Prevalence Of End-stage Kidney Disease Research Articles

Comparisons of Intradialytic Exercise Versus Home-Based Exercise in Hemodialysis Patients: A Narrative Review.

With the increasing prevalence of end-stage kidney disease, the number of patients requiring hemodialysis (HD) continues to rise. While life-sustaining, HD is often associated with adverse effects such as muscle loss, physical deconditioning, fatigue, and compromised health-related quality of life (HRQoL). Recent research suggests that intradialytic exercise (IDE) and home-based exercise (HBE) may mitigate these adverse effects and improve patient outcomes. However, the existing literature mainly focuses on the outcomes of both exercises, whereas the comparison of types is often omitted. Hence, this review consolidates findings from studies investigating the effectiveness, implementation, safety, feasibility, and adherence of different types of IDE and HBE in HD patients. Overall, the current literature bolsters the significance of IDE and HBE for improving health in HD patients. IDE and HBE enhance physical function, cardiopulmonary capacity, HRQoL, and cognitive well-being. Some research proposed an indirect link between IDE and survival rates. Despite these benefits, challenges remain in implementing these exercise modalities, including patient adherence and the feasibility of routine exercise during HD sessions. Integrating these exercises into routine care allows healthcare providers to enhance outcomes for HD patients. Further research is suggested to optimize exercise protocols and explore long-term effects and cost-effectiveness.

Diagnostic and Prognostic Value of Machine Perfusion Biomarkers in Kidney Graft Evaluation

BackgroundWith the rising prevalence of end-stage kidney disease, the use of expanded criteria donor allografts, seen as essential for meeting organ demand, still proves challenging due to their higher risk of graft loss, delayed function, and rejection. Machine perfusion, a technique in preserving allografts, offers improved allograft outcomes compared to static cold storage while allowing for the noninvasive measurement of kidney injury biomarkers in the perfusate solution. This offers an objective method to assess graft function at various preservation stages. Materials and MethodsWe conducted a narrative review of the databases PubMed and Scopus, including studies written in the English language and published after 2010. ResultsIn this narrative review, we identified biomarkers, like 4-hydroxyproline, taurine, and glutathione transferase, as predictive markers of delayed graft function. Additionally, biomarkers, like extracellular histone h3, vascular cell adhesion protein, and matrix metalloprotease protein, have shown correlation with decreased graft function, although their predictive ability remains inconclusive. DiscussionThe review outlines various suggestions for potential areas of research focus to enhance future expanded criteria donor allograft utilization. However, limitations exist, including the absence of a singular reliable biomarker and the challenges of validating biomarker effectiveness across diverse outcomes.

Program Report: Expanding the Deceased Donor Pool in Manitoba With an Age-Targeted Kidney Transplant Program.

