Prevalence Of Chronic Disease Research Articles

Health monitoring system using ECG and PPG techniques

The demand for portable health monitoring systems has grown rapidly in recent years due to the increasing prevalence of chronic diseases and the need for continuous health monitoring. This article introduces the development and implementation of a portable health monitoring system using photo plethysmography (PPG) and electrocardiogram (ECG) technologies. The system integrates the Node MCU ESP8266 microcontroller, AD8232 ECG sensor, and MAX30100 sensor to measure vital signs such as heart rate and blood oxygen saturation level. The proposed system provides a cost-effective and efficient solution for real-time health monitoring, enabling early detection of abnormalities and timely intervention. The feasibility and performance of the system were proven through experimental tests.

Clinical and endoscopic characteristics of patients undergoing gastrointestinal endoscopic procedures in Egypt: a nationwide multicenter study

BackgroundEgypt faces a significant public health burden due to chronic liver diseases (CLD) and peptic ulcer disease. CLD, primarily caused by Hepatitis C virus (HCV) infection, affects over 2.9% of the population nationwide, with regional variations. Steatotic liver disease is rapidly emerging as a significant contributor to CLD, especially in urban areas. Acid-related disorders are another widespread condition that can significantly impact the quality of life. These factors and others significantly influence the indications and findings of gastrointestinal endoscopic procedures performed in Egypt.AimWe aimed to evaluate the clinico-demographic data, indications, and endoscopic findings in Egyptian patients undergoing gastrointestinal endoscopic procedures in various regions of Egypt.MethodsThis study employed a retrospective multicenter cross-sectional design. Data was collected from patients referred for gastrointestinal endoscopy across 15 tertiary gastrointestinal endoscopy units in various governorates throughout Egypt.Results5910 patients aged 38–63 were enrolled in the study; 75% underwent esophagogastroduodenoscopy (EGD), while 25% underwent a colonoscopy. In all studied patients, the most frequent indications for EGD were dyspepsia (19.5%), followed by hematemesis (19.06%), and melena (17.07%). The final EGD diagnoses for the recruited patients were portal hypertension-related sequelae (60.3%), followed by acid-related diseases (55%), while 10.44% of patients had a normally apparent endoscopy. Male gender, old age, and the presence of chronic liver diseases were more common in patients from upper than lower Egypt governorates. Hematochezia (38.11%) was the most reported indication for colonoscopy, followed by anemia of unknown origin (25.11%). IBD and hemorrhoids (22.34% and 21.86%, respectively) were the most prevalent diagnoses among studied patients, while normal colonoscopy findings were encountered in 18.21% of them.ConclusionThis is the largest study describing the situation of endoscopic procedures in Egypt. our study highlights the significant impact of regional variations in disease burden on the utilization and outcomes of GI endoscopy in Egypt. The high prevalence of chronic liver disease is reflected in the EGD findings, while the colonoscopy results suggest a potential need for increased awareness of colorectal diseases.

Guest Editorial: Implantable bioelectronics

The realm of implantable bioelectronics represents a frontier in medical science, merging technology, biology, and medicine to innovate treatments that enhance, restore, or monitor physiological functions. This field has yielded devices like cochlear implants, cardiac pacemakers, deep brain stimulators, and vagus nerve stimulators, each designed to address a specific health condition, ranging from sensorineural hearing loss to chronic pain, neurological disorders, and heart rhythm irregularities. Such devices underscore the potential of bioelectronics to significantly improve patient outcomes and quality of life. Recent technological breakthroughs in materials science, nanotechnology, and microfabrication have enabled the development of more sophisticated, smaller, and biocompatible bioelectronic devices. However, the field also encounters challenges, particularly in extending the capabilities of devices such as retinal prostheses, which aim to restore vision but currently offer limited visual acuity. Research in implantable bioelectronics is highly timely, driven by an aging global population with a growing prevalence of chronic diseases that could benefit from these technologies. The convergence of societal health needs, advancing technological capabilities, and a supportive ecosystem for innovation marks this era as pivotal for bioelectronic research.

Dynamic hydrogel–metal–organic framework system promotes bone regeneration in periodontitis through controlled drug delivery

Periodontitis is a prevalent chronic inflammatory disease, which leads to gradual degradation of alveolar bone. The challenges persist in achieving effective alveolar bone repair due to the unique bacterial microenvironment’s impact on immune responses. This study explores a novel approach utilizing Metal–Organic Frameworks (MOFs) (comprising magnesium and gallic acid) for promoting bone regeneration in periodontitis, which focuses on the physiological roles of magnesium ions in bone repair and gallic acid's antioxidant and immunomodulatory properties. However, the dynamic oral environment and irregular periodontal pockets pose challenges for sustained drug delivery. A smart responsive hydrogel system, integrating Carboxymethyl Chitosan (CMCS), Dextran (DEX) and 4-formylphenylboronic acid (4-FPBA) was designed to address this problem. The injectable self-healing hydrogel forms a dual-crosslinked network, incorporating the MOF and rendering its on-demand release sensitive to reactive oxygen species (ROS) levels and pH levels of periodontitis. We seek to analyze the hydrogel’s synergistic effects with MOFs in antibacterial functions, immunomodulation and promotion of bone regeneration in periodontitis. In vivo and in vitro experiment validated the system's efficacy in inhibiting inflammation-related genes and proteins expression to foster periodontal bone regeneration. This dynamic hydrogel system with MOFs, shows promise as a potential therapeutic avenue for addressing the challenges in bone regeneration in periodontitis.Graphical

