Non-dialysis Dependent Chronic Kidney Disease Research Articles

Dietary quality and adherence to dietary recommendations in Chinese patients with chronic kidney disease

ObjectivesThere is a lack of data regarding the quality of the diet and the adherence to dietary guidelines of patients with non-dialysis-dependent CKD (NDD-CKD) in China.Design and methodsSingle-center cross-sectional study of 261 patients with CKD stages 3–5, who responded to 3-day dietary records and undertook 24-h urine samples along with clinical, laboratory, and anthropometric assessments. We compared their food intake with Chinese recommendations for CKD patients, assessed dietary quality through the Chinese Healthy Eating Index (CHEI), and calculated the contribution to energy intake by processed foods according to the NOVA classification.ResultsAverage energy intake was 30 ± 9 Kcal/kg/d, and 65% consumed less energy than recommended. The average protein intake was 1.2 ± 0.5 g/Kg/d, and 81% consumed more than recommended. 71% of patients consumed excess sodium and 80% consumed too little fiber. These proportions worsened across more severe CKD stages (all P trend value <0.05). The diet was considered of moderate quality (CHEI score 59.5 ± 11.0), and patients with CKD stages 4–5 scored progressively worse (P trend = 0.008). Total grains and tubers supplied 50 and 30% of the total energy and protein intake, respectively. Processed and ultra-processed foods contributed to 23.3% of dietary energy and 11.7% of food weight.ConclusionA large proportion of NDD-CKD at our center showed low adherence to diet recommendations. Although consumption of processed foods was low, diet quality worsened with more severe CKD, with low intake of whole grains, dairy, and soybean.

Association of iron deficiency with kidney outcome and all-cause mortality in chronic kidney disease patients without anemia

BackgroundIron deficiency is prevalent in patients with chronic kidney disease (CKD), even in those without anemia. However, the effects of iron deficiency on CKD progression and all-cause mortality in non-dialysis-dependent CKD (NDD-CKD) patients without anemia remain incompletely understood.MethodsThis multicenter retrospective nationwide cohort study included adult patients with non-anemia NDD-CKD from 24 hospitals across China. The study investigated the associations between serum ferritin or transferrin saturation (TSAT) levels and the risks of CKD progression and all-cause mortality.ResultsAmong 18,878 patients with NDD-CKD, 9,989 patients were included in the kidney outcome analysis, and 18,481 patients in the all-cause mortality analysis. Of the patients with the measurement, 2,450 (27.2%) had ferritin levels ≤ 100ng/mL and 2,440 (13.1%) had a TSAT level ≤ 20%. Compared with patients with TSAT level of > 20%, those with TSAT level of ≤ 20% had significantly higher risks of CKD progression (adjusted hazard ratio [aHR]: 1.66, 95% confidence intervals [CI]: 1.16–2.37; P = 0.005) and all-cause mortality (aHR: 2.21, 95% CI: 1.36–3.57; P = 0.001). The robustness of results was supported by subgroup analyses. However, there was no significant association found between ferritin levels and the risk of CKD progression or all-cause mortality (P > 0.05).ConclusionIron deficiency was prevalent in NDD-CKD patients without anemia, and TSAT could be a modifiable risk factor of CKD progression and all-cause mortality. The screening of iron biomarkers, especially TSAT, in the early stage of NDD-CKD is important to assess and improve prognosis.

Efficacy and Safety of Roxadustat in Patients with CKD: Pooled Analysis by Baseline Inflammation Status.

