Prevalence Of Kidney Dysfunction Research Articles

Prevalence of Kidney Dysfunction and Its Relationship with Components of Metabolic Syndrome in a Hospital Setting

Metabolic syndrome (MetS) is defined by a set of components including hyperglycemia, dyslipidemia, hypertension, and central obesity. Despite the well-established association between MetS and chronic kidney disease (CKD) whose prevalence is on the increase, significant gap remains in our understanding of the relationship between kidney dysfunction and individual components of MetS, particularly in Nigeria. The objectives were to determine the prevalence of kidney dysfunction among adults with MetS and to examine the relationship of key components of MetS with kidney dysfunction using a cross-sectional study of randomly selected hospital outpatients with MetS. Kidney function was assessed using estimated glomerular filtration rate (eGFR). Descriptive and inferential statistical analyses were performed and statistical significance was set at p < .05. The mean age of the 75 study participants with MetS was 53.33 ± 13.94 years. Females constituted 65.3% and males, 34.7%. The prevalence of kidney dysfunction (eGFR < 60 mL/min/1.73 m²) was 36.0%, with no significant difference between genders. The key components of MetS that significantly correlated with kidney function were blood pressure, serum high density lipoprotein-cholesterol, and triglyceride. The same components independently predicted kidney function. To conclude, the study highlights the considerable burden of kidney dysfunction among adults with metabolic syndrome in Nigeria. Hypertension and dyslipidemia were the components of metabolic syndrome significantly associated with kidney dysfunction. Screening, early detection and targeted interventions including lifestyle modification and appropriate drug management are crucial to mitigate the impact of metabolic syndrome on kidney health, to improve health outcomes and to reduce CKD burden.

Forgotten but not gone in rural South Africa: Urinary schistosomiasis and implications for chronic kidney disease screening in endemic countries.

Background: Urinary schistosomiasis caused by infection with Schistosoma haematobium ( S. haematobium) remains endemic in Africa and is associated with haematuria and albuminuria/proteinuria. Kidney Disease Improving Global Outcomes clinical guidelines recommend evaluating proteinuria/albuminuria and glomerular filtration rate for chronic kidney disease (CKD) diagnosis. The guidelines are informed by population data outside of Africa but have been adopted in many African countries with little validation. Our study aimed to characterise the burden of urinary schistosomiasis in rural South Africa (SA) and evaluate its relationship with markers of kidney dysfunction with implications for CKD screening. Methods: In this population-based cohort study, we recruited 2021 adults aged 20 - 79 years in the Mpumalanga Province, SA. Sociodemographic data were recorded, urinalysis performed, and serum creatinine and urine albumin and creatinine measured. Kidney dysfunction was defined as an estimated glomerular filtration rate (eGFR) <60ml/min/1.73m 2 and/or urine albumin-creatinine ratio >3.0mg/mmol. S . haematobium infection was determined by urine microscopy. Multivariable analyses were performed to determine relationships between S. haematobium and markers of kidney dysfunction. Results: Data were available for 1226 of 2021 participants. 717 (58.5%) were female and the median age was 35 years (IQR 27 - 47). Prevalence of kidney dysfunction and S. haematobium was 20.2% and 5.1% respectively. S. haematobium was strongly associated with kidney dysfunction (OR 8.66; 95% CI 4.10 - 18.3) and related to albuminuria alone (OR 8.69; 95% CI 4.11 - 18.8), with no evidence of an association with eGFR <90ml/min/1.73m 2 (OR 0.43; 95% CI 0.05 - 3.59). Discussion: The strong association between urinary schistosomiasis and albuminuria requires careful consideration when screening for CKD. Screening for, and treatment of, schistosomiasis should be a routine part of initial work-up for CKD in S. haematobium endemic areas. Urinary schistosomiasis, a neglected tropical disease, remains a public health concern in the Mpumulanga province of SA.

