Predictors Of Chronic Kidney Disease Research Articles

Urinary non-albumin protein-creatinine ratio is an independent predictor of mortality in patients with type 2 diabetes: a retrospective cohort study

Albuminuria is a well-known predictor of chronic kidney disease in patients with type 2 diabetes mellitus (DM). However, proteinuria is associated with chronic complications in patients without albuminuria. In this retrospective cohort study, we explored whether non-albumin proteinuria is associated with all-cause mortality and compared the effects of non-albumin proteinuria on all-cause mortality between patients with and without albuminuria. We retrospectively collected data from patients with type 2 DM for whom we had obtained measurements of both urinary albumin-to-creatinine ratio (UACR) and urinary protein-to-creatinine ratio (UPCR) from the same spot urine specimen. Urinary non-albumin protein-creatinine ratio (UNAPCR) was defined as UPCR–UACR. Of the 1809 enrolled subjects, 695 (38.4%) patients died over a median follow-up of 6.4 years. The cohort was separated into four subgroups according to UACR (30 mg/g) and UNAPCR (120 mg/g) to examine whether these indices are associated with all-cause mortality. Compared with the low UACR and low UNAPCR subgroup as the reference group, multivariable Cox regression analyses indicated no significant difference in mortality in the high UACR and low UNAPCR subgroup (hazard ratio [HR] 1.189, 95% confidence interval [CI] 0.889–1.589, P = 0.243), but mortality risks were significantly higher in the low UACR and high UNAPCR subgroup (HR 2.204, 95% CI 1.448–3.356, P < 0.001) and in the high UACR with high UNAPCR subgroup (HR 1.796, 95% CI 1.451–2.221, P < 0.001). In the multivariable Cox regression model with inclusion of both UACR and UNAPCR, UNAPCR ≥ 120 mg/g was significantly associated with an increased mortality risk (HR 1.655, 95% CI 1.324–2.070, P < 0.001), but UACR ≥ 30 mg/g was not significantly associated with mortality risk (HR 1.046, 95% CI 0.820–1.334, P = 0.717). In conclusion, UNAPCR is an independent predictor of all-cause mortality in patients with type 2 DM.

Incidence and predictors of chronic kidney disease among patients with diabetes treated at governmental hospitals of Harari Region, eastern Ethiopia, 2022.

Chronic kidney disease (CKD) is the leading cause of morbidity and mortality in diabetic patients. However, limited evidence is available about its incidence and predictors in Ethiopia, specifically in the Harari region. A retrospective follow-up study was conducted among 520 diabetes patients who followed their treatment at governmental hospitals in the Harari region between 1 September 2012, and 30 May 2022. The risk of developing CKD was calculated with a 95% CI, and the risk was stratified by type of diabetes mellitus. Predictors of CKD were determined using the Gompertz regression model with the baseline Cox model. Data from 494 patients were included in the final analysis with 26 (5%) excluded. A total of 51 patients (10.32%) developed CKD over the 10-year follow-up period with an incidence rate of 2.16 cases (95% CI 1.64-2.84) per 100 person-years of observation. The risk of CKD was increased by three times (AHR: 3.09, 45 95% CI: 1.56, 6.14) among patients older than 60 years and by more than three times (AHR: 3.53, 95% CI: 1.43, 8.71) among patients with diabetes mellitus for longer than 5 years of stay with the diabetes mellitus. Moreover, the risk of CKD was increased four-fold among patients with high-density lipoprotein cholesterol (HDL-C) levels <40 mg/dL (AHR: 3.84, 95% CI, 1.80-8.18) and those with positive baseline proteinuria (AHR: 3.77, 95% CI: 1.43-8.71). We found that one in ten diabetic patients had developed CKD within 10 years of the diabetes mellitus diagnosis. Advanced age, longer duration of diabetes, lower baseline HDL-C level, and proteinuria had increased the hazards of developing CKD. We recommend a more focused follow-up of older adult patients with advanced disease status at baseline for optimal control of diabetes mellitus that prevents its furthering to CKD.

Characteristics and predictors of chronic kidney disease in children with myelomeningocele: a nationwide cohort study.

