Prevalence Of Chronic Kidney Disease In Patients Research Articles

#198 Different patterns of renal thrombotic microangiopathy

Abstract Background and Aims Thrombotic microangiopathy (TMA) is a renal lesion often associated with microangiopathic hemolysis. However, there are cases of TMA that present without hemolysis, hematuria or even proteinuria, sometimes being an incidental histopathological finding. In these situations, little is known about the long-term effects on renal function. The aim of our study is to describe the clinical and histopathological presentation of patients with renal TMA biopsied in our center, focusing on those without hemolysis and with low clinical suspicion of TMA. Method We conducted a retrospective observational unicentric study. Clinical and histological parameters were collected from patients biopsied between 2015 and 2023, whose renal biopsy (RB) showed TMA, with a minimum follow-up of 6 months. We excluded renal transplant recipients. Results Data were collected from 41 patients (17 men, 24 women), with a mean age at the time of RB of 54 ± 16 years and a mean eGFR of 80 ± 23 ml/min/1.72 m2. 12 of them (29%) had chronic kidney disease (CKD). Twenty-seven patients (66%) did not have hemolysis at diagnosis. Compared to patients with hemolysis, they were of older age (58 vs 47 years, p = 0.030) and had higher prevalence of CKD (41% vs 7%, p = 0.028). They had a milder clinical presentation, with lower creatinine (168 vs 419 μmol/L, p = 0.029), lower need for renal replacement therapy (RRT) (4% vs 50%, p = 0.001), less hematuria (33% vs 79%, p = 0.008) and proteinuria (67% vs 100%, p = 0.035). Histologically, patients without hemolysis had less fibrosis (56% vs 86%, p = 0.084) and fewer chronic TMA lesions (double contours, wrinkling of the basement membrane) (52% vs 93%, p = 0.009), despite delayed renal biopsy compared to patients with hemolysis (99 ± 118 vs 28 ± 30 days since clinical presentation, p = 0.036). The causes of TMA that were most commonly associated with the absence of hemolysis were drugs (89% without hemolysis) and glomerulopathies such as IgA nephropathy, minimal change disease and fibrillary glomerulonephritis (100% without hemolysis). Within this group of patients without hemolysis, 13 (32%) had a low clinical suspicion of TMA, defined as the absence of hemolysis, hypertension and predisposing factors, in some cases being an incidental finding in the RB. As expected, they also had a mild presentation and did not require RRT. In some cases, they even presented without proteinuria (7 patients, 64%). When comparing the severity of the lesions in renal tissue with patients with high clinical suspicion of TMA, patients with low clinical suspicion presented a similar prevalence of mesangiolysis, vascular damage and a similar proportion of affected glomeruli. Chronic TMA lesions were present in both groups (Table 1). When analysing the evolution of renal function, there are several confounding factors to consider (higher prevalence of CKD in patients without hemolysis, targeted treatment in patients with hemolysis, different time of follow-up between groups...). In our results, there were no statistically significant differences in the evolution of creatinine and proteinuria between groups, even when TMA was an incidental finding. In our sample, these findings were not attributable to a larger number of other histopathological lesions in patients with low suspicion of TMA, as there were no differences between groups (see Table 1). Conclusion Renal TMA should be suspected even in the absence of hemolysis, hypertension or proteinuria, as in our sample one third of diagnoses were incidental and their mild presentation may have delayed renal biopsy. The severity of histological lesions and the evolution of renal function in these cases are comparable to those of patients with a high clinical suspicion. Therefore, its prompt identification, etiological study and treatment are equally important. Currently, we have insufficient data to provide the different clinical scenarios in which TMA should be suspected. However, based on our findings, in the presence of drugs TMA should be considered in the differential diagnosis along with Acute Interstitial Nephritis, even in the absence of urinary abnormalities.

Higher Prevalence of Chronic Kidney Disease in Myelodysplastic Syndromes Patients Compared to Age- Adjusted General Population - Results from the Polish Adult Leukemia Group (PALG) Registry