Forgotten but not gone in rural South Africa: Urinary schistosomiasis and implications for chronic kidney disease screening in endemic countries

Background: Urinary schistosomiasis caused by infection with Schistosoma haematobium (S. haematobium) remains endemic in Africa and is associated with haematuria and albuminuria/proteinuria. Kidney Disease Improving Global Outcomes clinical guidelines recommend evaluating proteinuria/albuminuria and glomerular filtration rate for chronic kidney disease (CKD) diagnosis. The guidelines are informed by population data outside of Africa but have been adopted in many African countries with little validation. Our study aimed to characterise the burden of urinary schistosomiasis in rural South Africa (SA) and evaluate its relationship with markers of kidney dysfunction with implications for CKD screening. Methods: In this population-based cohort study, we recruited 2021 adults aged 20 – 79 years in the Mpumalanga Province, SA. Sociodemographic data were recorded, urinalysis performed, and serum creatinine and urine albumin and creatinine measured. Kidney dysfunction was defined as an estimated glomerular filtration rate (eGFR) &lt;60ml/min/1.73m2 and/or urine albumin-creatinine ratio &gt;3.0mg/mmol. S. haematobium infection was determined by urine microscopy. Multivariable analyses were performed to determine relationships between S. haematobium and markers of kidney dysfunction. Results: Data were available for 1226 of 2021 participants. 717 (58.5%) were female and the median age was 35 years (IQR 27 – 47). Prevalence of kidney dysfunction and S. haematobium was 20.2% and 5.1% respectively. S. haematobium was strongly associated with kidney dysfunction (OR 8.66; 95% CI 4.10 – 18.3) and related to albuminuria alone (OR 8.69; 95% CI 4.11 – 18.8), with no evidence of an association with eGFR &lt;90ml/min/1.73m2 (OR 0.43; 95% CI 0.05 – 3.59). Discussion: The strong association between urinary schistosomiasis and albuminuria requires careful consideration when screening for CKD. Screening for, and treatment of, schistosomiasis should be a routine part of initial work-up for CKD in S. haematobium endemic areas. Urinary schistosomiasis, a neglected tropical disease, remains a public health concern in the Mpumulanga province of SA.

Chronic kidney disease prevalence and awareness in middle age and young old: Regional comparative study in Japan.

Patients with chronic kidney disease are not aware of the illness because of its asymptomatic nature, but the association of disease progression and awareness in general population has not been sufficiently analysed on a large scale. We analysed the nationwide annual specific health checkup covering more than a half of the overall population at aged 40-74 in Japan, approximately 29.4 million people as of 2018, in combination with parameters to represent regional characteristics. The rate of the examinees with kidney dysfunction, an estimated glomerular filtration rate of <45 mL/min/1.73 m2 , was 1.0%, while that of examinees with of dipstick proteinuria ≥ (+) was 3.7%. Next, we conducted a regional comparative study on 335 medical administrative areas divided in the country. The regional rate of examinees aged 65-74 over the total examinees was positively correlated with the prevalence of kidney dysfunction (r = 0.72, p < .0001). Additionally, the mean rate of examinees aware of their 'chronic kidney failure' was 0.6%, and the awareness rate was correlated with the prevalence of both kidney dysfunction (r = 0.36, p < .001) and positive dipstick proteinuria (r = 0.31, p < .001) in those aged 65-74 at the regional level. Association of nephrology care resources with the prevalence or awareness was unclear at the regional level. We found a regional association of chronic kidney disease prevalence and awareness in a recent young old population in Japan. Further studies are needed to evaluate the patient screen and referral at the individual level.

