Predictors Of Chronic Kidney Disease Research Articles

Rewriting Medical Textbooks: The Kidney as a Window to the Heart – The Role of Sodium–Glucose Transport Protein 2 Inhibitors in Cardiovascular and Renal Disease in Type 2 Diabetes Mellitus

This symposium took place during the 2019 meeting of the European Association for the Study of Diabetes (EASD). Focussing on the kidney as a window to the heart, the speakers discussed connections between the kidney and the heart, potential mechanisms, and the role of sodium–glucose co-transporter 2 (SGLT2) inhibitors in patient management. Prof De Nicola set the scene with projected numbers of patients with diabetes and diabetic nephropathy. Prof DeFronzo gave a description of the natural history of diabetic nephropathy, microalbuminuria as a predictor of chronic kidney disease (CKD), and the Steno hypothesis linking impaired vascular endothelial dysfunction with vascular leakage of albumin. He concluded his talk by describing why patients with CKD are predisposed to cardiovascular disease (CVD). Prof Groop provided insights into the mechanisms of renal protection by SLGT2 inhibitors. He explained the ‘tubular hypothesis’, whereby SLGT2 inhibitors correct glomerular hypertension by inhibiting tubuloglomerular feedback (TGF). Prof Perkovic highlighted data from randomised controlled trials which enhanced understanding of the potential effects that might be achieved with SLGT2 inhibitors. The meeting concluded with a lively discussion between panel members and the audience.

Natural history and risk factors for diabetic nephropathy in Italy: insights from AMD Annals initiative

Diabetic patients have a high risk to develop diabetic nephropathy. Diabetic nephropathy represents non only a risk factor for progression toward end stage renal disease but it is also associates with an increased risk to have of major cardiovascular events. Over the last few years, analysis of the AMD annals dataset has contributed several important insights on the clinical features of type 2 diabetes kidney disease and their prognostic and therapeutic implications. First, non-albuminuric renal impairment is the predominant clinical phenotype. Even though associated with a lower risk of progression compared to overt albuminuria, it contributes significantly to the burden of end-stage renaldisease morbidity. Second, optimal blood pressure control provides significant but incomplete renal protection. It reduces albuminuria but there may be a J curve phenomenon with eGFR at very low blood pressure values. Third, hyperuricemia and diabetic hyperlipidemia, namely elevated triglycerides and low HDL cholesterol, are strong independent predictorsof chronic kidney disease onset in diabetes, although the pathogenetic mechanisms underlying these associationsremain uncertain. These data help clarify the natural history of CKD in patients with type 2 diabetes and provide important clues for designing futureinterventional studies. KEY WORDS albuminuria; glomerular filtration rate; hypertension; uric acid; type2 diabetes mellitus.

Kidney Failure After Occlusion of Accessory Renal Arteries in Endovascular Abdominal Aneurysm Repair.

To evaluate the incidence of acute renal failure and chronic kidney disease due to occlusion of accessory renal arteries during endovascular aneurysm repair of infrarenal abdominal aortic aneurysm. We retrospectively reviewed the course of 181 patients (mean age, 71, SD ± 9 years) who underwent EVAR of infrarenal abdominal aortic aneurysm. The renal vessel anatomy was analyzed in all pre- and postoperative CT scans. Diameter and origin of accessory renal arteries were evaluated. Renal function was determined by pre- and postoperative serum creatinine and eGFR levels. Long-term follow-up (>3months) of patients was available in 121 cases (66.9%). Acute kidney injury and chronic kidney failure were defined according to guidelines of "Kidney Disease: Improving Global Outcomes" (KDIGO). In 65 of 181 patients (33.9%), 82 accessory renal arteries were identified preoperatively. In 19 of 181 patients (10.5%), one or more accessory renal arteries were covered and subsequently occluded by the implanted stent-graft device. Neither acute kidney injury (10.3% vs 12.5%; p = .785) nor chronic kidney disease (10.7% vs 15.38%; p = .452) was detected significantly more often in patients with covered accessory renal artery. The only significant predictor of acute kidney injury was the preoperative serum creatinine level (1.12mg/dl vs. 0.98mg/dl; p = .03). Significant predictors for chronic kidney disease were preoperative serum creatinine, eGFR, and impaired renal function (p < .001). Coverage of accessory renal artery due to stent-graft does not lead either to temporary acute kidney injury after endovascular aneurysm repair or to chronic kidney disease. Level II b.