Introduction Chronic comorbidities that are common in the elderly population can have a significant impact on the clinical course, the choice of treatment, and survival of myelodysplastic syndromes (MDS) patients. No studies have focused on the coexistence of two diseases that are common in the elderly population, chronic kidney disease (CKD) and MDS, so the epidemiological data and clinical implications of both diseases occurring together are unknown. Aims Primary objective: to assess the prevalence of CKD in patients with MDS in comparison to the age-adjusted general population. Secondary objective: to evaluate the impact of CKD on clinical course in MDS patients. Methods This was a prospective analysis using clinical and laboratory data from MDS patients who were registered in the Polish Adult Leukemia Group (PALG) Registry from 2010 to 2023. Data have been provided by 28 hematologic centers. CKD was defined as an eGFR < 60 mL/min/1.73m², disregarding albuminuria since urinalysis results were not recorded in the database. The stages of CKD were classified based on eGFR according to the NKF KDOQI National Kidney Foundation Kidney Disease Outcome Quality Initiative guidelines, and eGFR was calculated using CKD-EPI equation. For comparison of the prevalence of CKD in MDS subjects aged ≥60 years to the general population, we used data from the PolSenior 2 study (covering the years 2018-2019). Data were age and sex standardized using demographic tables from Statistics Poland (https:// demografia.stat.gov.pl/bazademografia/Tables.aspx). Median survival time was calculated using Kaplan-Meier estimator. Multivariate analysis was performed using Cox regression. Results Overall, data (including eGFR) were available for 1813 MDS patients. Median age at diagnosis was 71 years [IQR 64 - 78]. and 55.3% patients were male. Sixty percent of the patients were diagnosed as IPPS lower risk. At the time of MDS diagnosis, CKD was detected in 479 patients (26.4%). Among patients aged ≥ 60, the crude rate of CKD was 30.3%. The standardized rate of CKD in the general population aged ≥ 60 years was significantly lower than in the similarly aged MDS group, with rates of 13.2% [CI 12.3-14.1] and 25.5% [CI 22.9-28.4]; p<0.001, respectively. (Figure 1) Patients with CKD were significantly older (median 78 yo) than those without CKD (median 68 yo; p<0.001), and more likely to have diabetes (33.2% vs 19.7%; p<0.001), and to have coincidence of another malignancy (21.6%) than those without CKD (14.9%; p=0.001). Median hemoglobin concentration was significantly lower in the CKD group (8.9 g/dL) than in the non-CKD group (9.4 g/dL; p < 0.05). Subjects with decreased eGFR were more likely to be dependent on RBC transfusion (56.5%) than subjects with eGFR ≥ 60 ml/min per 1.73m 2 (48.9%; p=0.0008). Median survival of patients with eGFR ≥ 60 ml/min per 1.73m 2 was 2.5 y [CI 1.0-6.1] vs 1.4 y [CI 0.6-4.2] for CKD. In multivariate analysis we found that CKD stage, age ≥ 65, higher IPSS score, high-risk IPSS cytogenetics and ECOG >1 were independent predictors of shorter survival. (Figure 2). Conclusions Myelodysplastic syndrome (MDS) subjects are more likely to have chronic kidney disease (CKD) than the general population. The presence of CKD in MDS patients is associated with worse overall survival and higher RBC transfusion requirement.

Association of the dietary inflammation index (DII) with the prevalence of chronic kidney disease in patients with type-2 diabetes mellitus

Chronic kidney disease (CKD) is a major complication of diabetes mellitus (DM). Inflammation is an essential component in the process of CKD progression in patients with DM. Diet is a significant determinant of systemic inflammation levels. However, the association between the dietary inflammatory index (DII) and CKD in individuals with DM remains largely unknown; therefore, the aim of this study was to explore whether the DII is linked to the prevalence of CKD in patients with DM. The research method was as follows: first, data from the National Health and Nutrition Examination Survey (NHANES) between 1999 and 2018 were obtained. There were 7,974 participants in our study. These individuals were then classified into three groups according to DII tertiles (T1-T3), with each group consisting of 2,658 participants. Logistic regression analysis was employed to examine whether there was a connection between the DII and CKD. We observed a significant association between the DII and the prevalence of CKD in individuals with DM. After full adjustment for age, sex, ethnicity, smoking, drinking, body mass index (BMI), triglyceride (TG), total cholesterol (TC), metabolic equivalents (METs), energy intake, hypoglycemic medications, hypertension, and cardiovascular disease (CVD), the group with a higher DII had a greater frequency of CKD (T2 group: OR: 1.40; 95% CI: 1.10–1.76; p = 0.006; T3 group: OR: 1.67; 95% CI: 1.29–2.17; p < 0.001). The implementation of an anti-inflammatory diet could serve as an intervention strategy for patients with DM to prevent the onset of CKD.

#5047 DIABETES AND CHRONIC KIDNEY DISEASE IN TURKEY (DIAKIT): THE STUDY ON CHRONIC KIDNEY DISEASE IN DIABETES MELLITUS PATIENTS IN THE CAPPADOCIA COHORT