Forgotten but not gone in rural South Africa: Urinary schistosomiasis and implications for chronic kidney disease screening in endemic countries

Background: Urinary schistosomiasis caused by infection with Schistosoma haematobium (S. haematobium) remains endemic in Africa and is associated with haematuria and albuminuria/proteinuria. Kidney Disease Improving Global Outcomes clinical guidelines recommend evaluating proteinuria/albuminuria and glomerular filtration rate for chronic kidney disease (CKD) diagnosis. The guidelines are informed by population data outside of Africa but have been adopted in many African countries with little validation. Our study aimed to characterise the burden of urinary schistosomiasis in rural South Africa (SA) and evaluate its relationship with markers of kidney dysfunction with implications for CKD screening. Methods: In this population-based cohort study, we recruited 2021 adults aged 20 – 79 years in the Mpumalanga Province, SA. Sociodemographic data were recorded, urinalysis performed, and serum creatinine and urine albumin and creatinine measured. Kidney dysfunction was defined as an estimated glomerular filtration rate (eGFR) &lt;60ml/min/1.73m2 and/or urine albumin-creatinine ratio &gt;3.0mg/mmol. S. haematobium infection was determined by urine microscopy. Multivariable analyses were performed to determine relationships between S. haematobium and markers of kidney dysfunction. Results: Data were available for 1226 of 2021 participants. 717 (58.5%) were female and the median age was 35 years (IQR 27 – 47). Prevalence of kidney dysfunction and S. haematobium was 20.2% and 5.1% respectively. S. haematobium was strongly associated with kidney dysfunction (OR 8.66; 95% CI 4.10 – 18.3) and related to albuminuria alone (OR 8.69; 95% CI 4.11 – 18.8), with no evidence of an association with eGFR &lt;90ml/min/1.73m2 (OR 0.43; 95% CI 0.05 – 3.59). Discussion: The strong association between urinary schistosomiasis and albuminuria requires careful consideration when screening for CKD. Screening for, and treatment of, schistosomiasis should be a routine part of initial work-up for CKD in S. haematobium endemic areas. Urinary schistosomiasis, a neglected tropical disease, remains a public health concern in the Mpumulanga province of SA.

Fasting insulin level and Homatest IR as predictors of acute kidney injury in critically ill patients

BackgroundKidney dysfunction is a major cause of morbidity and mortality whose prevalence, mainly because of population ageing, is rising worldwide. Also the epidemics of abnormalities clustering with insulin resistance might have played a role in increasing the prevalence of kidney dysfunction. Insulin resistance has been associated with increased risk of cardiovascular events and mortality in multiple large community-based cohort studies.ObjectiveThe aim of the study is to prove that insulin resistance not only may have a role in the development of chronic kidney disease but also may have a role in acute kidney injury.MethodsThis was a case-control study. The cases of the study were taken from the medical intensive care unit (ICU) of the Faculty of Medicine Cairo University, 100 control patients stratified by age and gender and 219 critically ill ICU patients with AKI.ResultsIn the current study, we find that there is statistically significant higher fasting insulin levels and higher levels Homa IR in patients with AKI than patients without AKI. These results signify that patients with AKI had insulin resistance. In our study, the Homa IR showed non-significant correlation with APACHE and SOFA score. While fasting insulin level shows significant correlation only with SOFA score after 96 h.ConclusionOur present observations indicate that patients with acute kidney injury have statistically significant higher insulin resistance.

Prevalence and factors associated with statin use in high-risk patients with type 1 diabetes from a specialized diabetes unit

IntroductionThe use of statins in non-selected type 1 diabetes (T1D) populations is low. We assessed the prevalence and factors associated with statin treatment in patients meeting criteria for this therapy for primary prevention of cardiovascular disease (CVD). Material and MethodsFrom 2015 to 2018, T1D patients from a tertiary hospital were selected. Inclusion criteria were: ≥40 years-old, diabetic nephropathy, or T1D duration ≥10 years with ≥1 cardiovascular risk factor (CVRF). A standardized cardiovascular risk evaluation protocol was performed. Prevalence of statin treatment was evaluated according to presence of several CVRFs, and multivariable models were constructed to assess independent determinants of statin use. ResultsWe included 241 patients (50% women, age 48.2±9.9 years, T1D duration 26.6±9.0 years). Diabetic retinopathy and nephropathy, active smoking, and hypertension were present in 38%, 12%, 28%, and 27%, respectively. Overall, 43% of patients were on statins and 27% had LDL-cholesterol <100mg/dl. Statin users were older, and had higher body mass index (BMI), prevalence of kidney dysfunction, and hypertension (p<0.05 for all). However, among both T1D-related and classical CVRFs, only hypertension (odds ratio [OR], 2.96; 95% confidence interval [CI] 1.48-5.91) and BMI (OR, 1.08; CI, 1.01-1.16) were independently associated with statin use in multiple regression analysis. ConclusionsLess than half of T1D patients from a tertiary hospital who met criteria for statin use were on treatment. Hypertension and BMI emerged as the only CVRFs independently associated with statin therapy. New strategies are needed to better address CVD prevention in this very high-risk population.