Abstract 114: Renal Inflammation Correlates With Pararenal and Perirenal Adipose Inflammation in Obesity

The global obesity epidemic has led to a 10-fold increase in the incidence of obesity-related chronic kidney disease, highlighting the need for improved understanding of its pathogenesis. Perirenal and pararenal fat capsules surround the kidneys and the thickness of these specific fat deposits is an independent predictor of chronic kidney disease in type-2 diabetes patients. Whilst visceral fat is well-known to promote inflammation in obesity, the role of pararenal and perirenal fat in renal inflammation is still unknown. Due to their close proximity to the kidneys, we hypothesize that pararenal and perirenal fat deposits directly cause renal inflammation and damage in obesity. Thus, we aimed to characterize perirenal, pararenal and renal inflammation in a diet-induced mouse model of obesity. Six-week-old male C57BL/6 mice were fed either normal chow (NC; n=12) or a high-fat diet (HFD; n=12) for 10 weeks. Compared with NC, the HFD resulted in greater bodyweight (38.4±1.1g vs. 29.4±0.6g), blood cholesterol (184±13mg/dL vs. 115±6mg/dL) and fasting blood glucose levels (12.3±0.6mmol/L vs. 9.7±0.3mmol/L) by the completion of the diet regimen (all P &lt;0.05). Flow cytometry was used to enumerate immune cell populations in the blood, kidneys and surrounding (perirenal and pararenal) adipose. In HFD mice, the frequency of CD11b+ cells and inflammatory (Ly6CHi) monocytes was higher in the blood (34±2% vs. 26±2% and 15±1% vs. 8±1%), perirenal (37±5% vs. 19±5% and 8±1% vs. 4±1%) and pararenal fat (65±4% vs. 50±3% and 8±1% vs. 3±1%) than in NC mice (all P &lt;0.05). This was associated with greater Ly6CHi monocyte infiltration in the kidneys from HFD mice ( P &lt;0.05). Interestingly, renal neutrophils (Ly6G+) were more prevalent in HFD than NC mice (3.5±0.5% vs. 2.2±0.3%; P &lt;0.05), but not in pararenal and perirenal adipose. Our data is the first to reveal similarities in the inflammatory cell profiles of blood, perirenal and pararenal adipose tissues and kidneys during obesity.

Prevalence and predictors of chronic kidney disease among Ghanaian patients with hypertension and diabetes mellitus: A multicenter cross-sectional study.

The burden of chronic kidney disease (CKD) is rapidly rising in developing countries due to astronomical increases in key risk factors including hypertension and diabetes. We sought to assess the burden and predictors of CKD among Ghanaians with hypertension and/or diabetes mellitus in a multicenter hospital-based study. We conducted a cross-sectional study in the Ghana Access and Affordability Program (GAAP) involving adults with hypertension only (HPT), hypertension with diabetes mellitus (HPT+DM), and diabetes mellitus only (DM) in 5 health facilities in Ghana. A structured questionnaire was administered to collect data on demographic variables, medical history, and clinical examination. Serum creatinine and proteinuria were measured, and estimated glomerular filtration rate derived using the CKD-EPI formula. A multivariable logistic regression model was used to identify factors associated with CKD. A total of 2781 (84.4%) of 3294 participants had serum creatinine and proteinuria data available for analysis. The prevalence of CKD was 242 (28.5%) among participants with both DM and HPT, 417 (26.3%) among participants with HPT, and 56 (16.1%) among those with DM alone. Predictors of CKD were increasing age aOR 1.26 (1.17-1.36), low educational level aOR 1.7 (1.23-2.35), duration of HPT OR, 1.02 (1.01-1.04), and use of herbal medications aOR 1.39 (1.10-1.75). Female gender was protective of CKD aOR 0.75 (0.62-0.92). Among patients with DM, increasing age and systolic blood pressure were associated with CKD. There is high prevalence of CKD among DM and hypertension patients in Ghana. Optimizing blood pressure control and limiting the use of herbal preparations may mitigate CKD occurrence in high cardiovascular risk populations in developing countries.