Background/Objectives: Inflammation may contribute to hyporesponsiveness to erythropoiesis-stimulating agents (ESAs) and is often present in patients with chronic kidney disease (CKD). Roxadustat is approved in multiple countries for the treatment of anemia of CKD. This pooled analysis evaluated the efficacy and safety of roxadustat in patients with dialysis-dependent (DD) or non-dialysis-dependent (NDD) CKD by inflammation status. Methods: Data from five studies comparing roxadustat versus ESAs were pooled by patient populations in this analysis (NDD: DOLOMITES; DD: ROCKIES, SIERRAS, HIMALAYAS, PYRENEES). The mean change from baseline in hemoglobin levels to Weeks 28-52 and mean weekly dose of roxadustat or ESA at Week 24 were assessed by baseline inflammation levels (determined by high-sensitivity C-reactive protein [hsCRP] levels, divided into quintiles). Safety data were summarized descriptively. Results: In total, 613 patients with NDD CKD (roxadustat n = 320; ESA n = 293) and 4072 patients with DD CKD (roxadustat n = 2022; ESA n = 2050) were evaluated. Roxadustat increased hemoglobin levels in a manner similar to ESAs, independent of baseline inflammation status. In both the NDD and DD populations, roxadustat doses did not increase at Week 24 in patients with higher hsCRP levels at baseline. Patients with high baseline hsCRP levels required greater ESA doses at Week 24 compared with patients who had lower baseline hsCRP levels in both patient populations. The incidence rates of treatment-emergent adverse events were generally comparable with those of roxadustat and ESA across hsCRP quintiles in both the NDD and DD populations. Conclusions: Roxadustat addresses the multiple causes of anemia of CKD, regardless of inflammatory status, without requiring dose increases.

Sacubitril/Valsartan for Blood Pressure Lowering in Non-Dialysis-Dependent Chronic Kidney Disease Stage 3-5 Patients With Hypertension: A Multicenter Clinical Study.

To assess the effectiveness and safety of Sacubitril/Valsartan in reducing blood pressure in individuals with non-dialysis-dependent chronic kidney disease (NDD-CKD) Stage 3-5 complicated by hypertension. This study was a multicenter retrospective analysis conducted from March 1, 2022 to March 31, 2024, involving adult patients with NDD-CKD Stage 3-5 and hypertension, who received Sacubitril/Valsartan either as a monotherapy or in addition to current antihypertensive treatments that were insufficient. The main outcomes measured were blood pressure control, changes in blood pressure and laboratory parameters within 8 weeks post-treatment initiation, and incidence of adverse events. The study included a total of 459 individuals with NDD-CKD Stage 3-5 and hypertension. At the study endpoint, mean systolic blood pressure, diastolic blood pressure, and pulse pressure were markedly reduced compared to baseline (all p < 0.001). The average blood pressure reductions were 12.17 (4.66, 22.00), 6.00 (0.67, 12.66), and 6.67 (0.08, 14.00) mmHg, respectively. Throughout the study period, 96 patients (20.92%) with NDD-CKD Stage 3-5 developed worsening renal function, 15 patients (3.27%) developed hyperkalemia, and 49 patients (10.68%) experienced symptomatic hypotension. Overall, there were no significant differences in the changes in serum creatinine, estimated glomerular filtration rate, and serum potassium before and after treatment (p = 0.28, p = 0.91, p = 0.61, respectively). Sacubitril/Valsartan significantly lowers blood pressure in patients with NDD-CKD Stage 3-5 complicated by hypertension, with good safety profiles. Trial Registration: ClinicalTrials.gov identifier: ChiCTR2400086079.

Resting energy expenditure: Is there any difference between dialysis and non-dialysis dependent chronic kidney disease patients?

Background Energy imbalance can be caused by several clinical conditions commonly found in advanced CKD and end-stage renal disease (ESRD), resulting in nutritional deficiencies. Objective We aimed to investigate whether there is a difference in resting energy expenditure (REE) between patients with ESRD undergoing HD or PD and those with non-dialysis-dependent chronic kidney disease (NDD-CKD) and also to evaluate the relationship among REE and possible factors that might affect REE. Methods We included 29 patients undergoing HD, 29 patients undergoing PD, and 29 patients with stage 3–5 NDD-CKD. FFM was estimated using multifrequency bioimpedance analysis. REE was evaluated with indirect calorimetry. The serum level of Interleukin-6(IL-6) was measured using the chemiluminescence immunoassay technique. REE was normalized for FFM via the REE/FFM ratio. Results The study included 45(52%) females. A total of 87 patients were included in the study. The mean age of the patients was 50 ± 12 years. REE/FFM ratio was higher in the HD group than in the PD ( p = 0.031) and NDD-CKD ( p = 0.002) groups. IL-6 was higher in the HD group than the NDD-CKD group ( p = 0.004) and similar in the HD and PD groups ( p = 0.089). REE/FFM ratio was positively correlated with IL-6 (r = 0.47, p &lt; 0.001). Age, IL-6, and HD predicted REE/FFM ratio (F = 7.763, p &lt; 0.001). In the analysis performed by including HD and PD patients, gender and HD were effective in predicting REE/FFM ratio (F = 3.315, p = 0.011). Conclusions REE was to be higher in the HD group than in the PD and NDD-CKD groups. The fact that HD patients have a higher REE than the NDD-CKD group may be explained by the higher IL-6 level. Further studies are needed to identify factors that may cause HD patients to have a higher REE than PD patients.