Prevalence and factors associated with statin use in high-risk patients with type 1 diabetes from a specialized diabetes unit

IntroductionThe use of statins in non-selected type 1 diabetes (T1D) populations is low. We assessed the prevalence and factors associated with statin treatment in patients meeting criteria for this therapy for primary prevention of cardiovascular disease (CVD). Material and MethodsFrom 2015 to 2018, T1D patients from a tertiary hospital were selected. Inclusion criteria were: ≥40 years-old, diabetic nephropathy, or T1D duration ≥10 years with ≥1 cardiovascular risk factor (CVRF). A standardized cardiovascular risk evaluation protocol was performed. Prevalence of statin treatment was evaluated according to presence of several CVRFs, and multivariable models were constructed to assess independent determinants of statin use. ResultsWe included 241 patients (50% women, age 48.2±9.9 years, T1D duration 26.6±9.0 years). Diabetic retinopathy and nephropathy, active smoking, and hypertension were present in 38%, 12%, 28%, and 27%, respectively. Overall, 43% of patients were on statins and 27% had LDL-cholesterol <100mg/dl. Statin users were older, and had higher body mass index (BMI), prevalence of kidney dysfunction, and hypertension (p<0.05 for all). However, among both T1D-related and classical CVRFs, only hypertension (odds ratio [OR], 2.96; 95% confidence interval [CI] 1.48-5.91) and BMI (OR, 1.08; CI, 1.01-1.16) were independently associated with statin use in multiple regression analysis. ConclusionsLess than half of T1D patients from a tertiary hospital who met criteria for statin use were on treatment. Hypertension and BMI emerged as the only CVRFs independently associated with statin therapy. New strategies are needed to better address CVD prevention in this very high-risk population.

Prevalence of kidney dysfunction in diabetes mellitus and associated risk factors among productive age Indonesian

BackgroundThe prevalence of diabetes mellitus is increasing in Indonesia due to population growth, urbanization, and lifestyle. Diabetes mellitus (DM) is the leading cause of chronic kidney disease that escalates mortality rate, but not all DM develop into chronic kidney disease.AimsTo estimate the prevalence of kidney dysfunction (KD) in DM and the associated dominant risk factors among productive age Indonesian based on the National Health Survey (Riskesdas) 2013.MethodsThe statistical data consisted of 15,791 females and 10,349 males, aged 20 to 54, who lived in rural and urban areas. The data was obtained from National Institute of Health Research and Development (NIHRD), Ministry of Health. Data were collected from 33 provinces using cross sectional method. The variables data analyzed were sociodemographic, lifestyle, anthropometric, blood pressure, blood lipid, blood glucose, and creatinine. Kidney dysfunction was defined according to Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. Multivariable logistic regression was used to analyze the dominant associated risk factors.ResultsThe prevalence of KD in DM was 4% (CI 95% 3.1–5.1) and only 0.6% had been diagnosed. Many associated risk factors could affect DM leading to KD such as age, sex, rural, economic status, sugary food/drinks, salty food, coffee, hypertension, hypercholesterolemia, low HDL, high LDL, and hypertriglyceridemia. The dominant associated risk factors were age, sex, economic status, sugary food/drinks, and low HDL.ConclusionThe prevalence of KD in DM among productive age Indonesian was 4% and only 0.6% had been diagnosed. Early detection of identification of KD in DM is needed in order to slow progression and complications. The dominant associated risk factors of KD in DM were age, sex, economic status, sugary food/drinks, and low HDL. Controlling of risk factors in DM should be done in order to prevent diabetic kidney disease.