Abstract Background and Aims Diabetes mellitus (DM) is the most common cause of chronic kidney disease (CKD) [1]. The prevalence of CKD is therefore increasing worldwide with increasing prevalence of DM [1]. Among those with DM, CKD prevalence varies widely between countries. The actual prevalence of CKD in patients with DM in Turkey is unknown. This study aimed to determine frequency of CKD among diabetic patients of Cappadocia cohort and patients’ awareness about the disease. Method A total of 1591 diabetic patients from the Cappadocia cohort were invited to this cross-sectional study. A trained study team administered a questionnaire for patients’ medical history, knowledge, attitudes, and awareness of the disease and measured patients’ blood pressures (BPs) at least three times using an automated device. Serum creatinine was measured and spot urine albumin/creatinine ratio (ACR) measurements were performed for three consecutive days. A diagnosis of CKD was established if glomerular filtration rate (GFR)is &amp;lt;60 mL/min or ACR is &amp;gt;30 mg/g. Results The mean age of the patients was 63±10 years. Overall, 60.9% patients were obese (body mass index ≥30 kg/m2), and 70% patients were hypertensive. HbA1c was analyzed in 98.2% of the patients; HbA1c was &amp;lt;7% in 27.4%, ≥7%-≤8% in 20.8%, &amp;gt;8%-≤9% in 17.7%, and &amp;gt;9% in 34.1% of the patients. of 1535 patients with blood and urine analyses, 231 of 1008 (22.9%) females and 154 of 527 (29.2%) males had CKD (P = .007). Among patients with GFR values, 11.4% had a GFR of &amp;lt;60 mL/min and 88.6% had a GFR of ≥60 mL/min. Among 1544 patients with ACR measurements, 18.2% had values ≥30 mg/g and 4.4% had values ≥300 mg/g. CKD was detected in 385 (25.1%) of 1535 patients with both GFR and ACR values (Figure 1). of these patients, 28.1% had Stage 1, 25.7% had Stage 2, 32.5% had Stage 3A, 11.2% had Stage 3B and 2.6% had Stage 4 or 5 CKD. Excluding two patients with missing data, 36 of 383 CKD patients (9.4%) knew that they had CKD. In the logistic regression analysis, old age (OR=1.05, 95% CI 1.03-1.07; p&amp;lt;0.001), male sex (OR=2.11, 95% CI 1.43-3.12; p&amp;lt;0.001), duration of DM (OR=1.03, 95% CI 1.00-1.05; P = .022), morbid obesity (OR=3.58, 95% CI 1.28-10.03, P = .015), a CRP level of &amp;gt;5 mg/L (OR=1.60, 95% CI 1.12-2.27; P = .009), a triglyceride level of ≥150 mg/L (OR=1.74, 95% CI 1.24-2.45; P = .002), and grade 3 hypertension (OR=2.13, 95% CI 1.02-4.44; P = .043) were found to be significantly associated with an increased risk of CKD in patients with DM. Conclusion In the present study, CKD prevalence among diabetic patients in Turkey was 25.1%. Overall, 53.8% of the patients with CKD had a GFR of ≥60 mL/min although they had an ACR of ≥30 mg/day; that is, if albuminuria was not studied, this subgroup of patients would have been considered to have normal kidney function according to GFR. The awareness of CKD was found to be quite low in the patients. Therefore, periodic screening of diabetic patients should always include urinalysis, particularly ACR, as well as serum creatinine, fasting blood glucose and HbA1c.

Identification of Patients With Elevated Urine Albumin-to-Creatinine Ratio Levels in a Type 2 Diabetes Mellitus Cohort Based on Data Submitted by Patients via a Smartphone App (SMART-Finder): Protocol for an Observational Study.

Despite effective treatment options, chronic kidney disease (CKD) has become a major cause of mortality worldwide due to the ever-increasing number of patients with type 2 diabetes mellitus (T2DM). Guideline-compliant, at least, annual screening of patients with T2DM is crucial to prevent renal disease progression. However, data on the prevalence of CKD in patients with T2DM and on screening frequency are limited. SMART-Finder is the first study to exclusively use data provided directly by patients via an adherence app to collect information on the prevalence of CKD, risk factors, disease management, and quality of life of patients with T2DM in Germany. The primary objective of this study is to determine the proportion of patients with T2DM and an elevated urine albumin-to-creatinine ratio (UACR; albumin-to-creatinine ratio stage A2 and A3) at baseline and after 12 (±3) months. Secondary objectives include the proportion of patients who remain in or switch to another albumin-to-creatinine ratio classification category after 12 months, information on quality of life, disease awareness, and adherence rates, as well as the proportion of patients without any UACR-screening data. Recruitment occurs via push notification among MyTherapy app users with T2DM. This is a single-arm, retrospective/prospective, observational, digital, patient-centered cohort study, with recruitment and data documentation via a health app. Required routine laboratory data are provided by treating physicians to their patients for data entry. The study population includes adult patients with T2DM documenting their data in the MyTherapy app using their own smartphone or tablet. Study participants are provided with a specifically developed electronic case report form containing questions on demographic and general data, quality of life, disease awareness, and laboratory values including estimated glomerular filtration rate, UACR, hemoglobin 1Ac, and blood pressure. Apart from demographic and general data, all data are collected at baseline and 12 months after the last UACR assessment. An automatically generated push notification reminds participants of the second data entry. The extracted and pseudonymized data are analyzed descriptively. The enrollment period for this study started in February 2023 and shall end after 12 months or after the enrollment of 5000 patients. An interim analysis is planned 3 months after the inclusion of the first patient and the final analysis after 12 months of follow-up. Overall, the study will contribute to minimizing the existing data gap on the prevalence of CKD in patients with T2DM in Germany, provide important insights into the current disease management of patients with T2DM in everyday clinical practice in Germany, and support guideline-based care for the participating patients. PRR1-10.2196/44996.

Chronic Kidney Disease Prevalence in Patients with Colorectal Cancer Undergoing Surgery.