NEUROGENIC DYSFUNCTIONS: ASSESSMENT AND TREATMENT TECHNOLOGY

This literature review is devoted to a common problem in children – neurogenic bladder dysfunction. The main types of neurogenic bladder dysfunction (NBD) in children (overactive bladder, underactive («lazy») bladder, stress incontinence, vesico-vaginal reflux and giggle incontenence) are presented. The importance of neurogenic bladder dysfunction as a predictor of chronic kidney disease is discussed. Emphasis is placed on diagnostic and therapeutic strategy for the treatment of NBD, including urotherapy and pharmacological treatment.

Cystatin C as the Predictor of Chronic Kidney Disease in Patients with Comorbid Pathology

Cystatin C as the Predictor of Chronic Kidney Disease in Patients with Comorbid Pathology

Delayed lupus nephritis in the course of systemic lupus erythematosus is associated with a poorer treatment response: a multicentre, retrospective cohort study in Japan.

ObjectiveThe objective of this study was to investigate possible differences in treatment responses between two categories for the onset of lupus nephritis.MethodsWe performed a multicentre, retrospective cohort study of class III–V lupus nephritis patients diagnosed between 1997 and 2014. The renal responses to initial induction therapy were compared between patients who developed lupus nephritis within one year from diagnosis of systemic lupus erythematosus (early (E-) LN) and the remainder (delayed (D-) LN) using the Kaplan–Meier method. We determined the predictors of renal response as well as renal flares and long-term renal outcomes using multivariate Cox regression analyses.ResultsA total of 107 E-LN and 70 D-LN patients were followed up for a median of 10.2 years. Log-rank tests showed a lower cumulative incidence of complete response in D-LN compared with E-LN patients. Multivariate analysis identified D-LN (hazard ratio (HR) 0.48, 95% confidence interval (CI) 0.33–0.70), nephrotic syndrome at baseline, and a chronicity index greater than 2 as negative predictors of complete response. D-LN patients were more likely to experience renal flares. D-LN (HR 2.54, 95% CI 1.10–5.83) and decreased renal function were significant predictors of chronic kidney disease at baseline.ConclusionD-LN was a predictor of poorer treatment outcomes, in addition to renal histology and severity of nephritis at lupus nephritis onset.

Association between chronic kidney disease and synergistic, potentially nephrotoxic medication use in elderly hospitalized patients: A single-center cross-sectional study .

In elderly patients, age-related, disease-related, and drug-related factors are associated with chronic kidney disease (CKD). Little is known about which factors are the best predictors for CKD in elderly patients. The study was based on 784 patients aged 75 years or older for whom the clinical and serum creatinine on admission to our hospital were available. Impaired renal function, including CKD and transient renal insufficiency, was defined as a non-indexed glomerular filtration rate (GFR) below 60mL/min. A logistic regression model was developed for predictors of CKD and was internally validated using bootstrapping. Approximately 61% of the patients, who had CKD (46%) and transient renal insufficiency (15%), had a non-indexed GFR <60mL/min. Synergistic use of 3 drugs potentially impairing renal function, diuretics, ACE-I/ARB, and NSAIDs (odds ratio (OR), 4.66; 95% confidence interval (CI), 1.48-17.7, p=0.012) was a significantly associated factor for CKD in a multivariate logistic regression analysis. Age (OR 1.56, 95% CI 1.04-2.33, p=0.03), female gender (OR 1.58, 95% CI 1.04-2.39, p=0.03), any prescription ACE-I/ARB either alone or in combinations with diuretics or NSAIDs (OR 2.74, 95% CI 1.83-4.13, p=0.0001), and proteinuria (OR 1.98, 95% CI 1.27-3.10, p=0.003), were included as the best model for CKD. The area under the curve (AUC) of the best model and the bootstrapping validation were 0.68 and 0.71, respectively. Given the widespread use of ACE-I/ARB for elderly patients, our findings suggest that caution is needed when they are prescribed because of the possibility of the patient developing CKD.

Clinical predictors of chronic kidney disease in congenital lower urinary tract obstruction.