Myelomeningocele (MMC) is highly prevalent in developing countries, and MMC-related neurogenic bladder is an important cause of childhood chronic kidney disease (CKD). This nationwide study aimed to evaluate demographic and clinical features of pediatric patients with MMC in Turkey and risk factors associated with CKD stage 5. Data from children aged 0-19years old, living with MMC in 2022, were retrospectively collected from 27 pediatric nephrology centers. Patients > 1year of age without pre-existing kidneyabnormalities were divided into five groups according to eGFR; CKD stages 1-5. Patients on dialysis, kidney transplant recipients, and those with eGFR < 15ml/min/1.73 m2 but not on kidney replacement therapy at time of study constituted the CKD stage 5 group. A total of 911 (57.8% female) patients were enrolled, most of whom were expectantly managed. Stages 1-4 CKD were found in 34.3%, 4.2%, 4.1%, and 2.4%, respectively. CKD stage 5 was observed in 5.3% of patients at median 13years old (range 2-18years). Current age, age at first abnormal DMSA scan, moderate-to-severe trabeculated bladder on US and/or VCUG, and VUR history were independent risk factors for development of CKD stage 5 (OR 0.752; 95%; CI 0.658-0.859; p < 0.001; OR 1.187; 95% CI 1.031-1.367; p = 0.017; OR 10.031; 95% CI 2.210-45.544; p = 0.003; OR 2.722; 95% CI 1.215-6.102; p = 0.015, respectively). Only eight CKD stage 5 patients underwent surgery related to a hostile bladder between 1 and 15years old. MMC-related CKD is common in childhood in Turkey. A proactive approach to neurogenic bladder management and early protective surgery in selected cases where conservative treatment has failed should be implemented to prevent progressive kidney failure in the pediatric MMC population in our country.

Chronic kidney disease and its predictors among highly active antiretroviral therapy naïve and experienced HIV-infected individuals at the selected hospitals, Southwest Ethiopia: a comparative cross-sectional study

ObjectiveThis study aimed to determine the prevalence of chronic kidney disease (CKD) and its predictors among highly active antiretroviral therapy (HAART) naïve and experienced HIV-infected individuals.Method and analysisHospital-based comparative cross-sectional...

The Association between the Platelet to White Blood Cell Ratio and Chronic Kidney Disease in an Aging Population: A Four-Year Follow-Up Study.

The platelet to white blood cell ratio (PWR) has been reported to be a prognostic factor for some diseases, such as subarachnoid hemorrhage. However, the association between the PWR and chronic kidney disease (CKD) remains unknown. To investigate the cross-sectional and longitudinal association between the PWR and CKD, this study was performed. This study used datasets from a national prospective cohort in China (China Health and Retirement Longitudinal Study). A retrospective cohort from 2011 to 2015 was constructed. The PWR was stratified as a categorical variable according to tertiles (T1-T3 groups). CKD was defined as an estimated glomerular filtration rate < 60 mL min-1/1.73/m2. Univariate and multivariate logistic regressions and restricted cubic spline regression were adopted to assess the linear and non-linear association between the PWR and CKD. Propensity score matching was used to balance the discrepancies between covariates. Subgroup and interactive analyses were performed to explore potential interactive effects of covariates. Missing values were interpolated using random forest. The PWR was also stratified according to the median and quartiles as sensitivity analyses. A total of 8600 participants were included in this study. In the full model, the odds ratios (ORs) of prevalent CKD were 0.78 (95% CI = 0.62-0.97, p < 0.05) for the T2 group and 0.59 (95% CI = 0.46-0.76, p < 0.001) for the T3 group. There were significant interactive effects of marital status and smoking in the PWR-CKD association (both p for interaction < 0.05). An L-shaped, non-linear association was detected between the PWR and prevalent CKD in the overall population, participants ≥ 60 years, and females subgroups (all p for non-linear < 0.05). All sensitivity analyses supported the negative association between the PWR and prevalent CKD. In the 2011-2015 follow-up cohort, the ORs of incident CKD were 0.73 (95% CI = 0.49-1.08, p > 0.05) and 0.31 (95% CI = 0.18-0.51, p < 0.001) for the T2 and T3 groups, respectively, in the full model. A high PWR is associated with a reduced risk of prevalent and incident CKD. The PWR may serve as a predictor for CKD, facilitating the early identification and intervention of kidney function decline.

Para-perirenal fat thickness is associated with reduced glomerular filtration rate regardless of other obesity-related indicators in patients with type 2 diabetes mellitus.

