composed the POAF group. The median follow-up was 4.6 years. After adjustment, patients who experienced POAF had a significantly higher risk of recurrent AF (HR 2.30; 95% CI 2.21, 2.41), heart failure (HR 1.17; 95% CI 1.10, 1.25), chronic kidney disease (HR 1.15; 95% CI 1.07, 1.24), all-cause mortality (HR 1.11; 95% CI 1.04, 1.18), and cardiovascular mortality (HR 1.16; 95% CI 1.06, 1.26). POAF was associated with a numerically higher risk of ischemic stroke (HR 1.07; 95% CI 0.96, 1.20) and major bleed (HR 1.11; 95% CI 0.98, 1.25), but these findings were not statistically significant. Over a median of 4.6 years of follow-up in Swedish cardiac surgery patients, POAF was associated with a statistically significantly higher risk of long-term recurrent AF, heart failure, chronic kidney disease, and all-cause and cardiovascular mortality.

Risk factors and 180-day mortality of acute kidney disease in critically ill patients: A multi-institutional study.

Critically ill patients with acute kidney injury (AKI) have a poor prognosis. Recently, the Acute Disease Quality Initiative (ADQI) proposed to define acute kidney disease (AKD) as acute or subacute damage and/or loss of kidney function post AKI. We aimed to identify the risk factors for the occurrence of AKD and to determine the predictive value of AKD for 180-day mortality in critically ill patients. We evaluated 11,045 AKI survivors and 5,178 AKD patients without AKI, who were admitted to the intensive care unit between 1 January 2001 and 31 May 2018, from the Chang Gung Research Database in Taiwan. The primary and secondary outcomes were the occurrence of AKD and 180-day mortality. The incidence rate of AKD among AKI patients who did not receive dialysis or died within 90 days was 34.4% (3,797 of 11,045 patients). Multivariable logistic regression analysis indicated that AKI severity, underlying early CKD, chronic liver disease, malignancy, and use of emergency hemodialysis were independent risk factors of AKD, while male gender, higher lactate levels, use of ECMO, and admission to surgical ICU were negatively correlated with AKD. 180-day mortality was highest among AKD patients without AKI during hospitalization (4.4%, 227 of 5,178 patients), followed by AKI with AKD (2.3%, 88 of 3,797 patients) and AKI without AKD (1.6%, 115 of 7,133 patients). AKI with AKD had a borderline significantly increased risk of 180-day mortality (aOR 1.34, 95% CI 1.00-1.78; p = 0.047), while patients with AKD but no preceding AKI episodes had the highest risk (aOR 2.25, 95% CI 1.71-2.97; p < 0.001). The occurrence of AKD adds limited additional prognostic information for risk stratification of survivors among critically ill patients with AKI but could predict prognosis in survivors without prior AKI.

Environmental and Social Factors Associated with High Chronic Kidney Disease Mortality Rates in Municipalities of Guatemala: An Ecological Study of Municipal-Level Mortality Data

The purpose of this study was to determine the association between social and environmental indicators and high mortality rates from chronic kidney disease (CKD) in municipalities of Guatemala. An ecological study of municipal-level factors associated with CKD mortality in Guatemala was conducted. Crude mortality rates were calculated for the 2009-2019 period for each of the country's 340 municipalities, by gender and age groups. Municipal-level social and environmental indicators were used as independent variables. Linear regression was used for bivariate and multivariate analysis. A total of 28,723 deaths from CKD were documented for the 2009-2019 period. Average crude mortality rate for all ages for the country's 340 municipalities was 70.66 per 100,000 [0-502.99]. Very highly positive associations with high mortality rates were found in two agrarian territories where land use is mainly for permanent crops (e.g., sugar cane, coffee, rubber, banana, plantain, African palm) and pastures for cattle, with very low percentages of land covered by forests or protected areas. Social factors related to poverty and environmental factors related to agricultural use of land may play a role in the high CKD mortality rates documented in a cluster of municipalities of Guatemala.

Nrf2 Protein Serum Concentration in Human CKD Shows a Biphasic Behavior.