Colorectal cancer (CRC) is a common and mortal disease. Chronic kidney disease (CKD) is the relatively common comorbidity among cancer patients affecting the available therapy and outcomes. However, data on prevalence of CKD in patients with CRC undergoing surgery is limited. The aim of the study was to evaluate the prevalence of CKD in a cohort of 560 consecutive patients with CRC undergoing surgical treatment with curative intent. Neoadjuvant therapy in a form of radiotherapy or radiochemotherapy was administered before the surgery in 67 patients and in 86 patients, respectively. Results: CKD was reported in 10%, diabetes in 25%, and hypertension in 60%, while anemia was reported in 47%. The patients with CKD were more likely to be older and anemic with higher serum CRP, which reflects a general inflammatory state. Relative to patients without this therapy, patients undergoing neoadjuvant radiochemotherapy were older, had significantly lower eGFR and albumin, and higher creatinine, aspartate aminotransferase and INR, before the surgery. All CKD patients, except two, were older than 65 years of age. Conclusions: In order to ensure the best possible outcomes, CKD should be diagnosed and treated appropriately in oncology patients to prevent complications, so they may continue their therapy with the least interruption or discontinuation of treatment.

Characteristics of patients with coronary artery disease and chronic kidney disease.

Background and Aims: Patients with ischemic heart disease (CHD) and chronic kidney disease (CKD) constitute a particular group due to a high risk of CV events. The objective was to estimate the prevalence of CKD in patients with CHD and the characteristics that differentiate them from those without CKD.

Hypertension and chronic kidney disease in Asian populations.

The countries of Asia are home to multiple ethnicities. There are ethnic differences in diet, culture, and attitudes towards health screening, access to care, and treatment of chronic diseases. Chronic kidney disease (CKD) and end‐stage kidney disease (ESKD) have rising incidence and prevalence due to increased affliction with non‐communicable diseases of diabetes and hypertension. To prevent the expensive complications of ESKD, one of the most important risk factors to control is hypertension in patients with CKD. We performed a narrative review on the prevalence of CKD in patients with hypertension, the prevalence and control of hypertension in patients with CKD, and the dietary sodium intake in CKD populations.

Chronic kidney disease prevalence and cardiovascular risk in a cohort of patients with type 2 diabetes followed for 10 years in Badajoz (Spain). An observational study

AimsTo estimate the prevalence of chronic kidney disease (CKD), their risk factors the incidence of cardiovascular and coronary events and total and cardiovascular mortality in a cohort of type 2 diabetes (T2DM) patients observed for 10 years in primary care practices in Badajoz, Spain. MethodsObservational, longitudinal study. A total of 643 patients with T2DM (mean age 64.0 years, 55.7% women), without evidence of cardiovascular disease, were studied. CKD was defined as an estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m2 at the beginning of the study, by applying the simplified Modification of Diet in Renal Disease (MDRD) Study formula. ResultsThe prevalence rate of CKD was 24.3%. Patients with CKD had higher percentages of coronary, cerebrovascular and cardiovascular events and higher rates of cardiovascular mortality (18.6 vs. 6.0%, p < 0.001) and total mortality (42.3 vs. 23.4%, p < 0.01), compared to patients without CKD. The Cox proportional hazards model, adjusted for age, systolic blood pressure levels, glycated haemoglobin, total cholesterol, obesity and smoking, revealed that patients with CKD had an increased risk of coronary events (HR:2.18; 95% CI:1.13−4.22, p < 0.05). ConclusionsOur study confirms a high prevalence of CKD in patients with T2DM and its relationship with the presence of cardiovascular disease.

S0659 The Prevalence of Chronic Kidney Disease Is Increased in Inflammatory Bowel Disease, but Decreased After Anti-TNF Treatment: A Population-Based Study

INTRODUCTION: Patients with inflammatory bowel disease (IBD) may be at an increased risk of chronic kidney disease (CKD) due to autoimmune-mediated glomerulopathy. Additionally, traditional IBD therapies are known to be nephrotoxic. The effect of Anti-tumor necrosis factor (anti-TNF) on renal function remains unclear especially in IBD. We sought to investigate the prevalence of CKD in IBD patients treated with and without anti-TNF. METHODS: We used a commercial database (Explorys Inc, Cleveland, OH) which includes electronic health record data from 26 major integrated US healthcare systems. Based on Systematized Nomenclature Of Medicine—Clinical Terms (SNOMED-CT), we identified all patients (age >18 years) who were diagnosed with either CD or UC between 2015 and 2020 who were treated with any type of anti-TNFs. We investigated the prevalence of CKD in IBD patients compared to patients with no IBD. Also, we compared the prevalence between IBD patients with and without anti-TNF therapy. RESULTS: Of the 32, 411,600 individuals in the database from 2015 to present, we identified 139,710 (0.43%) patients with CD and 114,770 (0.35%) patients with UC, of whom 24,160 (17.3%) and 8,080 (7%) patients received anti-TNFs, respectively. The prevalence of CKD was 8.3% and 8.7% for CD and UC, respectively, compared to 3.6% in individuals without IBD, P < 0.001 to all. The prevalence of CKD was significantly lower in anti-TNF treated CD patients (4.6%) compared to those who did not receive anti-TNF (9.1%). Similarly, anti-TNF treated UC patients were significantly less likely to have CKD (3.7%) compared to UC patients who did not receive anti-TNF therapy (9%), (P < 0.001 to all). CONCLUSION: This is the largest individual study investigating prevalence of CKD in patients with IBD with and without anti-TNF therapy. We found that IBD patients who were treated with anti-TNF were significantly less likely to have CKD when compared to IBD patients who were never treated with anti-TNF.Figure 1.: The prevalence of Chronic Kidney Disease in patients with Inflammatory Bowel Disease with and without Anti-TNF therapy.Table 1.: Type of Anti-TNF therapy used in inflammatory bowel disease patients with Chronic Kidney Disease.