The ongoing shortage of organs for transplant combined with the highest prevalence of end-stage kidney disease (ESKD) in Canada has resulted in long wait times for a deceased donor transplant in Manitoba. Therefore, the Transplant Manitoba Adult Kidney Program has ongoing quality improvement initiatives to expand the deceased donor pool. This clinical transplant protocol describes an age-targeted program intended to increase the use of transplants with a kidney donor profile index (KDPI) >85 by allocating them to suitable pre-consented recipients age ≥65 with low wait times. The goal is to improve survival and quality of life for older recipients by maximizing a previously under-utilized donor pool. Scoping literature review; Transplant Manitoba deceased donor audit; and key stakeholder engagement with patient partners, inter-disciplinary health care providers, and health system leaders. The alternative donor pool criteria include deceased donor kidneys with KDPI 86-100 or another concern for graft longevity but are otherwise suitable for transplantation. Patients with no living donor, age ≥65, low wait times and otherwise eligible for transplant listing will be educated, and if suitable, pre-consented for the age-targeted program. All patients remain eligible for a standard criteria donor according to the local allocation criteria. The age-targeted program waitlist follows the same provincial allocation rules using wait time, panel reactive antibody (PRA), and human leukocyte antigen (HLA) match points for determining rank order. If an age-targeted recipient experiences early graft loss from a KDPI 86-100 kidney within 12 months from transplant, their cumulative wait time, including time with the transplant, will be reinstated upon relisting. Transplant Manitoba's provincial allocation rules do not permit bypassing top of the list recipients for kidney offers; therefore, transplant providers were previously reluctant to utilize KDPI 86-100 donor kidneys to top of the list recipients eligible for higher quality kidneys. This age-targeted program facilitates allocation of KDPI 86-100 kidneys to suitable older pre-consented recipients with low wait times, who may obtain a survival and quality of life benefit from these transplants. This approach expands the utilized deceased donor pool to benefit all Manitobans awaiting a deceased donor kidney transplant. This program was launched in January 2023, and there are no data reported on outcomes given the small numbers and abbreviated follow-up. The goal of this quality improvement project is to improve access to deceased donor kidney transplantation for Manitobans with ESKD. This program was developed with patient and provider feedback, including multimedia patient education materials which may be helpful for other programs. We anticipate this program is a safe and effective way to expand access to deceased donor kidney transplantation using a previously under-utilized donor pool.

Prevalensi Penyakit Ginjal Stadium Akhir dengan Penyakit Kardiovaskular, Diabetes Mellitus, dan Anemia

This study aims to describe the prevalence of end-stage kidney disease with complications of heart and blood vessel disease, diabetes mellitus, and anemia. The design of this study is cross-sectional, in which the researcher wishes to describe the prevalence in patients with end-stage kidney disease and determine the relationship between the characteristics of respondents and complications in end-stage kidney disease. The population in this study were medical records of patients with end-stage kidney disease at a hospital in East Java from January 2022 - August 2022. The sample in this study consisted of 101 medical records. Data analysis used descriptive analysis and a chi-square test. The results showed that there is a relationship between gender and complications of diabetes mellitus (0.045), gender and complications of anemia (0.01), and work and the incidence of complications of anemia (0.008) in patients with end-stage kidney disease. This study concludes that most cases of complications experienced by end-stage kidney patients were heart and blood vessel disease.
 
 Keywords: CKD, End Stage Kidney Disease, Nursing.

#5153 CHARACTERISTICS AND MORTALITY OF PATIENTS STARTING HAEMODIALYSIS IN A PORTUGUESE TERTIARY HOSPITAL: A DESCRIPTIVE ANALYSIS

Abstract Background and Aims Portugal has one of the highest incidences and prevalence of end-stage kidney disease in Europe, with haemodialysis (HD) being the most common modality of renal replacement therapy. The aim of our study was to analyse a cohort of patients who started HD in a large tertiary care hospital in Lisbon and describe the evolution of the patient characteristics throughout the studied years. Method This study was a retrospective analysis of all adult individuals who started HD between January of 2014 and December of 2019 in tertiary care hospital in Lisbon. Data was attained from individual electronic clinical records. The primary outcome was mortality. Statistical significance was defined as a P-value lower than 0.05. Results We included 1122 patients (mean age 64.9 ±16.8 years, 21.2% at least 80 years old; 60.9% male and 79.7% caucasian). At HD start, mean eGFR was 8.98 ±5.66mL/min/1.73 m2 and the vascular access was a central venous catheter in 56.0%, an arteriovenous fistula in 40.6% and an arteriovenous graft in 3.4%. The number of patients that started HD per year was variable between 169-204 and the percentage of elderly patients increased throughout the years. There was a trend of initiating dialysis with progressively lower eGFR. The percentage of patients with central venous catheter increased. In total 392 patients died (7.5% within the first 90 days of starting HD). Mortality rate within the first 90 days and first year declined from 2015 to 2019. As expected mortality was higher in older patients (Fig. 1), as well as in patients that started HD with a central venous catheter (Fig. 2). Conclusion We describe a large cohort of Portuguese patients that started HD between 2014-2019 that correlates well with the available recent data from the national and european registries. There was a greater percentage of patients initiating HD by catheter, which was associated with higher mortality, Although, considering the increase in elderly patients starting HD, their underlying comorbidities might impair vascular access placement and also have an impact on mortality. Additionally, despite the increase in elderly patients, mortality within the first 90 days and first year declined, highlighting the quality of care provided, in addition to a better acknowledgment and referal to conservative care.