Oxidative stress contributes to the progression of chronic kidney disease (CKD) and CKD-related mortality. The nuclear factor erythroid 2-related factor 2 (Nrf2) is essential in the regulation of cellular redox status, and Nrf2-activating therapies are under evaluation in several chronic diseases, including CKD. It is therefore inevitable to understand how Nrf2 behaves in advancing CKD. We analyzed Nrf2 protein concentrations in patients with varying extents of CKD but without renal replacement therapy, and in healthy subjects. Compared to healthy controls, Nrf2 protein was upregulated in mild to moderate kidney function impairment (G1-3). Within the CKD population, we found a significant positive correlation between Nrf2 protein concentration and kidney function (estimated glomerular filtration rate). In severe kidney function impairment (G4,5), Nrf2 protein was reduced compared to mild to moderate kidney function impairment. We conclude that Nrf2 protein concentration in severe kidney function impairment is reduced relative to the mild to moderate kidney function impairment where increased Nrf2 protein concentrations prevail. With respect to the implementation of Nrf2 targeted therapies, it will be necessary to explore in which population of patients with CKD such therapies are able to effectively add to the endogenous Nrf2 activity.

Ultraprocessed Foods and Kidney Disease Progression, Mortality, and Cardiovascular Disease Risk in the CRIC Study

Ultraprocessed foods are widely consumed in the United States and are associated with cardiovascular disease (CVD), mortality, and kidney function decline in the general population. We investigated associations between ultraprocessed food intake and chronic kidney disease (CKD) progression, all-cause mortality, and incident CVD in adults with chronic kidney disease (CKD). Prospective cohort study. Chronic Renal Insufficiency Cohort Study participants who completed baseline dietary questionnaires. Ultraprocessed food intake (in servings per day) classified according to the NOVA system. CKD progression (≥50% decrease in estimated glomerular filtration rate [eGFR] or initiation of kidney replacement therapy), all-cause mortality, and incident CVD (myocardial infarction, congestive heart failure, or stroke). Cox proportional hazards models adjusted for demographic, lifestyle, and health covariates. There were 1,047 CKD progression events observed during a median follow-up of 7 years. Greater ultraprocessed food intake was associated with higher risk of CKD progression (tertile 3 vs tertile 1, HR, 1.22; 95% CI, 1.04-1.42; P=0.01 for trend). The association differed by baseline kidney function, such that greater intake was associated with higher risk among people with CKD stages 1/2 (eGFR≥60mL/min/1.73m2; tertile 3 vs tertile 1, HR, 2.61; 95% CI, 1.32-5.18) but not stages 3a-5 (eGFR<60mL/min/1.73m2; P=0.003 forinteraction). There were 1,104 deaths observed during a median follow-up of 14 years. Greater ultraprocessed food intake was associated with higher risk of mortality (tertile 3 vs tertile 1, HR, 1.21; 95% CI, 1.04-1.40; P=0.004 for trend). Self-reported diet. Greater ultraprocessed food intake may be associated with CKD progression in earlier stages of CKD and is associated with higher risk of all-cause mortality in adults with CKD. Ultraprocessed foods are industrial formulations produced using ingredients and processes that are not commonly used in culinary preparations and contain few, if any, intact unprocessed foods. Ultraprocessed foods are widely consumed in the United States, and high intakes of such foods have been linked to cardiovascular disease, kidney disease, and mortality in the general population. In this study, we found that greater intake of ultraprocessed foods was associated with higher risk of kidney disease progression and mortality in adults with chronic kidney disease. Our findings suggest that patients with kidney disease may benefit from greater consumption of fresh, whole, and homemade or hand-prepared foods and fewer highly processed foods.

The Relationship Between Serum Selenium Level, Cognitive Functions, and Depression in Patients With Chronic Kidney Disease.

Introduction Impairment of cognitive functions can commonly develop in patients with chronic kidney disease (CKD) and increase morbidity and mortality. The antioxidant activity of selenium reduces cognitive decline by protecting neurons from free radical damage. We aimed to explore the associations between serum selenium levels, cognitive impairment, and depression in CKD patients in this research. Methods In this prospective cross-sectional research, 100 participants between the ages of 20 and 65 were included, and four groups of 25 patients each were formed (control group, stage 3-4 CKD, peritoneal dialysis [PD], hemodialysis [HD]). The Standardized Mini Mental Test (sMMT) was used to measure cognitive skills, and the Beck Depression Inventory (BDI) was utilized to diagnose depression. Simultaneously, measurements of serum selenium levels were done from collected blood samples. Results Cognitive impairment was detected in 4% of the control group, 16% of CKD patients (n=75), and 30% of the dialysis patients (n=50). Depression was found in 16% of the control group, 40% of the stage 3-4 CKD group,50% of the PD group, and 44% of the HD group. In the control group, sMMT scores were higher than the other groups (p<0.001 for all), while the BDI score was statistically significantly lower (p=0.003). Serum selenium levels were found to be higher than HD and PD groups in patients with non-dialysis CKD and control groups in the post hoc analyses (p=0.001, p<0.001, p<0.001, p<0.001, respectively). Conclusion Depression and cognitive impairment are particularly prevalent in CKD and dialysis patients. Our results indicate serum selenium insufficiency may be related to depression and cognitive impairment in this patient group. Nonetheless, these findings need to be confirmed by larger-scale studies.