To investigate the relationship between estimated glomerular filtration rate (eGFR) and para-perirenal fat thickness in comparison with other indices of adiposity in type 2 diabetes mellitus (T2DM). This single-center, retrospective and cross-sectional study evaluated 337 patients with T2DM. The obesity-related indicators including height, weight, body surface area (BSA), body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), para-perirenal fat thickness (PRFT), total abdominal fat (TAF), subcutaneous adipose tissue (SAT), visceral adipose tissue (VAT). eGFR was calculated by CKD-EPI equation. The correlation between eGFR and obesity-related indicators was performed by pearson or spearman correlation analysis and multivariate linear regression. 337 subjects (mean age, 60.2 ± 11.6 years; 195 males, 57.9%) were evaluated. eGFR was negatively correlated with height, weight, BMI, PRFT, TAF, SAT, and VAT, among which the correlation between eGFR and PRFT was the strongest (r = -0.294, p< 0.001). eGFR remained the strongest correlation with PRFT in the subgroup separated by sex (r = -0.319 in the male subgroup, and -0.432 in the female subgroup, respectively, p < 0.001). Age and PRFT were the independent predictive factors for eGFR. PRFT was the best predictor of chronic kidney disease (CKD) in T2DM (AUC = 0.686, p = 0.001, 95% CI: 0.582-0.791). CKD in T2DM can be predicted well by linking age with PRFT (AUC = 0.708, p<0.001, 95% CI = 0.605-0.812). PRFT is more closely related to glomerular filtration rate than other obesity-related indicators in T2DM. The model combining age with PRFT could predict CKD in T2DM well.

Association of Coronary Artery Disease with Hypertension, Diabetes and Chronic Kidney Disease

Background: It is well known that patients with chronic hypertension (HTN), diabetes mellitus (DM) and kidney disease (CKD) have a strong risk of coronary artery disease. However, the excess risk of coronary artery disease in patients with CKD is only somewhat explained by the presence of traditional risk factors, such as hypertension and diabetes mellitus. Objective: To find out the association between coronary artery diseases who have hypertension, diabetes, and chronic kidney disease. Methodology: This prospective observational study was conducted in a Tertiary medical college Bangladesh, the department of Cardiology, Dhaka Medical College, Bangladesh during the period from July 2021 to June 2022. Total 150 patients with coronary artery disease were included as the study subjects for this study. Results: The majority of patients were above 60 years (49%), and 40-59 years old (37%), followed by 18-39 years (35%). The female patients (n=79) were 65.3%% and male patients (n=42) were 34.7%. Gender, age and DM, P value was significant with hypertension, diabetes mellitus, and chronic kidney disease among coronary artery disease patients. Hypertension and DM also significant with predictors of chronic kidney disease (CKD) on a representative sample of adults. Conclusion: In Bangladesh, coronary artery disease is currently a serious public health issue. The increased rate of CAD is assumed to be caused by rapid lifestyle changes, harmful behaviors like smoking and sedentary behavior, economic development, nutritional variables, and a higher prevalence of hypertension, diabetes, and CKD. To get more granular results, we would advise conducting comparable more experiments with bigger samples in more places.

Development of a novel score (RENSAFE) to determine probability of acute kidney injury and renal functional decline post surgery: A multicenter analysis

ObjectiveTo create and validate 2 models called RENSAFE (RENalSAFEty) to predict postoperative acute kidney injury (AKI) and development of chronic kidney disease (CKD) stage 3b in patients undergoing partial (PN) or radical nephrectomy (RN) for kidney cancer. MethodsPrimary objective was to develop a predictive model for AKI (reduction >25% of preoperative eGFR) and de novo CKD≥3b (<45 ml/min/1.73m2), through stepwise logistic regression. Secondary outcomes include elucidation of the relationship between AKI and de novo CKD≥3a (<60 ml/min/1.73m2). Accuracy was tested with receiver operator characteristic area under the curve (AUC). ResultsAKI occurred in 452/1,517 patients (29.8%) and CKD≥3b in 116/903 patients (12.8%). Logistic regression demonstrated male sex (OR = 1.3, P = 0.02), ASA score (OR = 1.3, P < 0.01), hypertension (OR = 1.6, P < 0.001), R.E.N.A.L. score (OR = 1.2, P < 0.001), preoperative eGFR<60 (OR = 1.8, P = 0.009), and RN (OR = 10.4, P < 0.0001) as predictors for AKI. Age (OR 1.0, P < 0.001), diabetes mellitus (OR 2.5, P < 0.001), preoperative eGFR <60 (OR 3.6, P < 0.001) and RN (OR 2.2, P < 0.01) were predictors for CKD≥3b. AUC for RENSAFE AKI was 0.80 and 0.76 for CKD≥3b. AKI was predictive for CKD≥3a (OR = 2.2, P < 0.001), but not CKD≥3b (P = 0.1). Using 21% threshold probability for AKI achieved sensitivity: 80.3%, specificity: 61.7% and negative predictive value (NPV): 88.1%. Using 8% cutoff for CKD≥3b achieved sensitivity: 75%, specificity: 65.7%, and NPV: 96%. ConclusionRENSAFE models utilizing perioperative variables that can predict AKI and CKD may help guide shared decision making. Impact of postsurgical AKI was limited to less severe CKD (eGFR<60 ml/min 71.73m2). Confirmatory studies are requisite.