Renal Replacement Therapy For Elderly Patients with ESKD Through Shared Decision-Making.

The incidence and prevalence of end-stage kidney disease (ESKD) in Korea are increasing, and ESKD constitutes a very important medical and social issue. Elderly dialysis patients have the highest risk of early mortality within 3 months after initiating dialysis, and geriatric syndromes such as aging, frailty, functional impairment, and cognitive impairment are crucial for the prognosis of elderly patients. Shared decision-making (SDM) is an approach through which clinicians and patients can achieve informed preferences, thereby yielding better clinical outcomes and quality of life. Through SDM-based, close consultation among patients, families, and healthcare providers, an ESKD Life-Plan for elderly patients should be established. A multidisciplinary approach led by nephrologists can help them to provide proper vascular access for dialysis at the right time, with the right evidence, and to the right patient. Strategies that can improve peritoneal dialysis in elderly patients include assisted peritoneal dialysis, homecare support programs, and automated peritoneal dialysis. In order to enhance the role of kidney transplantation in elderly patients with ESKD, it is necessary to accurately identify patients' clinical conditions before transplantation and to perform active rehabilitation activities and postoperative management to promote recovery after transplantation. With the aging population and the increase in ESKD in the elderly, clinicians must identify factors affecting the mortality and quality of life of elderly dialysis patients.

Hemodialysis patients’ satisfaction with dialysis care: a cross-sectional prospective study conducted in a non-profitable care facility, Minia Egypt

BackgroundThe prevalence of chronic kidney disease (CKD) and end-stage kidney disease (ESKD) is increasing continuously as a result of the dramatic growth in the prevalence of two main causes of ESKD which are diabetes mellitus (DM) and hypertension, hence, ESKD represents a global concern. Based on the sixth annual report of the Egyptian society of nephrology, the prevalence of ESKD in Egypt is estimated to be 375 per 1000,000. Meanwhile, other studies estimated the prevalence in El-Minia governorate to be around 308 per 1000,000. Hemodialysis (HD) represents the main modality of Kidney replacement therapy (KRT) for sufferers of ESKD in El-Minia governorate. Patients treated with in-center HD attend dialysis care usually three times per week for several hours each time, hence, their experiences during dialysis care will likely have a major impact on living with chronic illness. Hence, measuring patient satisfaction is very important as it is not only an outcome but also a contributor to other outcomes and objectives, it can provide valuable information about problem areas that can be modified to improve patient experience and outcomes.MethodsA single-center cross-sectional prospective study was conducted in the HD unit, Minia nephrology and urology university hospital. Demographic data were obtained through face-to-face interviews, Patients received a questionnaire to assess satisfaction with medical staff interactions, as well as care before, during, and after dialysis. An observational checklist of healthcare staff and equipment in the dialysis unit was also given to the patients.ResultsOne hundred nineteen patients participated in the study; patients were generally satisfied with the care provided in the dialysis unit (mean = 2.64), patients were most satisfied with aspects of care related to nurses, while they were neutral about aspects related to physicians, and were dissatisfied with nutritional care.ConclusionThere are multiple problem areas in the HD unit affecting patients’ experience, and further improvement in the care provided in the dialysis unit is required.

Systemic immune-inflammation index is associated with diabetic kidney disease in Type 2 diabetes mellitus patients: Evidence from NHANES 2011-2018.