1479-P: Regional Variations in Chronic Kidney Disease Prevalence among Patients with or without Type 2 Diabetes (RADAR) in the U.S.

Introduction: Type 2 diabetes (T2D) represents the leading cause of Chronic Kidney Disease (CKD) worldwide. While variation in T2D prevalence in the U.S. is well established, regional variation in the prevalence of CKD in patients with or without (w/o) T2D is less well characterized and may inform targeted implementation of risk-reducing interventions. Objective: We explored regional variations in the prevalence of CKD in patients with or w/o T2D in the U.S. Method: Data from January 1, 2013 through December 31, 2017 from an employer-based claims database (MarketScan) was used for this analysis. Continuously enrolled patients aged ≥18 years diagnosed with CKD with or w/o T2D were identified using International Classification of Disease diagnosis codes. We estimated overall CKD, CKD+T2D, and CKD w/o T2D prevalence for each year from 2013 to 2017. Geo-mapping was used to visualize the prevalence of CKD. Univariate and differential local indicators for spatial analyses (LISA) were performed to describe the geographic differences of CKD prevalence. Results: The overall prevalence of CKD doubled from 1.50% in 2013 to 3.11% in 2017. Within the CKD population, 46.3% had T2D in 2017. The prevalence of CKD+T2D increased from 0.70% in 2013 to 1.44% in 2017. From 2013 to 2017, low-low clusters from univariate LISA were consistently observed in the Northwest regions (e.g., MT, WY) (P&amp;lt;0.05), indicating the consistently low prevalence of CKD in these areas. High-high clusters from differential LISA, which implied the clusters of increasing CKD prevalence, were found in the Southeast regions (e.g., FL, MS) (P&amp;lt;0.05). Conclusion: This study provides real-world evidence of regional variations in CKD prevalence in the U.S. Additionally, this study identified lower CKD prevalence than previously cited in the literature, which may indicate major under-coding in the employer-based claims database. Further characterization of CKD patients with or w/o T2D could help understand these variations. Disclosure X. Feng: None. R. Farej: Employee; Self; Bayer U.S. F. Xia: None. A.S. Gaiser: None. S. Kong: None. J. Elliott: None. S. Lindemann: None. R. Singh: None.

MON-208 Age-Dependent Progression of Renal Dysfunction After Adrenalectomy for Aldosterone-Producing Adenomas in Japan

Context: In patients with aldosterone-producing adenomas (APAs), adrenalectomy causes a rapid decrease in blood pressure and increase in blood potassium levels; however, the effects of these intensive metabolic changes on kidney function with age have not yet been examined in Japan. Objective: To investigate factors related to the progression of kidney dysfunction after adrenalectomy in different age groups. Participants: Fifty Japanese patients with APAs with 27,572 health check-up subjects as controls were examined. Main Outcome Measures: We investigated changes in eGFR after adrenalectomy and characterized patients who progressed to chronic kidney disease (CKD).Results: Receiver Operating Characteristic and multivariate analyses revealed the postoperative cut-off age of CKD to be 50 years (sensitivity, 57%; specificity; 82%; AUC, 0.69) and identified age as a unique factor for the progression of CKD after adrenalectomy. Among preoperative patients with APAs, CKD was 6% for those younger than 50 years (<50) and 40% for those 50 years and older (≥50). As a control, in 27,572 health check-up subjects, the prevalence of CKD was 4.2% in men and 2.5% in women aged 41-50 years and 18.9% in men and 13.3% in women older than 61 years, clearly demonstrating the higher prevalence of CKD in patients with APAs than in healthy subjects, particularly those with APAs ≥50 years. In patients with APAs <50 years, median eGFR before and after adrenalectomy were 95 mL/min/1.73m2 and 88 mL/min/1.73m2, respectively, indicating that the percentage of the decrease in eGFR was -7%, which was not significant (paired t-test, p=0.13). In contrast, in patients with APAs ≥50 years, median eGFR after adrenalectomy decreased to 42 mL/min/1.73m2 from 67 mL/min/1.73m2 (adjusted by age, paired t-test, p=0.01) (percent decrease in eGFR, -24%) Patients with APAs ≥50 years who progressed to CKD showed higher preoperative aldosterone/renin ratios, lower potassium and chloride levels, lower BMI, and a higher incidence of a history of cardiovascular events and KCNJ5 mutation rates.Conclusion: Age is the most important predictor of the progression of kidney dysfunction after adrenalectomy in Japanese patients with APAs, particularly those with a history of cardiovascular events and positivity for KCNJ5 mutations.