Congenital lower urinary tract obstruction is associated with oligohydramnios and significant perinatal mortality and long-term chronic kidney disease. The counseling of families facing this diagnosis, especially when prenatal intervention is proposed, is fraught with ambiguity. This review aims to equip the provider with the current evidence behind the conventional and novel biomarkers predictive of chronic kidney disease. The relevant clinical predictors are categorized by when they are identified, antenatally or postnatally, and as either anatomic or chemical. They are considered for their prognostic value and the challenges in obtaining them, specifically the risk to the fetus in the case of prenatal biomarkers. Serum creatinine in infancy is the traditional chemical biomarker of kidney function and continues to be a consistent predictor of future serum creatinine. β-2 microglobulin may provide earlier information regarding fetal glomerular and tubular function and is also predictive of long-term serum creatinine. Renal parenchymal area is an anatomic surrogate of nephron mass that is used in both prenatal and postnatal settings. Understanding the anatomic and chemical biomarkers is essential for future refinement of the staging algorithm used to distinguish which patients may benefit from early in utero intervention.

Prevalence and Predictors of Chronic Kidney Disease in a Semiurban Community in Lagos

Background and Objectives The prevalence of noncommunicable diseases like chronic kidney disease is on the rise in third-world countries. In Nigeria and most sub-Saharan African countries, there is dearth of community-based studies on prevalence and predictors of chronic kidney disease, prompting us to undertake this study. Materials and Methods This was a cross-sectional study, aimed at ascertaining the prevalence and predictors of chronic kidney disease (CKD) in a semiurban community in Lagos, Southwest Nigeria. The study's subjects were recruited from Agbowa community in Ikosi-Ejirin Local Council Development Area of Lagos state. The community was randomly selected. Questionnaires were used to obtain relevant information from the subjects. Body mass index, anthropometric measurements, and other relevant data were also collected. Results CKD was observed in 30 subjects given prevalence of 7.5% in the community. Nine out of the 30 subjects (30%) with CKD were males, while 21 (70%) subjects were females. The prevalence of CKD was significantly higher in the female population. 28 of the subjects with CKD were in stage 3, while 2 of the subjects with CKD were in stage 4. Age, hypertension, and hyperuricemia were significantly associated with CKD. Using multiple logistic regression analysis, 4 variables predicted CKD in the study population. These were age (P =0.01, OR = 0. 274, CI = 0.102 – 0.739), hypertension (p = 0.011, OR = 0. 320, CI = 0.132 – 0.773), hyperuricemia (p=0.001, OR = 0.195, CI =0.083 – 0.461), and female sex (p = 0.009, OR = 3.775, CI = 1.401 – 10.17). Conclusion The prevalence of CKD in the population is low compared with other studies from other parts of the country, and the predictors included age, hypertension, hyperuricemia, and female gender. This is the first community-based study in Nigeria to identify hyperuricemia as a risk factor for chronic kidney disease in the country.

Predictors of chronic kidney disease among HIV-infected patients on highly active antiretroviral therapy at the University of Calabar Teaching Hospital, Calabar, South-South Nigeria.

Background: The burden of the people living with human immunodeficiency virus (HIV) infection and the acquired immunodeficiency syndrome (AIDS) is largely borne by communities in Sub-Saharan Africa. The rate of kidney disease is increasing amongst HIV patients and occurs more often in patients with advanced stage of the disease with lower CD4 counts and associated with a high rate of morbidity and mortality. The objective of this study is to determine the prevalence and predictors of chronic kidney disease (CKD) amongst HIV patients on highly active antiretroviral therapy (HAART) at the University of Calabar Teaching Hospital, Calabar.Materials and methods: This was a cross-sectional study that was carried out over a 4-month period from May to August 2018. In all, a total of 118 patients with HIV on HAART were recruited into the study in a consecutive manner and their serum creatinine measured with the calculation of estimated glomerular filtration rate (eGFR). Other data collected were sex, age, weight, height, body mass index (BMI), waist hip ratio (WHR), packed cell volume, CD4 count etcetera. Data collected were inputted and analyzed with SPSS version 18, and statistical significance was taken to be p<0.05.Results: There were more females (69.5%) amongst the HIV participants and the prevalence of CKD was 15.3%. The risk factors seen to be associated with CKD were lower levels of CD4 count below 200 cells/µl, lower PCV, weight, BMI, and eGFR. Also, higher levels of WHR and creatinine were associated with CKD. Factors directly correlated with CKD were weight, BMI and CD4 count levels, while creatinine level was inversely correlated with CKD. However, a logistic regression model showed only creatinine to be a predictor of CKD.Conclusion: HIV patients on antiretroviral therapy, mainly the highly active antiretroviral therapy (HAART) have a relatively high prevalence of CKD of 15.3% and high level of serum creatinine was predictive of CKD in the logistic regression model in our study.