Diabetic kidney disease (DKD) is the most common chronic kidney disease (CKD) and has the highest prevalence of end-stage kidney disease (ESKD) globally, owing mostly to the rise in Type 2 diabetes mellitus (T2DM) correlated with obesity. Current research suggested that the immune response and inflammation may play a role in the pathophysiology of T2DM. The systemic immune-inflammation index (SII) is a novel and integrated inflammatory biomarker that has not yet been linked to DKD. We aimed to identify the potential relationship between SII and DKD. In the National Health and Nutrition Examination Survey (NHANES) between 2011 and 2018, the current cross-sectional study was conducted among adults with T2DM. SII was calculated as the platelet count × neutrophil count/lymphocyte count. DKD was diagnosed with impaired glomerular filtration rate (< 60 mL/min/1.73 m2 assessed by using the Chronic Kidney Disease Epidemiology Collaboration algorithm), albuminuria (urine albumin to creatinine ratio ≥ 30 mg/g), or both in T2DM patients. To investigate the independent association between SII and DKD, weighted univariate and multivariable logistic regression analyses and subgroup analyses were performed. The study involved 3937 patients in total, of whom 1510 (38.4%) had DKD for the diagnosis. After adjustment for covariates, multivariable logistic regression revealed that a high SII level was associated with increased likelihood of DKD (OR = 1.42, 95% CI: 1.10-1.83, P = 0.01). Subgroup analyses and interaction tests revealed that age, gender, estimated glomerular filtration rate (eGFR), urine albumin-to-creatinine ratio (ACR), body mass index (BMI), hypertension, hyperlipidemia, anti-inflammation therapy (yes or no), metformin use (yes or no), and insulin use (yes or no) had no significant dependence on this positive relationship (all p for interaction >0.05). Our results indicate that the higher SII level is associated with DKD in T2DM patients. The SII could be a cost-effective and straightforward approach to detecting DKD. This needs to be verified in further prospective investigations.

Factors Influencing Self-Management Behaviors among Hemodialysis Patients.

To investigate the factors affecting hemodialysis patients' self-management ability at a dialysis center in Taiwan. Taiwan has the highest incidence and prevalence of end-stage kidney disease (ESKD) in the world. Over 90% of patients with ESKD receiving hemodialysis (HD) and self-management behaviors are critical among these patients. Failure to adhere to self-managed care increases the cost of medical care and the risk of morbidity and mortality. In this cross-sectional study, a total of 150 HD patients were observed for their self-management behaviors and the factors influencing these behaviors including education level, comorbid conditions, biochemical analysis, depression, and social support, etc., were analyzed. Self-management behaviors in HD patients were significantly impaired in the presence of diabetes mellitus, hypertension, anemia, hypoalbuminemia, and depression. The major predictor of patients' self-management was depression, explaining 14.8% of the total variance. Further addition of social support, hypertension, and diabetes mellitus into the regression model increased the total explained variance to 28.6%. Of the various domains of self-management, the partnership domain received the highest score, whereas emotional processing received the lowest score. This study found the important factors influencing self-management behaviors; through this acknowledgement and early correction of these factors, we hope to improve HD patients' individual life quality and further decrease their morbidity and mortality.

The “New Caledonia COVID-19 Paradox”: Dramatic indirect impact of the pandemic on organ donation and transplantation in a non-prevalence country