Prevalence of Chronic Kidney Disease and Associated Factors among Patients with Diabetes in Northwest Ethiopia: A Hospital-Based Cross-Sectional Study

BackgroundChronic kidney disease (CKD) is increasingly recognized as a global health issue and it affects 10% to 15% of the world population. Diabetes mellitus is the leading cause of end-stage renal disease. More than 422 million adults in the world populations are living with diabetes mellitus, 40% of whom will develop CKD. CKD in diabetes increases the risk of early death and cardiovascular morbidity and mortality. There is a paucity of published data on the prevalence of CKD and its associated factors among patients with diabetes in northwest Ethiopia.ObjectiveThe aim of this study is to determine the prevalence and factors associated with CKD among patients with diabetes at University of Gondar Hospital, Northwest Ethiopia.MethodsA hospital-based cross-sectional study was conducted from April 2 to July 31, 2018. Using convenience sampling, a total of 272 consecutive patients with diabetes were recruited for the study. Data regarding the patients’ sociodemographic information, clinical characteristics, and laboratory parameters were collected using patient interview and review of medical records. Serum creatinine was measured and used to calculate estimated glomerular filtration rate using modification of diet in renal disease and chronic kidney disease epidemiology equations. Data were analyzed using SPSS version 20. Bivariate and multivariate logistic regression analyses were used to identify predictors of CKD in patients with diabetes.ResultThe prevalence of CKD, defined by estimated glomerular filtration rate <60 mL/min/1.73 m2, was found to be 17.3% and 14.3% by modification of diet in renal disease and chronic kidney disease epidemiology equations, respectively. The proportion of stage 3 CKD by modification of diet in renal disease equation was 14.7%, whereas the proportions of stage 4 and stage 5 CKD were 2.2% and 0.4%, respectively. Among those who were diagnosed with CKD, 85.1% had pre-existing hypertension. Multivariate logistic regression analysis revealed that the presence of retinopathy (adjusted odds ratio = 14; 95% CI, 4–36; p < 0.001), pre-existing hypertension (adjusted odds ratio = 8.2; 95% CI, 2–23; P < 0.001), current systolic blood pressure >140 mm Hg (adjusted odds ratio = 6; 95% CI, 4–22; P = 0.001), and duration of diabetes >10 years (adjusted odds ratio = 3.2; 95% CI, 2–7; P = 0.004) were significantly associated with CKD in patients with diabetes.ConclusionsThe prevalence of CKD in patients with diabetes is high and comparable with previous studies from low- and middle-income countries. Pre-existing hypertension, current systolic blood pressure >140 mm Hg, duration of diabetes >10 years, and presence of retinopathy were significantly associated with CKD. Regular screening for CKD, retinopathy, and optimal blood pressure management should be practiced.

Chronic Kidney Disease in Patients Undergoing Cardiac Device Placement: Results of a Retrospective Study.

BackgroundCardiovascular issues (especially arrhythmia and sudden cardiac death) are one of the most common causes of mortality in patients with chronic kidney disease (CKD). To minimize cardiac mortality, these patients frequently require various cardiac devices, such as pacemakers, loop recorders, and defibrillators which can compromise their vascular access. In this study, we aim to determine the prevalence of CKD in patients undergoing cardiac device placement and their progression of CKD.MethodsInstitutional review board approval was obtained for this study. A total of 688 patients undergoing cardiac device placement were included in this study over a 3-year period at Jersey Shore University Medical Center. Demographic characteristics, comorbidities, base-line renal functions during the procedure, types of cardiac devices, sites of vascular access and follow-up renal function when available were assessed retrospectively. Patients were categorized into CKD stages 1 - 5 based on the National Kidney Foundation-Kidney Disease Outcomes Quality Initiative (NKF-KDOQI) guidelines. The patients who were already on hemodialysis were excluded in this study.ResultsThe average age of the patient were 73.9 years with male predominance (60%). A total of 227 patients (33%) had estimated glomerular filtration rate (eGFR) < 60 mL/min consistent with the evidence of advanced-stage CKD (stages 3 - 5) at the time of cardiac device placement. The most common types of device placements were new insertion/replacement of atrial and ventricular leads (39.5%), loop recorder implantation (21.1%) and generator changes on an already implanted device (11%). Only 4% (28/688) had a leadless cardiac device placement. The most common access sites were subclavian (47.1%), axillary (32.3%) and femoral (12.2%).ConclusionsThe present study demonstrated that nearly one-third of the patient undergoing cardiac device placement had an advanced degree of renal failure. Because CKD is a progressive disease, many of these patients might require renal replacement therapy in the future. Transvenous devices is not a good choice in this group of patients as they will ultimately require an arteriovenous fistula. Subcutaneous leadless cardiac device insertion might be a better option in patients with advanced CKD.