Urinary Biomarkers of Tubular Damage Are Associated with Mortality but Not Cardiovascular Risk among Systolic Blood Pressure Intervention Trial Participants with Chronic Kidney Disease

Background: Kidney tubulointerstitial fibrosis on biopsy is a strong predictor of chronic kidney disease (CKD) progression, and CKD is associated with elevated risk of cardiovascular disease (CVD). Tubular health is poorly quantified by traditional kidney function measures, including estimated glomerular filtration rate (eGFR) and albuminuria. We hypothesized that urinary biomarkers of tubular injury, inflammation, and repair would be associated with higher risk of CVD and mortality in persons with CKD. Methods: We measured urinary concentrations of interleukin-18 (IL-18), kidney injury molecule-1, neutrophil gelatinase-associated lipocalin, monocyte chemoattractant protein-1, and chitinase-3-like protein-1 (YKL-40) at baseline among 2,377 participants of the Systolic Blood Pressure Intervention Trial who had an eGFR < 60 mL/min/1.73 m². We used Cox proportional hazards models to evaluate biomarker associations with CVD events and all-cause mortality. Results: At baseline, the mean age of participants was 72 ± 9 years, and eGFR was 48 ± 11 mL/min/1.73 m². Over a median follow-up of 3.8 years, 305 CVD events (3.6% per year) and 233 all-cause deaths (2.6% per year) occurred. After multivariable adjustment including eGFR, albuminuria, and urinary creatinine, none of the biomarkers showed statistically significant associations with CVD risk. Urinary IL-18 (hazard ratio [HR] per 2-fold higher value, 1.14; 95% CI 1.01–1.29) and YKL-40 (HR per 2-fold higher value, 1.08; 95% CI 1.02–1.14) concentrations were each incrementally associated with higher mortality risk. Associations were similar when stratified by randomized blood pressure arm. Conclusions: Among hypertensive trial participants with CKD, higher urinary IL-18 and YKL-40 were associated with higher risk of mortality, but not CVD.

Heart rate and blood pressure is associated with renal function in patients with type 1 diabetes in the absence of nephropathy and therapeutical interventions

Background. Albuminuria, heart rate (HR) and blood pressure are established predictors of chronic kidney disease and cardiovascular disease. The objective of this study was to explore the relationship between HR, systolic blood pressure (SBP) and diastolic blood pressure (DBP) with renal function parameters in patients with type 1 diabetes (T1DM) without therapeutical interventions. Material and methods. Study included 313 normoalbuminuric T1DM. HR was determined using a standard 12-lead ECG and blood pressure with a mercury sphygmomanometer, both after a resting period of 10 minutes. Urinary albumin excretion rate (UAE) was measured from at least two 24-h urine samples. Data on serum creatinine levels, age, sex and race were used to calculate the estimated glomerular filtration rate (eGFR) using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula. Results. eGFR was significantly associated with duration of diabetes, HbA1c, LDL-cholesterol, and HDL-cholesterol (for the duration of diabetes r = –0.29, p < 0.001). UAE significantly correlated with duration of diabetes, HDL-cholesterol, triglycerides, HR and DBP (for HR and DBP r = 0.21–0.23, p < 0.001). Subjects in the 4th quartile of UAE had significantly higher HR rate compared to subjects in 1st, 2nd, and 3rd quartiles (70 ± 11 vs. 74 ± 12 vs. 74 ± 12 vs. 79 ± 13 beats/min, p = 0.001). Conclusions. Results of our study suggest that interplay between HR with renal function parameters is present even in T1DM with normal renal function.