IntroductionWith 270,000 inhabitants, New Caledonia has a very high prevalence of End-stage Kidney Disease (ESKD), with the fourth-highest globally. New Caledonia started a deceased and live-donor kidney transplantation program five years ago. On March 18th, 2020, the New Caledonian government halted all flights because of potential risk of COVID circulation. The consequences in term of ESKD patient management was significant.DescriptionThe purpose was to evaluate the impact of the COVID epidemic in 2020 on the rate of kidney transplantation in an isolated country free of local COVID cases over the period of one year.MethodsNumber of Covid tests performed in the general population, number of positive tests and number of transplantation performed over the year 2020 were collected.ResultsAn extensive screening program was implemented with an average COVID-19 RT-PCR test of 14,800 per million. Data showed that COVID-19 didn’t circulate among the population. Only a small number of imported cases were diagnosed in the context of a comprehensive screening policy and strict isolation rules. This government policy was very effective in protecting the country from the direct consequences of COVID-19, but it dramatically impacted kidney transplantation. No patient could be transplanted through the Australian and New Zealand kidney paired exchange program (ANZKX). Only 11 kidney transplants were performed in 2020 compared to an average of 23 transplants for the four preceding years, representing a nearly 50% drop in transplant activities (Fig. 1).ConclusionHalting elective surgeries was deleterious on the newly-established living-donor transplant program established less than one year prior in almost complete autonomy. The reduced mobility of surgeons from expert centers in France and Australia was an essential factor. The 2020 COVID-19 pandemic protective closure measures nipped this country's local kidney transplant program in the bud.

Outcomes of Nonstandard Donor Kidney Transplants in Recipients Aged 70 Years or More: A Single-Center Experience.

There is a global increase in the prevalence of end-stage kidney disease among the elderly. As a result, more elderly recipients are being considered for kidney transplants. Because of the scarcity of donor organs, such patients are more likely to receive transplants from nonstandard donor kidneys.Here, we examined the outcomes of kidney transplants with a nonstandard donor allograftin recipients ≥70 years of age. Records of patients who received transplants at a single UK centerfrom April 1, 2015, through March 31, 2021, were retrospectively analyzed to identify those who were ≥70 years old at the time of surgery. Outcomes ofthose who received a kidney transplantfrom a nonstandard donor (group 1) were compared to those who received a kidney transplant from a standard criteria donor or living donor (group 2). During the study period, of 670 kidney transplant procedures, 67 recipients (10%) were ≥70 years of age at the time of surgery, with 54 (80.6%) identified in group 1 and 13 (19.4%) identified in group 2. Cold ischemia time (P = .001) and incidence of delayed graft function (P = .044) were significantly higherin group 1. Duration of graft survival atthe end of follow-up was not different between the groups (log rank = 0.218), butthe mean serum creatinine values at 2 years (P = .016) and 3 years (P = .048) years were significantly higherin group 1. Patients in group 1 had shorter survival time (log rank = 0.037). Nonstandard donor kidneys should be used cautiously in elderly recipients as patient survival was shown to be comparatively poor compared with elderly recipients who received a kidney transplant from a standard criteria donor or a living donor.

Differentiated kidney tubular cell-derived extracellular vesicles enhance maturation of tubuloids

The prevalence of end-stage kidney disease (ESKD) is rapidly increasing with the need for regenerative therapies. Adult stem cell derived kidney tubuloids have the potential to functionally mimic the adult kidney tubule, but still lack the expression of important transport proteins needed for waste removal. Here, we investigated the potential of extracellular vesicles (EVs) obtained from matured kidney tubular epithelial cells to modulate in vitro tubuloids functional maturation. We focused on organic anion transporter 1 (OAT1), one of the most important proteins involved in endogenous waste excretion. First, we show that EVs from engineered proximal tubule cells increased the expression of several transcription factors and epithelial transporters, resulting in improved OAT1 transport capacity. Next, a more in-depth proteomic data analysis showed that EVs can trigger various biological pathways, including mesenchymal-to-epithelial transition, which is crucial in the tubular epithelial maturation. Moreover, we demonstrated that the combination of EVs and tubuloid-derived cells can be used as part of a bioartificial kidney to generate a tight polarized epithelial monolayer with formation of dense cilia structures. In conclusion, EVs from kidney tubular epithelial cells can phenotypically improve in vitro tubuloid maturation, thereby enhancing their potential as functional units in regenerative or renal replacement therapies.Graphical

Public survey of financial incentives for kidney donation in Bahrain.