Screening for renal impairment in viral hepatopathy B: it is time to begin.

The aim of this study was to assess the value of routine screening for renal damage in cases of B viral infection, by looking for proteinuria and elevated creatinemia. We investigate the frequency and associated factors of renal impairment in patients with viral B hepatopathy. Pathological albuminuria was confirmed in 44.73%. The chronic kidney disease with slightly decreased filtration rate was found in 21.05%. In multivariate analysis, only BMI was an independent factor for pathological albuminuria (p=0.013) and only age was an independent predictor of chronic kidney disease (p=0.056). Urine dipstick and creatinemia are useful for routine screening in viral B hepatopathy especially in the elderly and overweight.

Catestatin in diagnosing cardiovascular and metabolic disorders in patients with comorbid hypertension

Background. Hypertension is the major pandemic in human history, which determines the structure of cardiovascular morbidity and mortality. There is an obvious relationship between hypertension and various diseases that largely determine its development and increase the risk of cardiovascular complications. Neuropeptides appear to have a major impact on the progression of these complications. Catestatin (CST) is one of them, which deserves special scientific and practical concern, as it has a wide range of biological effects in the body. The aim of the study: to determine the place of CST in the early diagnosis of cardiovascular and metabolic complications in patients with comorbid hypertension among the Ukrainian population. Materials and methods. One hundred and eleven patients with hypertension, type 2 diabetes mellitus, obesity (men/women — 50/61) and 20 controls were examined. All patients with hypertension, type 2 diabetes mellitus, and obesity were aged 54.37 ± 1.18 years. Following a thorough examination and supervision, they were divi­ded into 2 groups depending on the median CST level of 2.45 ng/ml. The first group included 55 (49.5 %) patients who had a CST level below 2.45 ng/ml, the second one consisted of 56 patients (50.5 %) who had a CST level above 2.45 ng/ml. In all patients, we measured body weight, height, calculated body mass index, evaluated glycated hemoglobin levels, lipid metabolism (serum concentrations of total cholesterol, triglycerides, high-density lipoprotein, low-density lipoprotein, and very low-density lipoprotein cholesterol); systolic and diastolic blood pressure. The content of CST, cardiotrophin 1, leptin, cystatin C, neutrophil gelatinase-associated lipocalin, N-terminal prohormone of brain natriuretic peptide, 25(OH)D, β2-microglobulin, and insulin levels in the blood serum were determined by enzyme-linked immunosorbent assay. Results. A reliable difference between the groups was found by β2-microglobulin (p = 0.008). Univariate and multivariate linear regression analysis revealed a negative correlation between CST and cardiotrophin 1, N-terminal prohormone of brain natriuretic peptide, neutrophil gelatinase-associated lipocalin, and 25(OH)D. A positive correlation was found between CST and the level of glycated hemoglobin, body mass index, and triglycerides. A statistically significant correlation was found between CST and creatinine (R = –0.21, p = 0.029), high-density lipoprotein cholesterol (R = 0.207, p = 0.029), and β2-microglobulin (R = 0.279, p = 0.0029) in the patients with hypertension. Conclusions. It has been proven that a decrease in serum catestatin concentration can be a risk factor for the development of more severe comorbidities in patients with hypertension. The detected relationships of catestatin with creatinine, urea, and β2-microglobulin suggest that CST is a predictor of chronic kidney disease in patients with comorbidities. The revealed correlation of CST with high-density lipoprotein, obesity, and body mass index suggests its importance in the prevention of atherosclerotic and metabolic complications in patients with hypertension, type 2 diabetes mellitus, and obesity.