The association of metabolic syndrome components and chronic kidney disease in patients with hypertension

BackgroundHypertension is a highly prevalent disease and the leading cause of chronic kidney disease (CKD). Metabolic syndrome could also be the risk factor for CKD. We sought to study the association between metabolic syndrome components and the prevalence of CKD in patients with hypertension.MethodsWe carried out a multi-center cross-sectional study from Apr. 2017- Apr. 2018 in 15 cities in China.ResultsA total of 2484 patients with hypertension were enrolled. Among them, 56% were male and the average age was 65.12 ± 12.71 years. The systolic BP/diastolic BP was 142 ± 18/83 ± 12 mmHg. Metabolic syndrome components turned out to be highly prevalent in patients with hypertension, ranging from 40 to 58%. The prevalence of chronic kidney disease reached 22.0%. Multi-variate logistic analysis revealed that elevated triglyceride (TG) (OR = 1.81, 95% CI 1.28–2.57, p < 0.01), elevated fasting blood glucose (FBG) (OR = 1.43, 95% CI 1.00–2.07, p = 0.05) and hypertension grades (OR = 1.20, 95% CI 1.00–1.44, p = 0.05) were associated with the prevalence of CKD. In sub-group analysis, elevated TG remained strongly associated with CKD in both diabetes (OR = 2.10, 95%CI 1.22–3.61, p < 0.01) and non-diabetes (OR = 1.53, 95% CI 1.09–2.16, p = 0.01). In sub-group analysis of hypertension grades, there was also a graded trend between elevated TG and CKD from controlled blood pressure (BP) to hypertension grade 2 (OR = 1.81, 95%CI 1.06–3.11, p = 0.03; OR = 1.85, 95%CI 1.00–3.43, p = 0.05; OR = 2.81, 95% CI 1.09–7.28, p = 0.03, respectively).ConclusionElevated TG, elevated FBG and hypertension grades were significantly associated with the prevalence of CKD in patients with hypertension. Particularly, elevated TG was strongly associated with CKD, independent of diabetes and hypertension grades.

The Effect of Crizanlizumab Plus Standard of Care (SoC) Versus Soc Alone on Renal Function in Patients with Sickle Cell Disease and Chronic Kidney Disease: A Randomized, Multicenter, Open-Label, Phase II Study (STEADFAST)

The Effect of Crizanlizumab Plus Standard of Care (SoC) Versus Soc Alone on Renal Function in Patients with Sickle Cell Disease and Chronic Kidney Disease: A Randomized, Multicenter, Open-Label, Phase II Study (STEADFAST)

Prevalence and Correlates of Chronic Kidney Disease in Patients with Hypertension in Rural Malawi.

The prevalence of chronic kidney disease (CKD) in patients with hypertension is very high in Africa. We investigated the prevalence and correlates of CKD in patients with hypertension (defined as currently taking hypertension drugs at enrolment or systolic blood pressure ≥ 160 mmHg and / or diastolic blood pressure ≥ 110 mmHg) attending longitudinal care in rural Malawi, where currently no data on prevalence of CKD in patients with hypertension exists. We retrospectively reviewed medical records of all hypertensive patients who were screened for CKD between January 2018 and April 2019. Screening was done using serum creatinine, and CKD epidemiology formula was used to estimate the glomerular filtration rate (eGFR). We used Kidney Disease: Improving Global Outcomes definitions of renal insufficiency and CKD. Descriptive statistics were used to describe the variables and logistic regression analysis was used to identify correlates of CKD. During the study duration, 1197 patients with hypertension were screened for CKD. The mean creatinine and eGFR was 0.90 mg/dl (Confidence Interval (CI) 0.85–0.94 mg/dl) and 84.1 ml/min/1.73m2 (CI 82.7–85.4 ml/min/1.73m2) respectively. About half of the patients had a normal eGFR (48.3%, n = 578) and 36.3% (n = 435) had mildly decreased eGFR. The prevalence of renal insufficiency was 15.4% (CI 13.4–17.5, 184/1197) and the prevalence of CKD was 7.1% (CI 5.7–8.7%). By eGFR category in the CKD patients, 41.2% (n = 35), 31.8% (n = 27), 24.7% (n = 21) and 2.3% (n = 2) had CKD stage 3a, 3b, 4 and 5 respectively. CKD was strongly associated with age and diabetes. We found moderately high renal insufficiency and CKD in this cohort. We propose investing in screening for CKD in patients with hypertension in other clinics in Malawi.