With the increasing prevalence of end-stage kidney disease in Bahrain, kidney donation is of vital importance. In this study, we want to assess how financial incentives will influence peoples' views and decisions regarding kidney donation. The aim is to establish strategies to increase the number of kidneys for transplantation in Bahrain. We adapted a previously established questionnaire on financial incentives for living kidney donations. The questionnaire assessed the public opinion in Bahrain on how kidney donation can be influenced by two different financial incentives, namely 10,000 Bahraini Dinars and life-long health insurance. We collected a convenient sample of 446 participants by distributing an electronic version of the questionnaire. IBM SPSS Statistics version 23 software was used for data entry and analysis. Of the total participants, 39% were male and 61% were female. Eighty percent of the participants believed that their chances for kidney donation will not increase in turn of receiving a financial compensation, while 20% of them believed that it will increase. Our study found that generally married participants (70%) find it a preferable development for health insurance companies to offer financial compensation for kidney donation, while nonmarried participants (30%) found it not a preferable but also not an adverse development (P = 0.038). Furthermore, there is a positive correlation between age and preferable views toward financial incentives to increase kidney donation (P <0.001). Although financial incentives for kidney donation might encourage a minority of the population, the majority will not be influenced by implanting a financial incentives' system for kidney donation.

Health economics of kidney replacement therapy in Singapore: Taking stock and looking ahead

The prevalence of end-stage kidney disease (ESKD) in Singapore remains high and continues to rise. We continue to face major challenges in containing the rising incidence of ESKD and providing sustainable kidney replacement therapy. Our cost projections provide an insight into the present and future, urging a call to action to augment existing initiatives to address the emergent issues.

Trends in the incidence and prevalence of end-stage kidney disease requiring dialysis in Taiwan: 2010–2018

Taiwan has the highest incidence and prevalence of end-stage kidney disease (ESKD) worldwide. However, the epidemiologic features of ESKD requiring dialysis in Taiwan are unclear.Our study population included all patients undergoing chronic dialysis (i.e., receiving dialysis treatment for at least three successive months) from the National Health Insurance Research Database from 2010 to 2018. Dialysis was defined using ICD-9-CM order codes for dialysis treatment. The age-standardized incidence and prevalence rates were calculated based on the World Health Organization standard population.The mean age was 47.7 ± 15.4 years at dialysis initiation. The incidence of ESKD requiring dialysis increased steadily during the study period, whereas the age-standardized incidence rate remained constant. The increased rate was particularly prevalent in men aged 65-74 and 75+ years. Additionally, the percentage of patients with estimated glomerular filtration rates > 10 mL/min/1.73 m2 at dialysis inception increased during the study period, especially in persons aged 75+ years. Most patients chose hemodialysis as the initial dialysis modality, including 86.8% in 2010 and 90.6% in 2018. The prevalence of dialysis increased substantially between 2010 and 2018, whereas the age-standardized prevalence of dialysis remained stable. The increasing trend was especially prominent in men aged ≥ 65 years. Among the patients on dialysis, the proportion of patients with mean dialysis times of more than 10 years has been increasing.The annual incidence and prevalence of dialysis increased steadily from 2010 to 2018, whereas the age-standardized incidence and prevalence of dialysis remained stable. The increased numbers of patients undergoing incident and prevalent dialysis were mostly elderly, especially men aged ≥65 years. Age-based prevention strategies and multidisciplinary care should be implemented to target the elderly population at risk of developing ESKD.