Single-cell sequencing technology in diabetic wound healing: New insights into the progenitors-based repair strategies

Diabetes mellitus (DM), an increasingly prevalent chronic metabolic disease, is characterised by prolonged hyperglycaemia, which leads to long-term health consequences. Although much effort has been put into understanding the pathogenesis of diabetic wounds, the underlying mechanisms remain unclear. The advent of single-cell RNA sequencing (scRNAseq) has revolutionised biological research by enabling the identification of novel cell types, the discovery of cellular markers, the analysis of gene expression patterns and the prediction of developmental trajectories. This powerful tool allows for an in-depth exploration of pathogenesis at the cellular and molecular levels. In this editorial, we focus on progenitor-based repair strategies for diabetic wound healing as revealed by scRNAseq and highlight the biological behaviour of various healing-related cells and the alteration of signalling pathways in the process of diabetic wound healing. ScRNAseq could not only deepen our understanding of the complex biology of diabetic wounds but also identify and validate new targets for intervention, offering hope for improved patient outcomes in the management of this challenging complication of DM.

In-hospital outcomes in metabolically healthy and unhealthy individuals over 65 years of age with obesity undergoing percutaneous intervention for acute coronary syndrome: A nationwide propensity-matched analysis (2016–2020)

BackgroundThe obesity paradox in patients with coronary artery disease is well established, but the role of the metabolic syndrome associated with obesity is not well studied. Our study aims to evaluate the in-hospital outcomes of percutaneous coronary intervention (PCI) in metabolically healthy individuals with obesity (MHO) and metabolically unhealthy (MUHO) individuals with obesity over 65 years of age with acute coronary syndrome (ACS) between 2016 and 2020. MethodsThis was a retrospective and observational study. Patients were identified through utilizing the National Inpatient Sample (NIS) Database (2016–2020) and ICD-10 codes. By employing a t-test and Pearson's Chi-square test, we assessed and contrasted the initial attributes, concurrent conditions, and results pertaining to all-cause mortality (ACM), cardiogenic shock (CS), length of stay (LOS), and hospitalization expense. Moreover, propensity score matching was conducted in a 1:1 ratio with respect to age, gender, and race. We also utilized multivariable logistic regression to compare MHO and MUHO in terms of the impact on all-cause mortality. ResultsOut of a total of 135,395 patients identified, 2995 patients with MUHO were matched with 2995 MHO patients. Patients in the MUHO group had a higher prevalence of chronic pulmonary disease (24.9 % vs. 19.5 %), peripheral vascular disease (9.3 % vs. 6.7 %), hypothyroidism (16 % vs. 11.5 %), prior myocardial infarction (15.9 % vs. 6.2 %), and prior stroke (7.5 % vs. 2.8 %). Patients in the MHO group had a higher ACM (12.4 % vs. 2.8 %, p < 0.001), CS (18.55 % vs. 7 %, p < 0.001), stroke (2.2 % vs. 1 %, p < 0.001), ventricular assist device insertions (5.2 % vs. 2.7 %, p < 0.001), and IABP insertions (8.8 % vs. 3.8 %) compared to the MUHO cohort. ConclusionOur study revealed an obesity paradox in individuals over 65 years of age undergoing PCI demonstrating worse outcomes, including higher in-hospital mortality, CS, stroke, Ventricular assist device and IABP insertion in MHO patients compared to the MUHO cohort.

In-hospital outcomes of anterior versus non-anterior st elevation myocardial infarction complicated with complete atrioventricular block

Abstract Background Complete atrioventricular block (CAVB) is an infrequent complication of acute ST-elevation myocardial infarction (STEMI), and information on its outcomes is scarce. We aimed to address the characteristics and in-hospital outcomes of patients with anterior versus non-anterior STEMI complicated with CAVB in a contemporary, nationwide, all-comer registry, in the U.S. Methods Using the National Inpatient Sample (NIS) database, we identified patients who were hospitalized with STEMI, complicated with CAVB between 2016- 2019. Patients with any cardiac implantable electronic device (CIED) in-situ were excluded. Baseline characteristics, in-hospital procedures and outcomes including time to temporary or permanent pacemaker (PPM)/implantable cardioverter defibrillator (ICD) implantation, length of stay and mortality were collected. Results A total of 17470 patients, were hospitalized with a primary diagnosis of STEMI and concomitant diagnosis of CAVB, 2755(15.8%) with Anterior and 14715(84.2%) with non-anterior STEMI. Non-anterior STEMI patients included more women, had higher prevalence of hypertension, dyslipidemia, smoking history and chronic pulmonary disease, while anterior STEMI patients had higher prevalence of chronic kidney disease and ischemic cardiomyopathy. Anterior STEMI patient had significantly higher rate of in hospital death [955 (35%) vs 2220 (15%), p&amp;lt;0.001], CPR, VT/VF, cardiac arrest, acute heart failure, respiratory failure, mechanical ventilation &amp;gt;96 hours and acute kidney injury. In both groups 40% received temporary pacemaker, but mean time to implantation was longer in anterior STEMI patients [1.1±3.3 vs 0.3±1.2 days, p&amp;lt;0.001]. Rate of any permanent CIED implantation was also significantly higher in the anterior STEMI patients with longer time to PPM implantation, [3.3±3.5 vs 2.8±2.8 days, p&amp;lt;0.001]. Use of mechanical circulatory support devices was significantly higher in anterior STEMI patients. Conclusion In STEMI patients complicated with CAVB, in-hospital outcomes of anterior STEMI were worse comparing to non-anterior STEMI, with significantly higher rates of in-hospital death, in-hospital complications and CIED implantations.