Long-Term Efficacy of an AI-Based Health Coaching Mobile App in Slowing the Progression of Nondialysis-Dependent Chronic Kidney Disease: Retrospective Cohort Study.

Chronic kidney disease (CKD) is a significant public health concern. Therefore, practical strategies for slowing CKD progression and improving patient outcomes are imperative. There is limited evidence to substantiate the efficacy of mobile app-based nursing systems for decelerating CKD progression. This study aimed to evaluate the long-term efficacy of the KidneyOnline intelligent care system in slowing the progression of nondialysis-dependent CKD. In this retrospective study, the KidneyOnline app was used for patients with CKD in China who were registered between January 2017 and April 2023. Patients were divided into 2 groups: an intervention group using the app's nurse-led, patient-oriented management system and a conventional care group that did not use the app. Patients' uploaded health data were processed via deep learning optical character recognition, and the artificial intelligence (AI) system provided personalized health care plans and interventions. Conversely, the conventional care group received suggestions from nephrologists during regular visits without AI. Monitoring extended for an average duration of 2.1 (SD 1.4) years. The study's objective is to assess the app's effectiveness in preserving kidney function. The primary outcome was the estimated glomerular filtration rate slope over the follow-up period, and secondary outcomes included changes in albumin-to-creatinine ratio (ACR) and mean arterial pressure. A total of 12,297 eligible patients were enrolled for the analysis. Among them, 808 patients were successfully matched using 1:1 propensity score matching, resulting in 404 (50%) patients in the KidneyOnline care system group and another 404 (50%) patients in the conventional care group. The estimated glomerular filtration rate slope in the KidneyOnline care group was significantly lower than that in the conventional care group (odds ratio -1.3, 95% CI -2.4 to -0.1 mL/min/1.73 m2 per year vs odds ratio -2.8, 95% CI -3.8 to -1.9 mL/min/1.73 m2 per year; P=.009). Subgroup analysis revealed that the effect of the KidneyOnline care group was more significant in male patients, patients older than 45 years, and patients with worse baseline kidney function, higher blood pressure, and heavier proteinuria. After 3 and 6 months, the mean arterial pressure in the KidneyOnline care group decreased to 85.6 (SD 9.2) and 83.6 (SD 10.5) mm Hg, respectively, compared to 94.9 (SD 10.6) and 95.2 (SD 11.6) mm Hg in the conventional care group (P<.001). The ACR in the KidneyOnline care group showed a more significant reduction after 3 and 6 months (736 vs 980 mg/g and 572 vs 840 mg/g; P=.07 and P=.03); however, there was no significant difference in ACR between the two groups at the end of the follow-up period (618 vs 639 mg/g; P=.90). The utilization of KidneyOnline, an AI-based, nurse-led, patient-centered care system, may be beneficial in slowing the progression of nondialysis-dependent CKD.

Agreement Between Resting Energy Expenditure Predictive Formulas and Indirect Calorimetry in Non-Dialysis Dependent Chronic Kidney Disease.