Liver stiffness, hepatorenal index, and microRNA-130b as predictors for chronic kidney disease in patients with non-alcoholic fatty liver disease

Background and aimCurrently, nonalcoholic liver disease (NAFLD) is the most predominant chronic liver disorder. NAFLD has been linked to hepatic and extrahepatic morbidities. We aimed to investigate the role of acoustic radiation force impulse (ARFI), hepatorenal index (HRI), and serum microRNA-130b as non-invasive predictors for chronic kidney disease (CKD) in NAFLD patients.Material and methodsIn a case–control design, we included 40 NAFLD patients (20 NAFLD with CKD and 20 NAFLD without CKD) and 20 healthy controls. After clinical evaluation, laboratory assessments including liver test profile, renal function test, and quantification of microRNA-130b were done. Liver steatosis and stiffness were evaluated using HRI and ARFI.ResultsHRI and ARFI readings were significantly higher among NAFLD with CKD patients compared to other groups (P < 0.001). The median values of microRNA-130b were 32.1, 27.01, and 25.36 copies/µl in NAFLD with CKD, NAFLD without CKD, and healthy controls, respectively, with significant differences between groups (P < 0.05). ARFI values and HRI were positively correlated with microRNA-130b (P < 0.05). At a cutoff value > 28.13 copies/µl, microRNA-130b could differentiate between “NAFLD with CKD” and “NAFLD without CKD” patients with a sensitivity and specificity of 75% and 70%, respectively (AUC = 71.9%, P = 0.018).ConclusionsSerum microRNA-130b, HRI, and ARFI are valuable noninvasive markers for the assessment of NAFLD. MicroRNA-130b is suggested as a sensitive biomarker for the prediction of CKD among NAFLD patients with good sensitivity and specificity.

#6157 PREDICTORS OF 24 PULSE WAVE VELIOCITY IN HYPERTENSIVE CHRONIC KIDNEY DISEASE PATIENTS: A CASE CONTROL STUDY

Abstract Background and Aims Pulse wave velocity (PWV) is a significant predictor of chronic kidney disease (CKD) progression and death in people with impaired kidney function. It is known that patients with type 2 diabetes mellitus have higher values of PWV. Our study assessed the difference in arterial stiffness parameters (value of peripheral and central blood pressure parameters and PWV) according diabetic status and to evaluate predictors of PWV in hypertensive CKD patients. Method This case control, cross-sectional study included 252 hypertensive CKD patients 143 (56.7%) men and 109 (43.3%) women, aged 67 years (IQR = 15). For each participant data about sex, age, height, presence of CKD, AH and other comorbidities were collected. Laboratory parameters (urea, creatinine, estimated glomerular filtration rate (eGFR), glycated hemoglobin (HbA1c)) were obtained from peripheral blood and 24-hour urine samples were collected to analyze albuminuria. Each participant underwent 24-hour ambulatory blood pressure measurement using the IEM Mobil-O-Graph based on the oscillometry. Tanita MC780 Multi Frequency segmental body composition analyzer was used to measure body weight and level of visceral fat. Body mass index (BMI) was calculated. Results Out of 252 participants with AH and CKD, 107 (42.5%) also had DM. Participants with DM were older (p&amp;lt;0001), had higher pulse pressure (p&amp;lt;0.001) and PWV (p&amp;lt;0.001) while the levels of peripheral and central diastolic pressure (p&amp;lt;0.001) were lower. Regarding body composition parameters, DM participants had higher BMI (p = 0.001) and visceral fat level (p&amp;lt;0.001). Positive predictors of PWV adjusted for age, sex, presence of DM and eGFR were HbA1c (β = 0.216, p = 0.007), albuminuria (β = 0.000, p = 0.002), central and peripheral systolic and diastolic blood pressure (β = 0.035, p&amp;lt;0.001; β = 0.035, p&amp;lt;0.001; β = 0.033, p&amp;lt;0.001; β = 0.035, p&amp;lt;0.001), pulse pressure (β = 0.047, p&amp;lt;0.001) and mean arterial pressure (β = 0.042, p&amp;lt;0.001). Body composition parameters were not found to be significant predictors of PWV. Conclusion We found significant differences in 24-hour blood pressure parameters and body composition in relation to the presence of DM. One possible explanation for the lower peripheral and central diastolic blood pressure in diabetic participants is the older age of these participants. Accordingly, PWV as a parameter of arterial stiffness, which is higher in DM participants, could also be due to the age difference. As for the predictors of PWV, the expected predictors were parameters of blood pressure. HbA1c and albuminuria were also associated with PWV as parameter of arterial stiffness in CKD participants with AH.