Medical expenses and its determinants in female patients with urological disorder

BackgroundThe rising older adult population has led to an increase in the prevalence of chronic diseases and medical expenses. Women tend to have a longer healthy life expectancy than men and are more likely to be exposed to urological disorders around the age of 50, resulting in substantial healthcare expenses throughout their lifetime. Urological disorders often require continuous treatment owing to their high risk of recurrence, contributing to an increased financial burden from medical costs. This study aimed to identify factors influencing medical expense in female patients with urological disorders and propose strategies to alleviate the associated financial burden.MethodsWe used data from the Korea Health Panel Survey conducted from 2011 to 2016. The final sample comprised 2,932 patients who visited hospitals for urological disorders. To identify the factors influencing medical expense among female patients with urological disorders, we employed a generalized estimating equation model.ResultsThe results indicated that younger people and patients with middle-income levels tended to incur higher medical expenses. Furthermore, patients receiving treatment at tertiary hospitals and those enrolled in National Health Insurance also incurred higher health expenses.ConclusionsThis study suggests that effective management of medical expenses related to urological disorders in women requires improvements in healthcare accessibility to facilitate early detection and continuous disease management. In addition, the findings highlight the potential benefits of digital health and non-face-to-face treatments in addressing these needs.

Early relevant alerts from remote monitoring in heart failure patients with a cardiac implanted electronic device: what implications for long term outcome?

Abstract Background Alarms generated by remote monitoring (RM) of cardiac implantable electronic devices (CIEDs) have been associated with worse clinical outcomes in patients with heart failure (HF). However, whether the timing of RM alerts impact on the clinical trajectories of HF patients is still debated. Purpose To examine the impact of alerts occurring in the first 180 days after CIED implant on clinical outcomes, as well as potential predictors. Methods we retrospectively enrolled all patients with a history of HF implanted with a CRT-D or an ICD at our tertiary. We collected data regarding ATP, shock and HF score above threshold (defined as multiparametric scores provided and validated by all CIED manufacturers). We defined early relevant alerts (Early-RA) as alarms received during the first 180 days after implant. The primary clinical outcome of the study was a composite of death or HF hospitalization. Logistic and Cox regression analyses were used to determine associations. The occurrence of early-RA was used as a time dependent covariate. Results A total of 272 patients were included in the analysis (median age 67.4 years, IQR 58.6-74.6, 19.9% female). Twenty patients had an early-RA (7.3% of the overall study population) and were found to be older, more severely symptomatic for HF, with a higher prevalence of atrial fibrillation (AF) and chronic kidney disease (CKD) (all p values&amp;lt;0.05). On the other hand, HF etiology and prevalence of CRT-D did not differ between the two groups. At univariate logistic regression analysis, we found the following factors as significantly associated with early-RA: age (odds ratio [OR] 1.04, 95% confidence interval [CI] 1.00-1.10), NYHA class (OR 2.44, 95% CI 1.01-5.82) and CKD (OR 3.41, 95% CI 1.21-8.98), but these results were not confirmed at the multivariable logistic regression. After a median follow-up of 959 days (IQR 432-1484), patients reporting an early-RA had more primary outcome events (45.0% vs 12.3% p&amp;lt;0.001). At time-dependent multivariable Cox regression analysis adjusted for age, sex, left ventricular ejection fraction and type of CIED, we found that early-RA were independently associated with a higher risk of the primary outcome (hazard ratio [HR] 3.61, 95%CI 1.42-9.18) (Figure). Early-RA were also associated with a higher risk of death (HR 5.58, 95% CI 1.68-18.50) while no significant association was found for HF hospitalization (HR 2.46, 95% CI 0.80-7.57, p=0.116). Conclusions The occurrence of alerts detected by RM of CIEDs in a relatively early phase (within 180 days from implant), is associated with a higher risk of a composite of death and HF hospitalization in HF patients.Study Outcome according to Early RATime dependent Cox regression

#2514 Clinical impact of the CKD-EPI 2021 versus the CKD-EPI 2012 formula on GFR estimation and CKD prevalence: results from a Dutch routine-care cohort

Abstract Background and Aims Quantifying the kidney function is crucial for diagnosing and monitoring kidney disorders in clinical practice. Recently, the CKD-EPI 2021 formula was developed for estimating glomerular filtration rate (eGFR), excluding the ethnicity variable. In this study, we aimed to analyze the impact in a Dutch routine-care cohort of introducing the new serum creatinine-based CKD-EPI 2021 formula on glomerular kidney function estimation and the prevalence of chronic kidney disease (CKD), compared to the now used CKD-EPI 2012 formula. Method All patients of 18 years and older of whom serum creatinine was measured between January 2013 and December 2023 at the University Medical Center Utrecht in the Netherlands, were included. Differences in the eGFR measured with the CKD-EPI 2012 formula and the new CKD-EPI 2021 formula were defined as median difference, stratified by gender, age categories, and CKD stages. Results 251.960 patients with 2.312.313 serum creatinine measurements were included in our analysis. Our findings indicate that the CKD-EPI 2021 formula results in a higher eGFR compared to the CKD-EPI 2012 formula (median +3.6 (Inter quartile range (IQR) 2.4 to 4.5) ml/min/1.73 m2 in men, and median +3.1 (IQR 2.0 to 4.0) ml/min/1.73 m2 in women). In total, 21.1% of the patients with CKD stage 2-5 according to the CKD-EPI 2012 formula were classified as having a better CKD stage using the new CKD-EPI 2021 formula; 26.1%, 20.5%, and 15.1% of the patients classified as having CKD stage 3A, 3B, and 4 were classified as having CKD stage 2, 3A, and 3B, respectively (Table 1). Conclusion The introduction of the CKD-EPI 2021 formula would have significant implications for kidney function estimation in the Dutch clinical setting. It is crucial to consider these differences when interpreting kidney function data and making clinical decisions, especially given the potential impact on diagnosing CKD and dosing medication.