The gold standard method for measuring resting energy expenditure (REE) is indirect calorimetry (IC) using an expensive device that requires specialized training. To overcome the limitations of IC, REE prediction formulas are used in patients with chronic kidney disease (CKD). However, it is still controversial which of these formulas has greater accuracy compared to IC. We aimed to determine the accuracies of REE measured by IC and estimated by formulas in patients with CKD. Fifty-three patients with stage 4-5 CKD underwent IC and five current REE prediction formulas. Accuracy was measured by Lin's correlation coefficient. Bland-Altman repeated measures analysis was used to assess the agreement of the formulas' results with those of IC. Precision was measured by the predicted IC ± 10% and 20%. Systematic bias was assessed by the Student's t-test, and linear regression was used to assess proportionality bias. Patients had a mean estimated glomerular filtration rate (eGFR) of 12 ± 4 mL/min/1.73 m2, a mean age of 65 years, and 62% were male. The mean REE measured by IC was 1341 ± 37 Kcal/day, and the formula with the lowest mean bias (0.1509 [-653.5121; 398.9056]), best correlation (r = 0.789; p = 0.000), and best accuracy (85%) was the formula developed by Fernandes and Cols (REE (kcal/day) = 854 + (7.4 × body weight) + (179 × sex) - (3.3 × age) + (2.1 × eGFR) + 26 (if diabetes)). The Fernandes and Cols equation had good accuracy and was valuable for estimating energy requirements in the population studied.

Global Policy and Advocacy Initiatives for Improving Kidney Care: Report from the 2023 ISN-GKHA Study.

National strategies to address chronic kidney disease (CKD) are crucial to support kidney health. Lack of political support in the form of policy decisions and funding leads to fragmentation of kidney care and catastrophic health expenditure. This study used data from the third iteration of the International Society of Nephrology Global Kidney Health Atlas (ISN-GKHA) to obtain a global overview of the existence and reach of national strategies for kidney care. We leveraged data from an international survey of stakeholders (clinicians, policymakers, and patient advocates) conducted by the ISN between July and September 2022. Data were extracted on existence and scope of national non-communicable disease (NCD) and/or CKD-specific strategies and policies, as well as recognition of kidney disease as a national health priority through participant perception and existence of CKD advocacy groups. Overall, stakeholders from 167 countries responded to the survey representing 97.4% of the global population. National strategies for NCDs were reported by 56% of countries. In 29% of countries CKD was addressed within an NCD strategy while 25% of countries reported CKD-specific strategies. Countries with CKD-specific strategies were more likely to address all CKD populations (non-dialysis dependent CKD, chronic dialysis and kidney transplantation) compared to those with NCD strategies only (51.2% versus 19%). Of the 54% of countries with any CKD strategy 89% reported public funding of the full spectrum of CKD care compared to 64% of those with no CKD strategy. KF, CKD and AKI were reported to be recognized as national health priorities by 63%, 48% and 19% of countries respectively. The inclusion of CKD and kidney failure within national health strategies is frequently lacking. Countries with CKD-specific policies tend to include a broader spectrum of kidney disease populations and to fund kidney care more than those with CKD policies integrated within NCD strategies. Greater global and national prioritization of kidney health are required to reduce global inequities in access to kidney care.

The association of micro and macro worries with psychological distress in people living with chronic kidney disease during the COVID-19 pandemic.

Psychological distress can be exacerbated by micro (personal) and macro (societal) worries, especially during challenging times. Exploration of this relationship in people with chronic kidney disease is limited. (1) To identify the types and levels of worries concerning people with chronic kidney disease in the context of the COVID-19 pandemic; (2) to explore the association of worries with psychological distress including depression, stress, anxiety, and health anxiety. A cross-sectional online survey collected data at two time points (Autumn 2020, n = 528; Spring 2021, n = 241). Participants included kidney transplant recipients and people with non-dialysis dependent chronic kidney disease. The survey included questions about worry taken from the World Health Organisation COVID-19 Survey, the Depression, Anxiety and Stress Scale, and the Short Health Anxiety Index. Data were analysed using descriptive statistics and multiple regression. Worries about loved ones' health, the healthcare system becoming overloaded, losing a loved one, economic recession, and physical health were the highest rated concerns. Worrying about mental health was associated with higher depression, stress, anxiety, and health anxiety. Worrying about physical health was associated with anxiety and health anxiety. Worrying about losing a loved one was associated with health anxiety, and worrying about not being able to pay bills was associated with stress. People with kidney disease reported micro and macro worries associated with psychological distress during the COVID-19 pandemic. This study highlights factors that should be considered to improve the mental health and well-being of people with kidney disease.