The Prevalence of Kidney Dysfunction and Associated Risk Factors among ART-Naïve HIV-1 infected Adults at the University Teaching Hospital in Lusaka, Zambia

Background: Chronic HIV infection is associated with renal complications including renal dysfunction. Risk factors found in literature for kidney disease in the HIV population include hypertension, Diabetes mellitus, cardiovascular disease, low CD4 count, high viral load, hepatitis C virus co-infection, hypoalbuminemia, a family history of CKD, black race, and nephrotoxic drugs. The 2016 Zambian Consolidated guidelines for the prevention and treatment of HIVrecommends use of a kidney disease screening algorithm to guide choice of a cART regimen in the absence of serum creatinine. Despite using the Kidney disease screening algorithm, the risk factors listed in this algorithm have not been validated in our HIV-infected population. Therefore, this study aimed to determine the prevalence of renal dysfunction and validate the risk factors listed in the kidney disease screening algorithm in the ARTnaïve HIV-infected adults.General objective: To determine the prevalence of renal dysfunction and associated risk factors in ART naïve HIV infected adults at the University Teaching Hospital, Lusaka.Methods: This was a cross sectional analytical study with 360 participantsenrolled. A structured questionnaire was used to collect data. Blood and urine samples were collected for creatinine, CD4 count, HIV-1 viral load, serum albumin, hepatitis B surface antigen, Hepatitis C antibody, Random blood sugar, and urinalysis.Data was entered onto a Microsoft office excel spread sheet, and analyzed using STATA version 13.We investigated the association between the dependent variable and each independent variable.Results: The prevalence of renal dysfunction was 24.76%. The overall mean age for the sample population was 36.62 years comprising more females (54.63%) than males. Hypertension OR=2.63, (95% CI 1.11, 6.12) was the only factor found to be predictive of renal dysfunction.Conclusion: We recommend routine screening for hypertension in HIV cART naïve individuals and those found to be hypertensive should be further investigated for renal dysfunction prior to initiation of cART.

The Prevalence of Kidney Dysfunction and Associated Risk Factors among ART-Naïve HIV-1 infected Adults at the University Teaching Hospital in Lusaka, Zambia

Background: Chronic HIV infection is associated with renal complications including renal dysfunction. Risk factors found in literature for kidney disease in the HIV population include hypertension, diabetes mellitus, cardiovascular disease, low CD4 count, high viral load, hepatitis C virus co-infection, hypoalbuminemia, and a family history of CKD, black race, nephrotoxic drugs including antiretroviral medication. Other factors implicated being underweight, obesity, herbal medication use, chronic NSAID use.&#x0D; No local studies have been done to validate these risk factors in our ART naïve HIV infected adult population.&#x0D; General objective: To determine the prevalence of renal dysfunction and associated risk factors in ART naïve HIV infected adults at the University Teaching Hospital, Lusaka.&#x0D; Methods: This was a cross sectional analytical study with 360 participants enrolled. A structured questionnaire was used to collect data. Blood and urine samples were collected for creatinine, CD4 count, HIV-1 viral load, serum albumin, hepatitis B surface antigen, Hepatitis C antibody, Random blood sugar, urinalysis. Data was entered onto a Microsoft office excel spread sheet, and analysed using STATA version 13. We investigated the association between the dependent variable and each independent variable.&#x0D; Results: The prevalence of renal dysfunction was 24.76%. The overall mean age for the sample population was 36.62 (renal=37.53 and non-renal 35.47). The study population comprised more females (54.63%) than males. Hypertension OR=2.63, (95% CI 1.11, 6.12) was the only factor found to be predictive of renal dysfunction.&#x0D; Conclusion: The prevalence of renal dysfunction among ART naïve HIV infected adults was high. However, no significant predictors of renal dysfunction were found in our study other than hypertension.