#2116 Socioeconomic position and incidence of chronic kidney disease in Central Italy

Abstract Background and Aims Socioeconomic position is strongly related to most chronic conditions, with higher prevalence, higher incidence, and more adverse outcomes in disadvantaged groups of the population compared to well-off counterparts. Similar to other pathologies, several studies reported inequalities in the prevalence of chronic kidney disease (CKD). Few studies investigated socioeconomic differences in disease incidence, and some analyzed socioeconomic inequalities in long-term outcomes, such as mortality or end-stage renal disease, with conflicting results. We aimed to investigate the association between educational level and CKD in the Lazio Region Longitudinal Study, i.e., the 2011 census cohort of all residents followed through administrative databases from 1 Jan 2012 to 31 Dec 2022. Method The Lazio region is one of the twenty Italian regions. With its 5.5 million inhabitants, it is located in central Italy and includes Rome, the Italian capital city. We considered the population enrolled in the Lazio Region Longitudinal Study aged 35-90 years. We used a validated algorithm to identify prevalent cases of CKD at baseline (1 Jan 2012) and incident CKD cases during the follow-up (1 Jan 2012 to 31 Dec 2022). We used the education available for each individual from the census questionnaire to indicate socioeconomic position. We used Cox proportional hazard models to investigate the association between educational level and incidence of CKD. We used age as the time scale to punctually adjust for age, and we adjusted the multivariable models for place of residence, citizenship, marital status, and occupational status. Results We selected 3 752 190 25-90-year-olds included in the Lazio Longitudinal Study. We excluded 66 376 prevalent cases, obtaining a study population of 3 685 814 CKD-free individuals. The prevalent cases were more likely males than females, increased with age, were more Italians than foreigners, were diabetics, and residents in Rome compared to the general population. The study population comprised 1 754 781 men with a mean age of 52 years and 1 997 409 women with a mean age of 54 years. During the 11 years of follow-up, we identified 88 784 new CKD cases among men and 70 217 among women, with crude incidence rates of 540 and 364 per 100, 000 person-years, respectively. The age-adjusted models showed a strong association between educational level and CKD incidence in both men and women (Table 1). In men, compared to those with a university degree, those with upper secondary education had a 30% higher risk of suffering from CKD, those with lower secondary education had a 54% higher risk, while the primary educated men had a 70% higher risk. Among women, the excess risk of low-educated compared to those with a university degree was even higher than in men, with HR = 1.33 (95% CI 1.28-1.38), HR = 1.76 (95% CI 1.69-1.82), and HR = 2.24 (95% CI 2.16-2.32) in upper secondary, lower secondary and primary school educated, respectively. The socioeconomic gap was slightly reduced when we adjusted for possible confounders. Conclusion We found strong socioeconomic inequalities in CKD incidence. Further analyses will investigate the clinical risk factors that mediate the association between educational level and CKD incidence.

#2489 The prevalence of chronic kidney disease in different altitude areas: results from the China multi-ethnic cohort study

Abstract Background and Aims Chronic Kidney Disease (CKD) poses a significant public health challenge with substantial implications for human well-being. In China, there are significant geographical differences in the prevalence of CKD, with the highest prevalence in the southwest region, which may be related to differences in geographical environment and lifestyle. This study aimed to investigate variances in the prevalence of CKD across different altitude areas in southwest China. Method In this cross-sectional study, we used data from the China Multi-Ethnic Cohort (CMEC). CMEC was established in five provinces of Southwest China and recruited a total of 99,556 participants between 2018 and 2019. Altitude information for each participant was extracted from the Shuttle Radar Topography Mission (SRTM) (version 4) data based on their residential address. To facilitate analysis, we categorized them into groups of low altitude (0-1499 m) and high altitude (≥1500 m). CKD was defined as an estimated glomerular filtration rate (eGFR) of less than 60 mL/min/1.73 m2, using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. Crude and age-standardized prevalence of CKD was calculated by using R. Results A total of 92,163 participants were included in the study, and 39.7% were men. Among the current cohort, 30,904 were high-altitude residents, and 61,259 were from low altitude. Among the participants, 1636 cases of CKD were identified, corresponding to a prevalence of 1.78%. We found, the prevalence of CKD in high altitude group was higher than that in low altitude group, and the former is 2.53%, the latter is 1.40%. The age-standardized prevalence were 1.35% and 2.73% for the low and high altitude groups, respectively, and 1.38% and 2.57% for the sex-standardized groups. Conclusion In southwestern China, the prevalence of CKD was higher in the high altitude group than the low altitude group. And after adjusting for age and gender, the prevalence of CKD remained lower in the low-altitude group, and the gap slightly increased.