Incident cardiovascular-kidney disease, diabetic ketoacidosis, hypoglycaemia and mortality in adult-onset type 1 diabetes: a population-based retrospective cohort study in Hong Kong

Type 1 diabetes can occur at any age. The majority of literature on type 1 diabetes were reported in children whereas adult-onset type 1 diabetes is less well characterised. This study aims to compare the risk of diabetes-related complications and mortality in Chinese with adult-onset type 1 diabetes versus those with youth-onset type 1 diabetes and adult-onset type 2 diabetes. Between 2000 and 2018, 2738 people with type 1 and 499,288 with type 2 diabetes underwent metabolic and complication assessment in Hong Kong Hospital Authority. They were followed for incident diabetic ketoacidosis (DKA), severe hypoglycaemia, end-stage kidney disease (ESKD), cardiovascular disease (CVD) and all-cause mortality until2019. In multivariable Cox regression adjusted for sex, diabetes duration and calendar year, people with type 1 diabetes diagnosed aged ≥40 years had a lower hazard of DKA (hazard ratio HR [95% CI] 0.47 [0.32-0.70]) but higher hazards of severe hypoglycaemia (HR 1.37 [1.13-1.67]), ESKD (HR 4.62 [2.90-7.37]), CVD (HR 11.44 [6.92-18.91]) and mortality (HR 16.22 [11.43-23.02]) versus those diagnosed aged <20 years. Compared with peers with type 2 diabetes presenting at comparable age, people with type 1 diabetes diagnosed aged ≥40 years had higher age-, sex- and diabetes duration-adjusted hazards of DKA (HR 19.87 [13.95-28.31]), severe hypoglycaemia (HR 3.26 [2.81-3.80]), ESKD (HR 1.58 [1.20-2.09]) and mortality (HR 2.26 [1.96-2.60]), and a similar hazard of CVD (HR 1.11 [0.87-1.43]). These associations remained constant after adjustment for metabolic indices. People with type 1 diabetes diagnosed in late adulthood had elevated risks of a broad range of complications and mortality compared with people with youth-onset type 1 diabetes and people with type 2 diabetes presenting at same age bands. This study did not receive any specific funding.

WCN23-0170 RENAL RESISTIVE INDICES AND THEIR ASSOCIATION WITH KIDNEY DISEASE PROGRESSION AND MORTALITY

WCN23-0170 RENAL RESISTIVE INDICES AND THEIR ASSOCIATION WITH KIDNEY DISEASE PROGRESSION AND MORTALITY

Deprivation and chronic kidney disease-a review of the evidence.

The relationship between socioeconomic deprivation and health is inequitable. Chronic kidney disease (CKD) is an archetypal disease of inequality, being more common amongst those living in deprivation. The prevalence of CKD is rising driven by an increase in lifestyle-related conditions. This narrative review describes deprivation and its association with adverse outcomes in adults with non-dialysis-dependent CKD including disease progression, end-stage kidney disease, cardiovascular disease and all-cause mortality. We explore the social determinants of health and individual lifestyle factors to address whether patients with CKD who are socioeconomically deprived have poorer outcomes than those of higher socioeconomic status. We describe whether observed differences in outcomes are associated with income, employment, educational attainment, health literacy, access to healthcare, housing, air pollution, cigarette smoking, alcohol use or aerobic exercise. The impact of socioeconomic deprivation in adults with non-dialysis-dependent CKD is complex, multi-faceted and frequently under-explored within the literature. There is evidence that patients with CKD who are socioeconomically deprived have faster disease progression, higher risk of cardiovascular disease and premature mortality. This appears to be the result of both socioeconomic and individual lifestyle factors. However, there is a paucity of studies and methodological limitations. Extrapolation of findings to different societies and healthcare systems is challenging, however, the disproportionate effect of deprivation in patients with CKD necessitates a call to action. Further empirical study is warranted to establish the true cost of deprivation in CKD to patients and societies.

Predictive value of heart rate variability on long-term mortality in end-stage kidney disease on hemodialysis.