Hypertension and Kidney Dysfunction in Adult Population in Indonesia

Background: Prevalence of hypertension is high among countries included Indonesia. Hypertension is one risk factor for kidney disfunction. As the prevalence of hypertension is high in our population, association between hypertension and kidney dysfunction in population-based study is very important to explore. Objective: This national-wide epidemiology study aimed to find the association between hypertension and kidney dysfunction in Indonesia population. Method: A cross-sectional study was conducted on subjects from National Health Survey, Ministry of Health Republic of Indonesia 2007. Study population was adult more than 15 year-old. Hypertension was diagnosed based on seven report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure, while kidney dysfunction is evaluated with eGFR using CKD-EPI equation. Kidney dysfunction is defined as eGFR < 60 ml/min/1.73 m2 Result: A total of 16779 subjects age above 15 year-old from all-over Indonesia were selected and undergo history taking, physical examination, and laboratory examination. Prevalence of hypertension in adult population in Indonesia was 30.6%. Prevalence of kidney dysfunction was 3.8%. Hypertension was found in 58% people with kidney dysfunction and 29.5% people with normal kidney function. In further analysis, hypertension is associated with kidney dysfunction using eGFR with CKD-EPI equation (p < 0,001). Conclusion: Hypertension is associated with kidney dysfunction in our population. Assesment of kidney function should be done in hypertensive population.

Deficits in information transfer between hospital-based and primary-care physicians, the case of kidney disease: a cross-sectional study.

Late recognition plays an important role in prognosis associated with kidney disease; thus, information transfer at hospital discharge regarding kidney disease is crucial. Whether it is notified in patients' hospital discharge summary (HDS) is presently largely unknown. Cross-sectional. The prevalence of kidney dysfunction [estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m(2)] and its reporting to primary-care physicians from 26 units [11 surgery, 11 medical, 4 intensive care units (ICUs)] of a university hospital were analyzed in 14,000 hospitalizations. eGFR. Notification of kidney dysfunction in HDS. GFR was estimated from serum creatinine using the Modification of Diet in Renal Disease formula. Kidney dysfunction was frequent (27.2 %) but infrequently notified in the main-body of the HDS (overall 25.3 %, medical 25 %, surgical 16.3 %, ICU 48.4 %) even when severe (eGFR 15-29.9 ml/min/1.73 m(2) was notified in 68.8, 38.5, and 79.8 % of HDSs in medical, surgical and ICUs, respectively). Notification in the HDS conclusion was rare (overall 11.4 %, medical 9.8 %, surgical 8.4 %, ICU 27.5 %). Reporting remained low when eGFR remained abnormal at discharge (medical 35.8 %, surgical 22.5 %, ICU 62.2 %) but was worse for acute kidney injury (16.0, 17.1, and 37.7 %, respectively). The optimal eGFR cut-off for reporting was 39 ml/min/1.73 m(2). Longer durations of hospitalization, greater numbers of creatinine measurements and of abnormal eGFR were associated with notification, regardless of the type of unit. Lack of data to define acute or chronic kidney injury with precision. Kidney dysfunction is frequent in hospitalized patients but is usually not notified, even when severe or still present at discharge, suggesting that it is not considered important to disclose to primary-care physicians. This lack of information may decrease physicians' awareness, and may affect continuity of care in patients with kidney dysfunction.

Prevalence estimates of chronic kidney disease in Canada: results of a nationally representative survey.