#2356 Renal function in pediatric general population from a hot-spot of chronic kidney disease of unknown etiology: a cross-sectional study in Guatemala

Abstract Background and Aims Chronic kidney disease of unknown etiology incidence has been exponentially increasing in Central America. Subclinical kidney injury begins early in life and leads to a higher-than-expected prevalence of chronic kidney disease in adolescents and children. The pediatric population has not had a specific approach to the community with this type of kidney disease and very little data is known in Guatemala. We aim to estimate the glomerular filtration rate (eGFR) using two serum biomarkers (creatinine and cystatin C) and applying the Under 25 equation. Inflammatory and urine biomarkers (Urinary Neutrophil Gelatinase-Associated Lipocalin, albumin/creatinine ratio, and urine dipstick) were determined. Method During 2019, we performed a Cross-Sectional, population-based screening study in children and adolescents between 7-17 years of age, from local schools in a highly CKDu incident rural community in the Pacific Coast of Guatemala. Children with a diagnosis of kidney disease, hepatic and cardiac failure were excluded in the study. Subjects were chosen randomly from 10 different schools and renal function markers were analyzed by sex and age. Results Out of 97 participants of La Democracia, the median age was 11 years and 57% were male. Eighty-seven percent (81/97) of participants had an eGFR between 60 and 90 mL/min/1.73 m2 (Table 1). When comparing eGFR by sex, 63% (51/81) of males and 37% of females had an eGFR between 60 and 90 mL/min/1.73 m2. The difference was statistically significant (p 0.05). When comparing eGFR by age group, the scholar group had an eGFR of 82.7 mL/min/1.73 m2 (SD 7.9), pre-scholars eGFR of 82.2 mL/min/1.73 m2 (SD 6.3), and adolescents of 81.5 (SD 8.1) with no statistically significant difference (p 0.83). Among the twenty-four percent of participants who presented urine dipstick abnormalities, leukocyturia represented 23% (22/97). Twenty-two percent (21/97) of participants had albuminuria more than 0.2 mg/mg and the urinary NGAL/creatinine ratio was higher in females. Conclusion

#1402 CCG-level coding for chronic kidney disease and regional kidney replacement therapy incidence: an ecological study in England

Abstract Background and Aims With ageing of the population both prevalence of chronic kidney disease (CKD) and incidence of kidney replacement therapy (KRT) are rising. Existing research suggests that adding a formal diagnosis-code for CKD to the health record in those affected is associated with better implementation of recommended care and fewer hospitalisations for cardiovascular diseases. Furthermore, reliable estimates of the future need of KRT cannot be extrapolated from previous years after the COVID-19 pandemic. This ecological study investigates whether coding for CKD is associated with KRT incidence at clinical commissioning group (CCG) level in England. Method KRT incidence rates for CCGs in England were calculated using UK Renal Registry (UKRR) data from 01/2019 to 12/2021. Data on the percentage of uncoded CKD patients (PUCP) who had laboratory evidence of CKD but lacked a diagnostic code were obtained from the Cardiovascular Disease Prevention Audit (CVDPREVENT), a national primary care audit that extracts routinely held general practitioner (GP) data. The PUCP was modelled both as a continuous and a categorical variable using quintiles with an equally large population in each quintile to investigate potential non-linear associations. Data on potential confounders and acute kidney injury (AKI) mortality as a marker for underlying population frailty were obtained from CVDPREVENT and the UKRR, respectively. A hierarchical conceptual framework was used to assess the association between the PUCP and KRT incidence, in which covariates were grouped into sociodemographic, healthcare quality and health status covariates. Poisson models assessed the association between PUCP and KRT incidence and effect modification by AKI mortality was investigated using a simplified model for which AKI mortality was recoded to a binary variable. Results The crude overall KRT incidence rate was 141.30/1 000 000, ranging from 84.54 to 204.05/1 000 000 in the different CCGs (Fig. 1A). The mean PUCP was 15.47% (SD 5.55), ranging from 3.68% to 30.28%, with no immediately identifiable association with KRT incidence (Fig. 1B). Univariable Poisson regression showed no evidence of an association between the crude PUCP as a continuous measure and KRT incidence (p = 0.886). However, when included as a categorical variable, there was strong evidence (p &amp;lt; 0.001) for a difference in the crude KRT incidence rates, indicating a non-linear association. After adjusting for all covariates, there was evidence for an association between the PUCP as a continuous measure and KRT incidence (RR 1.004, 95% CI 1.000-1.008, p = 0.029). However, the PUCP was also considered as a categorical variable and there was still evidence of a difference in rates (p = 0.030) with the CCGs in the lowest PUCP quintile having a lower KRT incidence than the others. Considering the PUCP as a continuous variable, there was some evidence (p = 0.033) for effect modification: in CCGs with low AKI mortality, there was no evidence of an association between the PUCP and KRT incidence (RR 1.001, 95% CI 0.996-1.005, p = 0.823), whereas a 7% increase in KRT incidence for every 10% increase in uncoded CKD patients was found in CCGs with high AKI mortality (RR 1.007, 95% CI 1.003-1.012, p = 0.024) (Fig. 2A). Considering the PUCP as a categorical variable, there was very strong evidence (p &amp;lt; 0.001) for effect modification by AKI mortality: In CCGs with low AKI mortality, there was no evidence that rates were different in higher quintiles of the PUCP compared to the lowest. However, in CCGs with high AKI mortality, KRT incidence rates from the second up to the fifth quintile of the PUCP were between 10.3% and 18.5% higher than in the first quintile (Fig. 2B). Conclusion At a geographical level in England, the data suggest that the prevalence of not having formally diagnosed CKD is non-linearly associated with a higher KRT incidence rate, especially in areas with a high AKI mortality. The PUCP can be seen as a proxy for care quality. Therefore, improved care quality might be associated with lower KRT incidence rates. After the COVID-19 pandemic, PUCP follow-up data may be the first way to estimate future KRT needs and support the planning process.