Autonomic disturbance is common in end-stage kidney disease (ESKD). Heart rate variability (HRV) is a useful tool to assess autonomic function. We aimed to evaluate the predictive value of HRV on all-cause mortality and explore the proper timing of HRV assessment. This prospective cohort study enrolled 163 ESKD on hemodialysis patients from April-December 2018. HRV measurements were recorded ten minutes before hemodialysis, four hours during hemodialysis, and ten minutes after hemodialysis. Clinical parameters and all-cause mortality were recorded. Cox-proportional hazard regression was used for statistical analysis. After a median follow up of 40 months, 37 (22.7%) patients died. Post-dialysis HRV parameters including higher very low frequency (VLF) (hazard ratio [HR], 0.881; 95%confidence interval [CI], 0.828-0.937; p<0.001), higher normalized low frequency (nLF) (HR, 0.950; 95%CI, 0.917-0.984; p = 0.005) and higher LF/HF ratio (HR, 0.232; 95%CI, 0.087-0.619; p = 0.004) were the independent predictors associated with lower risk for all-cause mortality. Higher post-dialysis normalized high frequency (nHF) increased risk of mortality (HR, 1.051; 95%CI, 1.015-1.089; p = 0.005). HRV parameters at pre-dialysis and during dialysis were not predictive for all-cause mortality. The area under receiver operating characteristic curve (AuROC) of VLF for survival was highest compared to other HRV parameters at post-dialysis period (AuROC 0.71; 95% CI; 0.62-0.79; p<0.001). In conclusion, post-dialysis HRV parameters predicted all-cause mortaliy in ESKD. VLF measured at post-dialysis exhibited best predictive value for survival in chronic hemodialysis patients.

Secondary calciprotein particle size is associated with patient mortality in peripheral artery disease

Background and aimsSecondary calciprotein particles (CPP-II) induce inflammation and contribute to vascular calcification. CPP-II size is associated with vascular calcification in patients with chronic kidney disease (CKD) and all-cause mortality in hemodialysis patients. Here, we investigate for the first time a possible role of CPP-II size in patients with peripheral artery disease (PAD) without severe CKD. MethodsWe measured the hydrodynamic radius (Rh) of CPP-II by using dynamic light scattering in a cohort of 281 PAD patients. Mortality was evaluated over a period of ten years by central death registry queries. 35% of patients died during the observation period (median of 8.8 (6.2–9.0) years). Cox-regression analyses were performed to estimate hazard ratios (HR) and 95% confidence intervals (CI) and to allow for multivariable adjustment. ResultsThe mean CPP-II size was 188 (162-218) nm. Older patients, patients with reduced kidney function, and those with media sclerosis had larger CPP-II (p < 0.001, p = 0.008, and p = 0.043, retrospectively). There was no association between CPP-II size and overall atherosclerotic disease burden (p = 0.551). CPP-II size was independently significantly associated with all-cause (HR 1.33 (CI 1.01–1.74), p = 0.039) and cardiovascular mortality (HR 1.52 (CI 1.05–2.20), p = 0.026) in multivariable regression analyses. ConclusionsLarge CPP-II size is associated with mortality in PAD patients and might be a new feasible biomarker for the presence of media sclerosis in this patient population.

Sex differences in risk factors for end-stage kidney disease and death in type 2 diabetes: A retrospective cohort study.

This study investigated the sex differences in the risk of end-stage kidney disease (ESKD) and mortality, as well as the effect modification of sex on associated factors in patients with type 2 diabetes. This multicenter observational cohort study included 4328 patients with type 2 diabetes. Hazard ratios (HRs) with 95% confidence intervals (CIs) of sex for ESKD and death were estimated using Cox proportional regression with adjustment for baseline covariates. For assessing risk modification, HRs and incidence rates for ESKD and death were compared between sexes across patient characteristics using Cox proportional and Poisson regression models. During a median follow-up of 7 years, 276 patients (70% men) developed ESKD, and 241 patients (68% men) died. Men had higher risks of ESKD (HR 1.34; 95% CI 1.02-1.75; p=.034) and death (HR 1.64; 95% CI 1.24-2.16; p=.001) versus women after adjusting for multiple covariates. Among patients with microalbuminuria, men had a substantially higher risk of ESKD versus women, compared to those with normo- and macroalbuminuria (p for interaction .04). Incidence rates were also increased in men versus women with albuminuria of around 300 mg/g. No differences were detected in the association of sex and death across baseline patient subgroups. In type 2 diabetes, men had an increased risk of ESKD and death versus women. Moderately increased albuminuria was strongly associated with sex difference in developing ESKD.