Chronic kidney disease is an important risk factor for death and cardiovascular-related morbidity, but estimates to date of its prevalence in Canada have generally been extrapolated from the prevalence of end-stage renal disease. We used direct measures of kidney function collected from a nationally representative survey population to estimate the prevalence of chronic kidney disease among Canadian adults. We examined data for 3689 adult participants of cycle 1 of the Canadian Health Measures Survey (2007-2009) for the presence of chronic kidney disease. We also calculated the age-standardized prevalence of cardiovascular risk factors by chronic kidney disease group. We cross-tabulated the estimated glomerular filtration rate (eGFR) with albuminuria status. The prevalence of chronic kidney disease during the period 2007-2009 was 12.5%, representing about 3 million Canadian adults. The estimated prevalence of stage 3-5 disease was 3.1% (0.73 million adults) and albuminuria 10.3% (2.4 million adults). The prevalence of diabetes, hypertension and hypertriglyceridemia were all significantly higher among adults with chronic kidney disease than among those without it. The prevalence of albuminuria was high, even among those whose eGFR was 90 mL/min per 1.73 m(2) or greater (10.1%) and those without diabetes or hypertension (9.3%). Awareness of kidney dysfunction among adults with stage 3-5 chronic kidney disease was low (12.0%). The prevalence of kidney dysfunction was substantial in the survey population, including individuals without hypertension or diabetes, conditions most likely to prompt screening for kidney dysfunction. These findings highlight the potential for missed opportunities for early intervention and secondary prevention of chronic kidney disease.

The Relationship Between Pulmonary Emphysema and Kidney Function in Smokers

It has been reported that the prevalence of kidney dysfunction may be increased in patients exposed to tobacco with airflow obstruction. We hypothesized that kidney dysfunction would associate with emphysema rather than with airflow obstruction measured by the FEV₁. Five hundred eight current and former smokers completed a chest CT scan, pulmonary function tests, medical questionnaires, and measurement of serum creatinine. Glomerular filtration rates (eGFRs) were estimated using the method of the Chronic Kidney Disease Epidemiology Collaboration. Quantitative determinants of emphysema and airway dimension were measured from multidetector chest CT scans. The mean age was 66 ± 7 years, and mean eGFR was 101 ± 22 mL/min/1.73 m². Univariate and multivariate analysis showed a significant association between radiographically measured emphysema and eGFR: Participants with 10% more emphysema had an eGFR that was lower by 4.4 mL/min/1.73 m² (P = .01), independent of airflow obstruction (FEV₁), age, sex, race, height, BMI, diabetes mellitus, hypertension, coronary artery disease, patient-reported dyspnea, pack-years of smoking, and current smoking. There was no association between eGFR and either FEV₁ or quantitative CT scan measures of airway dimension. More severe emphysema, rather than airflow obstruction, is associated with kidney dysfunction in tobacco smokers, independent of common risk factors for kidney disease. This finding adds to recent observations of associations between emphysema and comorbidities of COPD, including osteoporosis and lung cancer, which are independent of the traditional measure of reduced FEV₁. The mechanisms and clinical implications of kidney dysfunction in patients with emphysema need further investigation.

Kidney dysfunction and cadmium exposure – Factors influencing dose–response relationships

Our early toxicological studies showed that metallothionein (MT) is a protein that carries cadmium (Cd) to the kidney, explaining why Cd exposures during long time periods may give rise to kidney dysfunction. This dysfunction is usually considered to be the critical effect, i.e. the adverse effect that occurs at the lowest exposure level. MT also provides intracellular protection against cadmium toxicity. In studies of population groups in cadmium contaminated areas in China, we investigated factors that affected the relationship between internal dose of Cd, as indicated by blood Cd (BCd) or urinary Cd (UCd), and the prevalence of kidney dysfunction. We found dose–response relationships between UCd and the prevalence of increased levels of biomarkers of renal tubular dysfunction (urinary beta-2-microglobulin, B2M, or N-acetyl-beta-d-glucosaminidase – NAG) or urinary albumin (UAlb), a biomarker of glomerular kidney dysfunction. Two years after Cd intake from contaminated rice was diminished, renal tubular dysfunction appeared unchanged or aggravated among those with higher UCd; Another 8years later, i.e. 10years after Cd intake was decreased, the prevalence of renal tubular dysfunction was still increased but UAlb had returned to normal. Factors that influenced the dose–response relationships were: (1) time after maximum exposure. (2) Concomitant exposure to other nephrotoxic agents such as inorganic arsenic. (3) Cd induced metallothionein mRNA levels in peripheral blood lymphocytes, used as a biomarker of the ability of each person, to synthesize MT. (4) The occurrence of increased levels in blood plasma of autoantibodies against MT. The two last points further support a role in humans of MT as a protective protein against tissue damage from cadmium and gives support to previous ideas developed partly in experimental systems.