#2701 Prevalence of chronic kidney disease associated pruritus among hemodialysis patients in Switzerland

Abstract Background and Aims Chronic Kidney Disease Associated Pruritus (CKD-aP) is a frequent symptom in patients with end-stage renal disease. The reported prevalence differs between countries and is estimated between 20-40%; data on the prevalence of CKD-aP in Switzerland are lacking. This ongoing study aims to determine the prevalence and severity of CKD-aP among patients on hemodialysis in the French-speaking part of Switzerland and to investigate its association with demographic and clinical factors. Method Patients aged ≥18 years, on hemodialysis for ≥6 months, and free of cognitive impairment were recruited. Clinical, laboratory and dialysis prescription characteristics were collected by an independent research nurse, who also performed CKD-aP assessment using the Visual Analog Scale (VAS, numeric score 0-10) and the Verbal Rating Scale (VRS, 0 = no itch - 4 = extremely severe itch). Multiple linear regression analysis was carried-out to investigate associations of CKD-aP with demographic and clinical factors. Results Preliminary data from 401 participants (mean age 69.4 years, SD 13.6; 65% men) showed a CKD-aP prevalence of 24%. Most participants with CKD-aP (69%) reported generalized itching and 35% waking-up at night because of the itching. Mean VAS in participants with CKD-aP was 4.78 (SD 2.02) during the last 24 hours and 6.65 (SD 2.2) for the worst intensity itching during the last 24 hours. According to the VRS, most participants with CKD-aP suffered from moderate (60%) to severe itching (23%), and 72% experienced at least one severe to extremely severe episode of itching during the last 24 hours. Conclusion Despite high dialysis standards and easy access to medications, CKD-aP affected around 24% of patients on hemodialysis in the French-speaking part of Switzerland, and its intensity was moderate to severe. Results may help to increase clinicians’ awareness of CKD-aP, improve its regular screening, severity reporting and treatment.

#1002 End of life healthcare utilisation and costs of older patients receiving kidney replacement therapy—analysis of Dutch health insurance claims data

Abstract Background and Aims The increasing prevalence of chronic kidney disease (CKD), an aging population and advancements in treatment options collectively contribute to a rise in older patients with a functioning kidney transplant (KTX) or undergoing dialysis. These treatments are associated with extensive healthcare utilisation, placing substantial demands on both patients and the healthcare system. Healthcare utilisation typically increases near the end of life, and is associated with increased costs. However, little is known about the end-of-life healthcare utilisation of patients receiving kidney replacement therapy (KRT). Therefore, our study aims to assess healthcare utilisation and costs during the last year of life. Method We analysed Dutch health insurance claims data from patients aged &amp;gt;65 years on KRT who deceased between June 2016 and December 2021. We matched each patient with two controls, defined as individuals who died within the same calendar year without any insurance claims related to CKD or KRT. Matching was performed on sex, age and socio-economic status. The primary outcomes were healthcare utilisation and costs in the last twelve months of life for patients treated with different KRT modalities and compared to matched controls. Healthcare utilisation was detailed at hospital and intensive care unit (ICU) admissions, emergency department (ED) and outpatient department (OPD) visits, hospital daycare and institutionalised care. Healthcare costs encompassed costs related to primary care, hospital care (inpatient and outpatient), mental care, institutionalised care, prescription medication, transportation and other costs. Hospital care costs were categorised as KRT-related and -unrelated costs. Results In total 7279 decedents were included; 4614 haemodialysis patients (HD), 766 peritoneal dialysis (PD) patients and 1899 KTx recipients. KRT patients had a mean age of 77.6 ± 6.6 years, with 64% being male, and had significantly more comorbidities than the control group. In the year preceding death, KRT patients had significantly more hospital admissions, ICU admissions, ED visits, outpatient visits, hospital daycare and institutionalised care than controls (see Fig. 1). When comparing across KRT-modalities, KTx patients were more often admitted to the ICU than HD and PD patients (p = 0.001 and p = 0.024, respectively). For both HD, PD and KTx patients, the mean number of days admitted to the hospital and ICU, as well as ED visits and OPD visits significantly increased in last three months preceding death, compared to the initial nine months of the last year of life (p &amp;lt; 0.0001). Mean total healthcare costs in the last year of life were €59.489 for KTx patients, €108.294 for PD and €117.520 for HD patients, compared to €19.820 for the controls. The majority of costs for dialysis patients were attributed to KRT, accounting for 55.5% (€65.216) and 60.0% (€64.559) of the total expenditures for HD and PD patients, respectively. In contrast, KRT-related costs constituted 25.7% (€15.262) of the total expenses in KTx patients. Besides substantial KRT-related costs, KRT-patients also incurred higher costs for specialist care in the hospital, primary care, medication and transport, compared to controls. Conclusion Healthcare utilisation is substantial for older KRT patients and intensifies during the last year of life. This is accompanied with elevated costs. Further research is necessary to evaluate the impact of healthcare utilisation on the quality of life and whether advanced care planning could prevent overutilisation.