Trends of kidney transplantation from the 2020 annual report on kidney disease in Taiwan

Renal transplantation (RTX) is the treatment of choice for end-stage kidney disease (ESKD). Taiwan has the highest incidence and prevalence of ESKD in this world. This is the first study to illustrate the national registry database of RTX. All patients who received RTX in Taiwan between 2010 and 2018 were enrolled in this study. Demographic data and comorbidities were obtained from the National Health Insurance Research Database and Transplantation Society of Taiwan. Graft and patient survival rates were also analyzed. Men were more likely to receive RTX. During the observation periods, > 30% of the recipients were relatively young (20-44 years). The percentage of preemptive RTX (p=0.014) and living RTX (p=0.022) increased annually with statistical significance (linear regression model). Recently, recipients had more cardiovascular disease (p=0.014), diabetes mellitus (p=0.097), and hypertension (p=0.021). The mean duration of graft survival increased yearly (p=0.001). The proportion of patients surviving till age of ≧65 years increased significantly with time (2.2% in 2010, 33.1% in 2018) (p<0.0001). Younger recipients (<44 years) had significantly better survival than the elderly (≧65 years). Patients with diabetes were more likely to have worse graft and patient survival rates. Recipients enrolled in pre-ESRD care program had better graft and patient survival rates than those not enrolled in these care program. The proportion of preemptive and livingdonor RTX increased but was still low. Despite increased number of commodities in recipients, graft and patient survival have increased recently. Enrolling patients with CKD in pre-ESRD care program was associated with better graft and patient survival.

Circulating miRNAs and Vascular Injury Markers Associate with Cardiovascular Function in Older Patients Reaching End-Stage Kidney Disease.

The prevalence of end-stage kidney disease (ESKD) is rapidly increasing and mostly occurring in patients aged 65 years or older. The main cause of death in these patients is cardiovascular disease (CVD). Novel markers of vascular integrity may thus be of clinical value for identifying patients at high risk for CVD. Here we associated the levels of selected circulating angiogenic miRNAs, angiopoietin-2 (Ang-2) and asymmetric dimethylarginine (ADMA) with cardiovascular structure and function (as determined by cardiovascular MRI) in 67 older patients reaching ESKD that were included from ‘The Cognitive decline in Older Patients with End stage renal disease’ (COPE) prospective, multicentered cohort study. We first determined the association between the vascular injury markers and specific heart conditions and observed that ESKD patients with coronary heart disease have significantly higher levels of circulating ADMA and miR-27a. Moreover, circulating levels of miR-27a were higher in patients with atrial fibrillation. In addition, the circulating levels of the vascular injury markers were associated with measures of cardiovascular structure and function obtained from cardiovascular MRI: pulse wave velocity (PWV), ejection fraction (EF) and cardiac index (CI). We found Ang-2 and miR-27a to be strongly correlated to the PWV, while Ang-2 also associated with ejection fraction. Finally, we observed that in contrast to miR-27a, Ang-2 was not associated with a vascular cause of the primary kidney disease, suggesting Ang-2 may be an ESKD-specific marker of vascular injury. Taken together, among older patients with ESKD, aberrant levels of vascular injury markers (miR-27a, Ang-2 and ADMA) associated with impaired cardiovascular function. These markers may serve to identify individuals at higher risk of CVD, as well as give insight into the underlying (vascular) pathophysiology.

Healthcare utilization and expenditure among individuals with end-stage kidney disease in Taiwan

The prevalence of end-stage kidney disease (ESKD) in Taiwan has been increasing in recent decades. ESKD care and medical expenditures constitute an important part of the entire healthcare system. This study analyzed data collected from the National Health Insurance (NHI) Research Database from 2010 to 2018. The annual medical cost increased by approximately 4% both in the entire Taiwanese population and in its ESKD population. The total medical expenditure in the ESKD population from 2010 to 2018 increased from 48.03 to 65.65 billion reimbursement points, with dialysis treatments costing higher than non-dialysis treatments. ESKD outpatient and inpatient costs accounted for 10.4%-11.1% and 4.8%-5.6% of the entire NHI expenditure, respectively. The leading cause of inpatient costs was circulatory diseases, accounting for 29.3% of the total ESKD inpatient costs in 2018. Furthermore, percutaneous coronary intervention had the highest cost followed by simple percutaneous transluminal angioplasty. In 2018, the hemodialysis population had the highest average monthly cost of 73 thousand points per person, while the kidney transplant population had the lowest average monthly cost of 39 thousand points per person. Medical expenditure, including both inpatient and outpatient costs, of the ESKD population continued to grow from 2010 to 2018. The non-dialysis cost in the ESKD population was mainly for cardiovascular disease management and vascular access care, for which prevention will always be challenging.