Prevalence and predictors of chronic kidney disease of undetermined causes (CKDu) in Western Kenya’s “sugar belt”: a cross-sectional study

BackgroundEpidemics of chronic kidney disease of undetermined causes (CKDu) among young male agricultural workers have been observed in many tropical regions. Western Kenya has similar climatic and occupational characteristics as many of those areas. The study objectives were to characterize prevalence and predictors of CKDu, such as, HIV, a known cause of CKD, in a sugarcane growing region of Kenya; and to estimate prevalence of CKDu across occupational categories and evaluate if physically demanding work or sugarcane work are associated with reduced eGFR.MethodsThe Disadvantaged Populations eGFR Epidemiology Study (DEGREE) protocol was followed in a cross-sectional study conducted in Kisumu County, Western Kenya. Multivariate logistic regression was performed to identify predictors of reduced eGFR.ResultsAmong 782 adults the prevalence of eGFR < 90 was 9.85%. Among the 612 participants without diabetes, hypertension, and heavy proteinuria the prevalence of eGFR < 90 was 8.99% (95%CI 6.8%, 11.5%) and 0.33% (95%CI 0.04%, 1.2%) had eGFR < 60. Among the 508 participants without known risk factors for reduced eGFR (including HIV), the prevalence of eGFR < 90 was 5.12% (95%CI 3.4%, 7.4%); none had eGFR < 60. Significant risk factors for reduced eGFR were sublocation, age, body mass index, and HIV. No association was found between reduced eGFR and work in the sugarcane industry, as a cane cutter, or in physically demanding occupations.ConclusionCKDu is not a common public health problem in this population, and possibly this region. We recommend that future studies should consider HIV to be a known cause of reduced eGFR. Factors other than equatorial climate and work in agriculture may be important determinants of CKDu epidemics.

Wen-Shen-Jian-Pi-Hua-Tan decoction protects against early obesity-related glomerulopathy by improving renal bile acid composition and suppressing lipogenesis, inflammation, and fibrosis

BackgroundObesity is an independent predictor of chronic kidney disease (CKD) development and may directly lead to kidney lesions such as obesity-related glomerulopathy (ORG) which might play a vital pathogenic role in obese patients with CKD. Wen-Shen-Jian-Pi-Hua-Tan decoction (WSHT) has been clinically used for the treatment of obesity and obesity-related metabolic diseases for years. However, the renoprotective effects and potential mechanism of action of WSHT against ORG remain unknown. PurposeThis study aimed to explore the potential effect of WSHT on ORG and reveal its mechanisms in high-fat diet (HFD)-induced obese rats. MethodsAn animal model of early stage ORG was established using HFD-induced obese rats. After treatment with WSHT for 6 weeks, an integrated metabolomics and molecular biology strategy was utilized to illustrate the effects and mechanism of WSHT on ORG. First, UPLC-ESI-MS/MS-based targeted metabolomics was used to analyze renal bile acid (BA) levels. Biochemical, histological, and immunofluorescence assays; electron microscopy; and western blotting were performed to evaluate the efficacy of WSHT against ORG and its underlying mechanisms in vivo. ResultsOur results showed that an HFD led to hyperlipidemia, proteinuria, renal lipid deposition, effacement of podocyte foot processes, and increased expression of proinflammatory factors and profibrotic growth factors in ORG rats. In addition, an HFD decreased the levels of renal BAs such as cholic acid, chenodeoxycholic acid, and lithocholic acid. After 6 weeks of treatment, WSHT markedly attenuated dyslipidemia and reduced body, kidney and epididymal fat weights in ORG rats. WSHT also significantly increased BA levels, suggesting that it altered BA composition; the effects of BAs are closely associated with farnesoid X receptor (FXR) activation. WSHT alleviated fat accumulation, podocyte loss and proteinuria, and reduced the expression of proinflammatory cytokines and profibrotic growth factors in the kidneys of ORG rats. Finally, WSHT remarkably upregulated the renal expression of FXR and salt-induced kinase 1 and blocked the renal expression of sterol regulatory element–binding protein-1c and its target genes. ConclusionWSHT attenuated early renal lesions in ORG rats by improving renal BA composition and suppressing lipogenesis, inflammation and fibrosis. This study develops a new way to alleviate obesity-induced renal damages.

Predictors of chronic kidney disease among Indonesian adult population: Results from the 2018 Indonesia Basic Health Research

Background:Three out of ten cases of chronic kidney disease (CKD) are cause by type 2 diabetes mellitus (T2DM). In addition, nutritional status, consumption of unhealthy foods, high blood pressure, and smoking habits were also previously identified as risk factors to CKD but there is a scarcity of data from Indonesia. Therefore, we sought to determine the risk factors using a predictive model for the incidence of CKD in Indonesia based on the Indonesia Basic Health Research 2018.Methods:Secondary data from the 2018 Indonesia Basic Health Survey with 300,000 respondents was used. Respondents with complete socio-demographic, food consumption data, anthropometric data and chronic disease status (i.e. T2DM and hypertension) type 2 were analyzed (n=96,098). Binary logistic regression model was performed to assess the association between socio-demographic, food group consumption, health and nutritional status with CKD.Results: Based on the final model of logistic regression analysis, ranging from the most and least factors that contribute to CKD were the presence of T2DM (p&lt;0.000; OR=2.353), hypertension (p&lt;0.000; OR=1.695); education level (p=0.028; OR=1.438), living area (p=0.025; OR=1.242); age (p&lt;0.000; OR=0.979); and sugary drink consumption (p=0.050; OR=0.884).Conclusions:Prediction equation of CKD risk factor in Indonesia Adult included 6 factors that are present: diabetes, present hypertension, education, living area, age, and sugary drink consumption. This result can be used by the health professional to predict the risk of CKD among patients with present diabetes and/or hypertension.