Feasibility of a Home-Based, Video-Supervised 12-Week Exercise Program in Nondialysis-Dependent CKD: The ESTEEM-VIDA Pilot Randomized Clinical Trial

Feasibility of a Home-Based, Video-Supervised 12-Week Exercise Program in Nondialysis-Dependent CKD: The ESTEEM-VIDA Pilot Randomized Clinical Trial

Patient-Reported Outcomes and Associations with Clinical Events in a Cohort of People with Nondialysis-Dependent CKD

Patient-Reported Outcomes and Associations with Clinical Events in a Cohort of People with Nondialysis-Dependent CKD

Effects of Type of Protein Intake on Risk of Kidney Disease Progression among Patients with Nondialysis-Dependent CKD: A Systematic Review

Effects of Type of Protein Intake on Risk of Kidney Disease Progression among Patients with Nondialysis-Dependent CKD: A Systematic Review

Phosphate Loading per Nephron Predicts CKD Progression and All-Cause Death in Patients with Nondialysis-Dependent CKD: The Fukuoka Kidney Disease Registry (FKR) Study

Phosphate Loading per Nephron Predicts CKD Progression and All-Cause Death in Patients with Nondialysis-Dependent CKD: The Fukuoka Kidney Disease Registry (FKR) Study

Impact of Adjunctive Active Vitamin D on Kidney Function during Treatment of Secondary Hyperparathyroidism (SHPT) with Extended-Release Calcifediol (ERC) in Nondialysis-Dependent CKD (ND-CKD)

Impact of Adjunctive Active Vitamin D on Kidney Function during Treatment of Secondary Hyperparathyroidism (SHPT) with Extended-Release Calcifediol (ERC) in Nondialysis-Dependent CKD (ND-CKD)

Safety and Efficacy of Hypoxia-Inducible Factor-Prolyl Hydroxylase Inhibitors Compared with Erythropoiesis-Stimulating Agents in Patients with Nondialysis-Dependent CKD: Analysis of Real-World Data

Safety and Efficacy of Hypoxia-Inducible Factor-Prolyl Hydroxylase Inhibitors Compared with Erythropoiesis-Stimulating Agents in Patients with Nondialysis-Dependent CKD: Analysis of Real-World Data

Sex Differences in Handgrip Strength in Nondialysis-Dependent CKD

Sex Differences in Handgrip Strength in Nondialysis-Dependent CKD

Association of Glucose Variability with Coronary Artery Calcium Score in Patients with Nondialysis-Dependent CKD: Findings from KNOW-CKD

Association of Glucose Variability with Coronary Artery Calcium Score in Patients with Nondialysis-Dependent CKD: Findings from KNOW-CKD

Association between Multimorbidity and the Risk of Major Adverse Cardiovascular Events and Mortality in Patients with Nondialysis-Dependent CKD

Association between Multimorbidity and the Risk of Major Adverse Cardiovascular Events and Mortality in Patients with Nondialysis-Dependent CKD

Safety and Efficacy of AND017, a Hypoxia-Inducible Factor-Prolyl Hydroxylase Inhibitor (HIF-PHI), in Patients with Nondialysis-Dependent CKD (NDD-CKD)

Safety and Efficacy of AND017, a Hypoxia-Inducible Factor-Prolyl Hydroxylase Inhibitor (HIF-PHI), in Patients with Nondialysis-Dependent CKD (NDD-CKD)

Association between Serum β2-Microglobulin and Executive Function in Patients with Nondialysis-Dependent CKD: The VCOHP Study

Association between Serum β2-Microglobulin and Executive Function in Patients with Nondialysis-Dependent CKD: The VCOHP Study