Renal Dysfunction after Living-Donor Liver Transplantation: Experience with 500 Cases

Introduction. The possible risk factors for chronic kidney disease in transplant recipients have not been thoroughly investigated after living-donor liver transplantation. Material and Methods. A retrospective cohort study of consecutive adults who underwent living-donor liver transplantation between May 2004 and October 2016, in a single center, was conducted. Kidney function was investigated successively for all the patients throughout the study period, with 12 months being the shortest follow-up. Postoperative renal dysfunction was defined in accordance with the Chronic Kidney Disease Epidemiology Collaboration criteria. The patients' demographic data, preoperative and intraoperative parameters, and outcomes were recorded. A calcineurin inhibitor-based immunosuppressive regimen, either tacrolimus or cyclosporine, was used in all the patients. Results. Of the 413 patients included in the study, 33 (8%) who survived for ≥1 year experienced chronic kidney disease 1 year after living-donor liver transplantation. Twenty-seven variables were studied to compare between the patients with normal kidney functions and those who developed chronic kidney disease 1 year after living-donor liver transplantation. Univariate regression analysis for predicting the likelihood of chronic kidney disease at 1 year revealed that the following 4 variables were significant: operative time, P < 0.0005; intraoperative blood loss, P < 0.0005; preoperative renal impairment, P = 0.001; and graft-to-recipient weight ratio (as a negative predictor), P < 0.0005. In the multivariate regression analysis, only 2 variables remained as independent predictors of chronic kidney disease at 1 year, namely, operative time with a cutoff value of ≥714 minutes and graft-to-recipient weight ratio as a negative predictor with a cutoff value of <0.91. Conclusion. In this study, prolonged operative time and small graft-to-recipient weight ratio were independent predictors of chronic kidney disease at 1 year after living-donor liver transplantation.

Natural history and risk factors for diabetic kidney disease in patients with T2D: lessons from the AMD-annals.

The Associazione Medici Diabetologi (AMD) annals initiative is an ongoing observational survey promoted by AMD. It is based on a public network of about 700 Italian diabetes clinics, run by specialists who provide diagnostic confirmation and prevention and treatment of diabetes and its complications. Over the last few years, analysis of the AMD annals dataset has contributed several important insights on the clinical features of type-2 diabetes kidney disease and their prognostic and therapeutic implications. First, non-albuminuric renal impairment is the predominant clinical phenotype. Even though associated to a lower risk of progression compared to overt albuminuria, it contributes significantly to the burden of end-stage renal disease morbidity. Second, optimal blood pressure control provides significant but incomplete renal protection. It reduces albuminuria but there may be a J curve phenomenon with eGFR at very low blood pressure values. Third, hyperuricemia and diabetic hyperlipidemia, namely elevated triglycerides and low HDL cholesterol, are strong independent predictors of chronic kidney disease (CKD) onset in diabetes, although the pathogenetic mechanisms underlying these associations remain uncertain. Fourth, the long-term intra-individual variability in HbA1c, lipid parameters, uric acid and blood pressure plays a greater role in the appearance and progression of CKD than the absolute value of each single variable. These data help clarify the natural history of CKD in patients with type 2 diabetes and provide important clues for designing future interventional studies.

Upper Normal Serum Creatinine Concentrations as a Predictor for Chronic Kidney Disease: Analysis of 14 Years' Korean Genome and Epidemiology Study (KoGES).

Both serum creatinine (sCr) and estimated glomerular filtration rate (eGFR) have been used to assess kidney function in public health check-ups. However, when the sCr is within the normal levels but the eGFR is <60 mL/min/1.73 m2, a dilemma arises, as the patients might progress to chronic kidney disease (CKD) after several years. We aimed to evaluate the association between normal sCr and the risk of incident CKD in the general population. For this, 9445 subjects from the Korean Genome and Epidemiology Study, with normal sCr and eGFR of >60 mL/min/1.73 m2 were analyzed. The subjects were classified into quartiles based on sCr levels. The primary outcome was the development of eGFR <60 mL/min/1.73 m2 on two consecutive measures. During a mean follow-up of 8.4 ± 4.3 years, 779 (8.2%) subjects developed eGFR <60 mL/min/1.73 m2. The incidence of the development of eGFR <60 mL/min/1.73 m2 was higher in the higher quartiles than in the lowest quartile. In multivariable Cox analysis, the highest quartile was associated with an increased risk for the development of eGFR <60 mL/min/1.73 m2 (hazard ratio (HR), 4.71; 95% confidence interval (CI), 3.29–6.74 in females; HR, 12.77; 95% CI, 7.69–21.23 in males). In the receiver operating characteristic curve analysis, adding sCr to the traditional risk factors for CKD improved the accuracy of predicting the development of eGFR <60 mL/min/1.73 m2 (area under the curve, 0.83 vs. 0.80 in females and 0.85 vs. 0.78 in males), and the cutoff value of sCr was 0.75 mg/dL and 0.78 mg/dL in females and males. Cautious interpretation is necessary when sCr is within the normal range, considering that the upper normal range of sCr has a higher risk of CKD development.