Clinical characteristics of hospitalised children with acute post-streptococcal glomerulonephritis in the Top End of Australia.

Despite the declining incidence of acute post-streptococcal glomerulonephritis (APSGN) in Australia, there is still a significant burden of disease amongst Aboriginal and Torres Strait Islander people in the Northern Territory. Childhood APSGN has been highlighted as a predictor of chronic kidney disease in this population. We aimed to describe clinical characteristics and outcomes of hospitalised children with APSGN in the Northern Territory. Single-centre, retrospective cohort study of children (<18 years) with APSGN admitted to a tertiary hospital in the Top End of the Northern Territory between January 2012 and December 2017. Cases were confirmed using the Centre for Disease Control case definition guidelines. Data were extracted from the case notes and electronic medical records. There were 96 cases of APSGN with median age of 7.1 years (interquartile range (IQR) 6.7-11.4). Majority were Aboriginal and Torres Strait Islander (90.6%) and from rural and remote areas (82.3%). Preceding skin infections were identified in 65.5% and sore throat in 27.1%. Severe complications included hypertensive emergencies (37.4%), acute kidney injury (43.8%) and nephrotic-range proteinuria (57.7%). All children improved from their acute illness with supportive medical therapy; however, only 55 out of 96 (57.3%) children were followed up within 12 months of their acute illness. APSGN disproportionately affects Aboriginal and Torres Strait Islander children and highlights the need for continued and improved public health response. There is room for significant improvement in the medium- and long-term follow-up of affected children.

Nadir creatinine as a predictor of renal outcomes in PUVs: A systematic review and meta-analysis.

Posterior urethral valves (PUVs) represent the most severe pediatric obstructive uropathy, responsible for chronic renal failure in up to 65% of cases and progression to end-stage kidney disease (ESKD) in about 8%-21% of patients. Unfortunately, renal outcomes have poorly improved over time. The key point is to identify patients at risk; thus, several prenatal and postnatal prognostic factors have been analyzed to improve clinical outcomes. Postnatal nadir creatinine seems to accurately predict long-term renal prognosis, but there is no definitive evidence to support this finding. We performed a systematic review with meta-analysis to analyze the predictive value of nadir creatinine on long-term renal function in infants with PUVs. We conducted this systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed and Cochrane Library were systematically searched for studies published from January 2008 to June 2022. All the articles were checked independently by two reviewers in two steps. A total of 24 articles were screened, and 13 were included for data extraction. Data from 1,731 patients with PUVs were analyzed, with a mean follow-up of 5.5 years; of these, on average, 37.9% developed chronic kidney disease (CKD) and 13.6% developed ESKD. All the articles evaluated nadir creatinine as a predictor of CKD, most using a level of 1 mg/dL, with statistical significance at the 5% level. The relative risk of developing CKD in patients with creatinine values higher than the nadir cutoff considered was 7.69 (95% CI: 2.35-25.17, I 2 = 92.20%, p < 0.001). Nadir creatinine is the best prognostic factor for long-term renal function in patients affected by PUV. A value above the cutoff of 1 mg/dL should be considered a significant predictor for the risk of CKD and ESKD. Further studies are needed to define different nadir creatinine cutoffs for better stratification of the different CKD stages and for the development of reliable scores, which include the association of several variables.