Chronic kidney disease among US adults with type 2 diabetes and cardiovascular diseases: A national estimate of prevalence by KDIGO 2012 classification

AimData on prevalence of chronic kidney disease (CKD) among US adults with type 2 diabetes (T2D) and cardiovascular diseases (CVD) are limited. The aim of this study was to provide such estimates for T2D, both overall and in those with CVD. Materials and methodsUsing the NHANES 2007–2014 data, we conducted a cross-sectional analysis of an adult sample with diagnosed and undiagnosed T2D, aged ≥18 years. CVD was defined based on self-reported personal interview data on a broad range of health conditions—congestive heart failure, coronary heart disease, angina, stroke, or heart attack. T2D was defined as diagnosed T2D (self-reported provider diagnosis) and undiagnosed T2D (FPG ≥126 mg/dL or HbA1c ≥ 6.5% without self-reported diagnosis). Participants who started insulin within a year of T2D diagnosis, or were pregnant at the time of health examination were excluded. Appropriate sample weights were used to provide a national estimate. ResultsThe prevalence of moderate to severe renal impairment based on eGFR below 60 ml/min/1.73 m2 among T2D was 18.0%. The prevalence of mild renal impairment was 36.9%: 28.3% with UACR<30 mg/g, 7.0% with UACR ≥30–300 mg/g and 1.6% with UACR >300 mg/g. For T2D and CVD subgroup, the prevalence was 33.6% for moderate to severe renal impairment and 42.8% for mild renal impairment. ConclusionsThis study confirms the high prevalence of CKD in patients with multiple comorbidities: T2D and CVD. It also provides estimates of the prevalence of CKD categories based on KDIGO 2012 classification for US adults with T2D.

Chronic Kidney Disease (CKD) in U.S. Adults with Type 2 Diabetes (T2D) and Cardiovascular Diseases (CVD)—A National Estimate of Prevalence by KDIGO 2012 Classification

Data on the prevalence of CKD among U.S. adults with T2D and CVD are limited. The aim of this study was to provide such estimates for T2D, both overall and in those with CVD. Using the NHANES 2007-2014 data, we conducted a cross-sectional analysis of an adult sample with diagnosed and undiagnosed T2D (n=3271), aged ≥18 years. Appropriate sample weights were used to obtain a national estimate. Results of prevalence of CKD in U.S. adults with T2D are presented in Table 1. The prevalence of moderately to severely decreased renal impairment based on eGFR &amp;lt; 60 ml/min/1.73m2 (Stage 3-5) was 18.0%. The prevalence of mildly decreased renal impairment (Stage 2, eGFR=60-90 ml/min/1.73m2) was 36.9%, including 28.3% with UACR&amp;lt;30 mg/g, 7.0% with UACR ≥ 30-300 mg/g and 1.6% with UACR&amp;gt;300mg/g. For T2D and CVD subgroup (n=837), the prevalence of moderately to severely decreased renal impairment was 33.6% (Stage 3a: 16.1%; Stage 3b: 12.3%; Stage 4 or 5: 5.2%). The prevalence of mildly decreased renal impairment (Stage 2) was 42.8%, including 29.0% with UACR&amp;lt;30 mg/g, 11.8% with UACR≥ 30-300 mg/g and 2.1% with UACR &amp;gt;300mg/g. This study confirms the high prevalence of CKD in patients with multiple comorbidities: T2D and CVD. It also provides insights into prevalence of all CKD categories based on KDIGO 2012 classification for U.S. adults with T2D, both overall and those with CVD. Disclosure T. Wang: Employee; Self; Merck &amp; Co., Inc.. Stock/Shareholder; Self; Merck &amp; Co., Inc.. Employee; Spouse/Partner; Janssen Pharmaceuticals, Inc.. Y. Xi: None. R.N. Lubwama: None. C. Koro: Employee; Self; Merck &amp; Co., Inc.. Stock/Shareholder; Self; GlaxoSmithKline plc..

Severe mental illness and chronic kidney disease: a cross-sectional study in the United Kingdom.

ObjectiveWe investigated the burden of chronic kidney disease (CKD) among patients with severe mental illness (SMI).MethodsWe identified patients with SMI among all those aged 25–74 registered in the UK Clinical Practice Research Datalink as on March 31, 2014. We compared the prevalence of CKD (two measurements of estimated glomerular filtration rate <60 mL/min/1.73 m2 for ≥3 months) and renal replacement therapy between patients with and without SMI. For patients with and without a history of lithium prescription separately, we used logistic regression to examine the association between SMI and CKD, adjusting for demographics, lifestyle characteristics, and known CKD risk factors.ResultsThe CKD prevalence was 14.6% among patients with SMI and a history of lithium prescription (n = 4,295), 3.3% among patients with SMI and no history of lithium prescription (n = 24,101), and 2.1% among patients without SMI (n = 2,387,988; P < 0.001). The prevalence of renal replacement therapy was 0.23%, 0.15%, and 0.11%, respectively (P = 0.012). Compared to patients without SMI, the fully adjusted odds ratio for CKD was 6.49 (95% CI 5.84–7.21) for patients with SMI and a history of lithium prescription and 1.45 (95% CI 1.34–1.58) for patients with SMI and no history of lithium prescription. The higher prevalence of CKD in patients with SMI may, in part, be explained by more frequent blood testing as compared to the general population.ConclusionCKD is identified more commonly among patients with SMI than in the general population.