#426 “Predict-PD”: a machine learning tool to predict patient survival in peritoneal dialysis patients

Abstract Background and Aims With the rising prevalence of chronic kidney disease (CKD), particularly among the elderly, the need for effective renal replacement therapy has become increasingly crucial. Peritoneal dialysis (PD), recognized as a gentler alternative to haemodialysis, offers advantages in cognitive preservation and overall quality of life. Patient survival on PD, a tangible outcome measure, gains particular importance, especially in an aging demographic confronting end-stage kidney disease. Predicting survival thus becomes vital in facilitating individualized treatment planning and has implications on resource allocation and patient counseling. Method Our study analysed data from the UK Renal Registry and included 22 711 incident dialysis patients choosing PD between 2007 and 2022. Our objective was to employ Artificial Intelligence (AI) algorithms in developing an advanced risk stratification indicator with high predictive capabilities, specifically tailored for use in the United Kingdom's transplant selection procedure. We conducted experiments using three distinct machine learning models and evaluated their performance in terms of calibration and discrimination, utilizing metrics such as the integrated Brier score (IBS) and Harrell's concordance index. We assessed the potential clinical utility using decision curve analysis. Results The XGBoost model demonstrated excellent predictive efficacy for patient survival, with a concordance of 0.78. Further scrutiny revealed AUC values at 1 year (0.81), 3 years (0.78), and 5 years (0.77). The integrated Brier score, a comprehensive measure of predictive accuracy, was 0.09. There was no statistical difference between the actual and predicted survival probabilities (P = 0.72). Decision curve analysis accentuated the model's clinical applicability. Conclusion This study illustrates the potential of machine learning in prognosticating patient survival in PD, offering a pathway towards individualized patient-centric management in nephrology. The findings advocate for the integration of data-driven methodologies in clinical decision-making, paving the way for enhanced personalized care in CKD management and can serve as a guide for future research.

#3104 Adequacy of nephroprotective prescription in an elderly diabetic population in a primary care setting

Abstract Background and Aims The prevalence of chronic kidney disease (CKD) has been increasing and one of the main risk factors is diabetes mellitus (DM). The addition of sodium-glucose cotransporter 2 inhibitors (SGLT2i) to the renin-angiotensin inhibitors (RASi) is recommended in patients with DM and CKD due to the benefits in metabolic control, decrease in proteinuria, and in delaying glomerular filtration decline. Method A retrospective cohort was performed and included a sample of patients with diabetes registered and monitored in a primary care facility. A random sample was selected, calculated for an expected prevalence of 40%, error of 4%, and alpha of 0.05. The primary outcome was to assess the adequacy of nephroprotective prescription. Secondary outcomes were to determine the prevalence of CKD (and associated factors) in the sample, and to assess the percentage of patients with correct CKD diagnosis. Demographic and analytical data of patients (glomerular filtration rates and values of albuminuria) were collected from their electronic health records. Statistical analysis was performed using SPSS v28.0. A p-value &amp;lt; 0.05 was considered statistically significant. The study protocol was approved by the Ethics Committee. Results 338 patients were included, 58% were men, and with a mean age of 71.4 years. 22.2% [95% CI 16.2-29.7%] of patients had the pathology properly coded in the problem list. The prevalence of CKD found was 42.6% [95% CI 37.4-48.0%]. Most patients were in stages G2 (33.3%), G3a (30.6%) and G3b (14.6%). Concerning albuminuria, most were in stage A2 (68.8%). Of the patients with CKD, 77.1% [95% CI 69.6%-83.2%], 60.4% [95% CI 52.3%-68.0%] and 43.1 [95% CI 35.3–51.2%] were medicated with RASi, SGLT2i and both, respectively. Conclusion In this primary setting study, the majority of this elderly population was under nephroprotective therapies (RASi and/or SGLT2i). The relatively low coding suggests underdiagnosis. Further optimization of nephroprotective therapies can be made in order to avoid renal failure, as long as the pathology is properly recognized.

#1620 Association of dietary live microbe intake with chronic kidney disease based on baseline characteristics of national population: NHANES 2011-2018