Burden and Predictors of Chronic Kidney Disease in Developing Country

Chronic Kidney Disease (CKD) is being recognized as a global public health problem. It is a major non-communicable disease with the global prevalence varying between 10.5% and 13.1%. Diabetes and hypertension appear to be the leading causes of chronic kidney disease worldwide. An institution based cross-sectional study was undertaken from Oct 20, 2018 to Nov 20, 2019 G.C. Data was collected using a pre-tested questionnaire designed to meet the study objective. After describing variables, logistic regression was conducted to identify independent associated factors of CKD. Statistical significance was declared at P&lt;0.05. Of the 450 studied patients, 260(57.8%) were males and more than half (54.2%) were between ages of 25 to 40 years. The prevalence of CKD among patients admitted to medical ward was 17.3% (95% CI 13 - 29.9) and 14.4% (95 % CI 6.2 – 12.3) by Cockcroft Gault and MDRD equations, respectively and majority (61.5%) of them were stage 5. Hypertension (AOR= 7.8 95%CI 4.1, 14.9), history of recurrent urinary tract infection (AOR= 3.5 95% CI 1.1, 7.3) and history of using nephrotoxic drugs (AOR=3.4 95% CI 2, 9.3) were significantly associated with CKD. The burden of CKD among patients in a medical inpatient unit was high and majority of the patients present late. Hypertension, use of nephrotoxic agents and recurrent urinary tract infections were found to be important predictors.

Prevalence and Predictors of Renal Disease in a National Representative Sample of the Romanian Adult Population: Data from the SEPHAR IV Survey.

The prevalence of chronic kidney disease (CKD) correlates with the prevalence of hypertension (HT). We studied the prevalence and predictors of CKD in a representative sample of the Romanian adult population. A sample of 1470 subjects were enrolled in the SEPHAR IV (Study for the Evaluation of Prevalence of Hypertension and Cardiovascular Risk) survey. All subjects were evaluated for blood pressure (BP) and extensive evaluations of target organ damage, blood, and urine samples were undertaken. A total of 883 subjects were included in the statistical analysis. Those experiencing CKD with an eGFR &lt; 60 mL/min/1.73 m2 were older at 71.94 ± 7.4 years (n = 19, 2.15%) compared with those without renal impairment at 50.3 ± 16.21 years (n = 864, 97.85%), p &lt; 0.0001. The prevalence of CKD among hypertensives (379 from 883) was 4.49% (17/379), while 17 out of 19 subjects with CKD had HT (89.47%). After adjusting for age, sex, and diabetic status, only serum uric acid (SUR) &gt; 6.9 mg/dL (OR: 6.61; 95% CI: 2.063, 10.83; p = 0.004) was an independent risk factor and a predictor of CKD. The prevalence of CKD in hypertensive Romanian adults was more than ten times higher than in the normotensive population. Levels of SUR &gt; 6.9 mg/dL were predictors of CKD.

Relationship between obesity-related parameters and chronic kidney disease in middle-aged and elderly populations in Taiwan: A community-based study.

Globally, obesity is a major health problem and can markedly increase the risk of various diseases, including type 2 diabetes mellitus, hypertension (HTN), dyslipidemia, and chronic kidney disease (CKD). The association of obesity-related parameters, such as lipid parameters and their ratio, with CKD in clinical settings is not well understood. This study aimed to investigate the association of obesity-related parameters with CKD in the middle-aged and elderly population in Taiwan. This cross-sectional, community-based study recruited 400 participants (141 males and 259 females) aged 50 years or over from a community health promotion project at the Linkou Chang Gung Memorial Hospital (Guishan District, Taoyuan City) in 2014. Each participant completed a questionnaire including personal information and medical history during a face-to-face interview. Laboratory data were obtained from blood and urine sampling. The data were analyzed using t-test, chi-square test, Pearson's correlation test, multivariate logistic regression, and receiver operating characteristic (ROC) analysis. A total of 81 participants were identified as having CKD [estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73 m2 or urine albumin/creatinine ratio ≥30 mg/g], and their mean triglyceride/high-density lipoprotein cholesterol (TG/HDL-C) ratio was 3.37 ± 2.72. The mean TG/HDL-C ratio of the 319 participants without CKD was 2.35 ± 1.66. After adjusting for age, TG/HDL-C was significantly positively correlated with blood pressure, body mass index, waist circumference, and fasting plasma glucose but not low-density lipoprotein cholesterol. There was a negative correlation between TG/HDL-C and eGFR. Multiple logistic regression model analysis showed that TG/HDL-C was still significantly associated with CKD (OR: 1.17, 95% CI: 1.01–1.36, p = 0.04) after adjusting for multiple covariates. The cut-off point of TG/HDL-C as a predictor of CKD was 2.54 with an area under the ROC curve of 0.61 (95% CI: 0.53–0.68). There was a significant positive correlation between TG/HDL-C and several cardiovascular disease risk factors, including obesity indices. The TG/HDL-C ratio was significantly associated with the risk of CKD and demonstrated predictive ability for CKD in the middle-aged and elderly population. Further studies on its application in clinical settings are warranted.