Precision medicine approaches for diabetic kidney disease: opportunities and challenges.

The prevalence of end-stage kidney disease (ESKD) continuously increases worldwide. The increasing prevalence parallels the growth in the number of people with diabetes, which is the leading cause of ESKD. Early diagnosis of chronic kidney disease (CKD) in patients with diabetes and appropriate intervention is important to delay the progression of kidney function decline and prevent ESKD. Rate of CKD progression and response to treatment varies among patients with diabetes, highlighting the need to tailor individual treatment. In this review, we describe recent advances and areas for future studies with respect to precision medicine in diabetic kidney disease (DKD). DKD is a multi-factorial disease that is subject in part to genetic heritability, but is also influenced by various exogenous mediators, such as environmental or dietary factors. Genetic testing so far has limited utility to facilitate early diagnosis, classify progression or evaluate response to therapy. Various biomarker-based approaches are currently explored to identify patients at high risk of ESKD and to facilitate decision-making for targeted therapy. These studies have led to discovery and validation of a couple of inflammatory proteins such as circulating tumour necrosis factor receptors, which are strong predictors of kidney disease progression. Moreover, risk and drug-response scores based on multiple biomarkers are developed to predict kidney disease progression and long-term drug efficacy. These findings, if implemented in clinical practice, will pave the way to move from a one-size-fits-all to a one-fit-for-everyone approach.

Impact of National Economy and Policies on End-Stage Kidney Care in South Asia and Southeast Asia.

Background The association between economic status and kidney disease is incompletely explored even in countries with higher economy (HE); the situation is complex in lower economies (LE) of South Asia and Southeast Asia (SA and SEA). Methods Fifteen countries of SA and SEA categorized as HE and LE, represented by the representatives of the national nephrology societies, participated in this questionnaire and interview-based assessment of the impact of economic status on renal care. Results Average incidence and prevalence of end-stage kidney disease (ESKD) per million population (pmp) are 1.8 times and 3.3 times higher in HE. Hemodialysis is the main renal replacement therapy (RRT) (HE-68%, LE-63%). Funding of dialysis in HE is mainly by state (65%) or insurance bodies (30%); out of pocket expenses (OOPE) are high in LE (41%). Highest cost for hemodialysis is in Brunei and Singapore, and lowest in Myanmar and Nepal. Median number of dialysis machines/1000 ESKD population is 110 in HE and 53 in LE. Average number of machines/dialysis units in HE is 2.7 times higher than LE. The HE countries have 9 times more dialysis centers pmp (median HE-17, LE-02) and 16 times more nephrologist density (median HE-14.8 ppm, LE-0.94 ppm). Dialysis sessions >2/week is frequently followed in HE (84%) and <2/week in LE (64%). “On-demand” hemodialysis (<2 sessions/week) is prevalent in LE. Hemodialysis dropout rates at one year are lower in HE (12.3%; LE 53.4%), death being the major cause (HE-93.6%; LE-43.8%); renal transplants constitute 4% (Brunei) to 39% (Hong Kong) of the RRT in HE. ESKD burden is expected to increase >10% in all the HE countries except Taiwan, 10%–20% in the majority of LE countries. Conclusion Economic disparity in SA and SEA is reflected by poor dialysis infrastructure and penetration, inadequate manpower, higher OOPE, higher dialysis dropout rates, and lesser renal transplantations in LE countries. Utility of RRT can be improved by state funding and better insurance coverage.