A clinical predictive model of chronic kidney disease in children with posterior urethral valves.

Posterior urethral valves (PUVs) are associated with severe consequences to the urinary tract and are a common cause of chronic kidney disease (CKD). The aim of this study was to develop clinical predictive model of CKD in a cohort of patients with PUVs. In this retrospective cohort study, 173 patients with PUVs were systematically followed up at a single tertiary unit. The primary endpoint was CKD ≥ stage 3. Survival analyses were performed by Cox regression proportional hazard models with time-fixed and time-dependent covariables. Mean follow-up time was 83months (SD, 70months). Sixty-five children (37.6%) developed CKD stage ≥ 3. After adjustment by the time-dependent Cox model, baseline creatinine, nadir creatinine, hypertension, and proteinuria remained as predictors of the endpoint. After adjustment by time-fixed model, three variables were predictors of CKD ≥ stage 3: baseline creatinine, nadir creatinine, and proteinuria. The prognostic risk score was divided into three categories: low-risk (69 children, 39.9%), medium-risk (45, 26%), and high-risk (59, 34.1%). The probability of CKD ≥ stage 3 at 10years age was estimated as 6%, 40%, and 70% for patients assigned to the low-risk, medium-risk, and high-risk groups, respectively (P < 0.001). The main limitation was the preclusion of some relevant variables, especially bladder dysfunction, that might contribute to a more accurate prediction of renal outcome. The model accurately predicts the risk of CKD in PUVs patients. This model could be clinically useful in applying timely intervention and in preventing the impairment of renal function.

Clinical assessment and treatment of diabetes in patients with chronic kidney disease

Diabetes mellitus type 2 is the main cause of chronic kidney disease. Patients with this disease have higher morbidity and mortality and risk of hypoglycaemia than those without this disease. In 2010, type 2 diabetes was the reason for starting renal replacement therapy in 24.7% of patients. The prevalence of microalbuminuria, proteinuria and a reduced glomerular filtration rate is 36%, 8% and 22%, respectively. The presence of albuminuria is a predictor of chronic kidney disease. Diabetic kidney disease, previously known as diabetic nephropathy, refers to kidney disease caused by diabetes. Renal hyperfiltration is a marker of intraglomerular hypertension and a risk factor for onset and progression. The new antidiabetic drugs, mainly dipeptidyl peptidase-4 inhibitors, sodium-glucose cotransporter inhibitors and glucagon-like peptide-1 agonists, have been shown to prevent or slow the progression of kidney disease.

Evaluación clínica y tratamiento de la diabetes en pacientes con enfermedad renal crónica

Diabetes mellitus type 2 is the main cause of chronic kidney disease. Patients with this disease have higher morbidity and mortality and risk of hypoglycaemia than those without this disease. In 2010, type 2 diabetes was the reason for starting renal replacement therapy in 24.7% of patients. The prevalence of microalbuminuria, proteinuria and a reduced glomerular filtration rate is 36%, 8% and 22%, respectively. The presence of albuminuria is a predictor of chronic kidney disease. Diabetic kidney disease, previously known as diabetic nephropathy, refers to kidney disease caused by diabetes. Renal hyperfiltration is a marker of intraglomerular hypertension and a risk factor for onset and progression. The new antidiabetic drugs, mainly dipeptidyl peptidase-4 inhibitors, sodium-glucose cotransporter inhibitors and glucagon-like peptide-1 agonists, have been shown to prevent or slow the progression of kidney disease.