Abstract Background and Aims The gut microbiota plays a crucial role in a variety of diseases, including chronic kidney disease (CKD). The gut-kidney axis is mediated through metabolism dependent pathways. The relationship between CKD and the dietary consumption of live microbes has not been explicitly studied. Probiotic food intake may play a beneficial role in human health including the gut microbiota. However, in addition to probiotic foods, live micro-organisms are also found in other food products, such as raw vegetables and fruits. In this study, we adjusted for the potential association between dietary live microbiome intake and chronic kidney disease (CKD) in different baseline characteristics, including kidney function status. Method A total of 22,039 subjects were included in the study. We used data from the US National Health and Nutrition Examination Survey 2011-2018. Based on a 2-day 24-hour dietary recall, the dietary intake of the live microbiome was adjusted and the participants were categorized into three groups: low (&amp;lt;104 CFU/g), medium (104–107 CFU/g), or high (&amp;gt;107 CFU/g) dietary intake of live microbes, according to the classification system for the dietary intake of live microbes and participants’ 24-hour dietary recall data. Low intake was used as a reference. Stage 3 CKD with high risk of progression was defined by a combination of estimated glomerular filtration rate (GFR-EPI &amp;lt;60 mL/min/1.73 m2) and urinary albumin-to-creatinine ratio (uACR &amp;gt;30 mg/g was defined as microalbuminuria). CKD was defined by a combination of GFR-EPI &amp;lt;60 mL/min/1.73 m2 or uACR, &amp;gt;30 mg/g. Albuminuria was defined as uACR &amp;gt;300 mg/g. The analyses used weighted logistic regression models (crude model and first, adjusted for age, gender, race, education and second, adjusted for hypertension, diabetes, total cholesterol level, BMI, hemoglobin level, total calorie intake, GFR and serum creatinine level). Results After model adjustment (Model 2, p&amp;lt; 0.0001), women in the medium dietary live microbe intake group had a low prevalence of stage 3 CKD with high risk of progression in contrast to those in the low dietary live microbiome intake group (OR: 0.913, 95% Cl: 0.63-1.32, p&amp;lt; 0.01), between high and low group (OR: 0.333, 95% Cl: 0.13-0.86, p&amp;lt; 0.01). However there was no significant association in men. In model 2, patients in the medium dietary live microbiome intake group had a low prevalence of microalbuminuria in contrast to those in the low dietary live microbiome intake group (OR: 0.789, 95% Cl: 0.63-0.98, p&amp;lt; 0.05). In model 2, we also found the significant association with albuminuria between high and low (OR 0.784, 95% Cl: 0.63-0.98, p&amp;lt; 0.05), medium and low (OR: 0.572, 95% Cl: 0.33-0.98, p&amp;lt; 0.05) dietary live microbiome intake patient groups. In model 2, those in the medium dietary live microbe intake group had a low prevalence of CKD in contrast to those in the low dietary live microbiome intake group (OR: 0.896, 95% Cl: 0.82-0.98) p&amp;lt; 0.01), but there was no significant association between the high and low dietary live microbiome intake groups. Conclusion In this study, a medium or high dietary live microbiome intake was associated with a low prevalence of stage 3 CKD with ahigh risk of progression in women. A medium dietary live microbiome intake was associated with a low prevalence of chronic kidney disease or microalbuminuria in the population. A medium or high dietary live microbiome intake was associated with a low prevalence of albuminuria. A medium dietary live microbiome intake was associated with a low prevalence of microalbuminuria.

#1185 Cardiovascular, renal and mortality risk by the KDIGO risk classification: the first observational study in Japan

Abstract Background and Aims The prevalence of chronic kidney disease (CKD) has been increasing, affecting 850 million people worldwide and 13 million individuals in Japan. CKD is a risk factor for cardiovascular complications including heart failure, and dialysis. KDIGO risk classification is widely used for the management of people with CKD in Japan; however, risk of clinical outcomes by the KDIGO classification in Japanese population is unclear. The aim of this study is to describe the risk of major adverse cardiovascular event (MACE) and renal outcomes according to the KDIGO classification in Japanese clinical practice. Method This study was a cohort study using data collated from the RWD database which includes electronic medical records and claims data from approximately 200 medical institutions across Japan since 2000. Subjects aged ≥18 years with two or more consecutive results of eGFR &amp;lt;90 mL/min/1.73 m2 at least 90 days apart within a 360-day period were included, and those received renal replacement therapy (RRT; dialysis or renal transplantation) before the index date was excluded. The index date was defined as the date of the second eGFR measurement &amp;lt;90 mL/min/1.73 m2 between January 2004 and December 2020. Patients were categorized into KDIGO classification G2-G5 based on their eGFR values and A1-A3 based on urine protein test (quantitative test and urine dipstick) results and into `no urine protein data` if no urine protein test was available. The primary endpoint was MACE that was defined as a composite of myocardial infarction, stroke, heart failure hospitalization, and in-hospital death. The secondary endpoint was renal outcomes defined as a composite of RRT, eGFR decline &amp;gt;50%, eGFR &amp;lt;15 mL/min/1.73 m2, diagnosis of CKD stage 5, and in-hospital death, and was analyzed in the group excluding patients with eGFR &amp;lt;15 mL/min/1.73 m2 or with diagnosis of stage 5 CKD on or before the index date. The risk of MACE and renal outcomes were evaluated using the cox proportional hazards model with G2A1 as a reference. Sensitivity analyses were performed for the population excluding those without urine protein data and for the population with quantitative urine protein test results. Results This study included 543,606 patients who met the criteria. Mean age was 61.6 ± 15.3 years, and 50.1% was male. Of those, 222,246 (40.9%) had no urine protein data. Tables 1 and 2 show hazard ratio (HR) for MACE and renal outcomes, respectively. HR (95% confidence interval) for MACE was 1.17 (1.12-1.21) in G2A2 and 1.16 (1.12-1.20) in G3aA1, showing significantly increased risk in early stages of CKD, and continued to increase as disease advances to 2.83 (2.54-3.15) in G5A3. HR for renal outcomes was similarly significantly increased in early stages of CKD, and further increased to 19.96 (18.62-21.40) in G4A3. Results of two sensitivity analyses, excluding subjects with no urine protein data (n = 321,360, 59.1% of overall population) shown in Table 3 and 4, and excluding patients with no quantitative data (n = 36,615, 6.7% of overall population) showed similar trends, supporting the robustness of primary findings. Conclusion This study is the first to demonstrate the applicability of the KDIGO risk classification in assessing the risk of cardiovascular events, including heart failure, and renal outcomes in Japan. Risk of events was increased from early stages of CKD (G3aA1 and G2A2), suggesting the importance of early diagnosis and therapeutic intervention through appropriate testing. These findings may contribute to better management of people with CKD.