Prevalence of Chronic Kidney Disease in Orthotopic Heart Transplant Recipients and Kidney Allograft Recipients Using the New Chronic Kidney Disease Epidemiology Collaboration Formula

Chronic kidney disease (CKD) is an important long-term complication of all forms of nonrenal organ transplantation. The aim of this study was to assess the prevalence of kidney dysfunction among heart (n = 163) and kidney allograft recipients (n = 169) using the new Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula, which includes age, gender, and comorbidities. The mean serum creatinine values in these populations were 1.58 ± 0.75 mg/dL and 1.36 ± 0.56 mg/dL, respectively. In heart allograft recipients mean estimated glomerular filtration rate (eGFR) by (MDRD) was 57.14 ± 26.17 mL/min, and by CKD-EPI formula was 57.44 ± 26.76 mL/min whereas in kidney allograft recipients it was 63.91 ± 25.43 mL/min and 65.20 ± 25.60 mL/min, respectively. According to the MDRD formula, stage 2 CKD was noted in 35 patients; stage 3 CKD in 79 patients, and stage 4 in 23 patients. According to the CKD-EPI formula stage 2 CKD was displayed by 35 patients; stage 3 CKD in 78 patients, and stage 4 in 23 patients. Clinically significant CKD (GFR < 60 mL/min) was observed in 62% of patients. According to the MDRD normal kidney function was present in 22 and according to the CKD-EPI formula in 27 patients. According to the MDRD formula stage 2 CKD was found in 59 kidney allograft recipients; stage 3 in 58 patients; and stage 4 in 16 patients. According to the CKD-EPI formula, stage 2 CKD was noted in 63 patients; stage 3 in 58 patients; and stage 4 in 15 patients. Clinically significant CKD was observed in 44% of patients. Using MDRD or CKD-EPI normal kidney function was found in 36 and 33 patient, respectively. CKD prevalence is extremely high among heart and kidney transplant recipients. Evaluation of renal function is important to select the appropriate strategy to reduce the cardiovascular risk.

Prevalence of kidney dysfunction in humans – Relationship to cadmium dose, metallothionein, immunological and metabolic factors

Long term cadmium (Cd) exposure in occupational and general environments may give rise to kidney dysfunction. This effect is usually considered to be the critical effect, i. e. the effect that occurs at relatively low level of exposure. The present review focused on studies of the prevalence of cadmium-related kidney dysfunction among population groups residing in cadmium contaminated areas in China. Dose–response relationships were shown between UCd and the prevalence of increased levels of biomarkers in urine of renal tubular dysfunction such as urinary beta-2-microglobulin or N-acetyl-beta- d-glucosaminidase – NAG or urinary albumin, a biomarker of glomerular kidney dysfunction. Factors that influence these dose–response relationships include: 1) Metallothionein mRNA levels in peripheral blood lymphocytes, used as a biomarker of the ability of each person, to synthesize metallothionein (a protein known to provide intracellular protection against cadmium toxicity). 2) The occurrence of increased levels in blood plasma of autoantibodies against metallothionein. 3) Concomitant changes in glucose metabolism i e Type II diabetes. 4) Concomitant exposure to other nephrotoxic agents such as inorganic arsenic. Increased susceptibility in diabetics has been shown also in population groups in Europe. In persons with type II diabetes and increased levels of autoantibodies against metallothionein in blood plasma or in persons with concomitant exposure to environmental inorganic arsenic, indications of Cd-related kidney dysfunction was observed at UCd levels around 1 μg/g creatinine, levels found among “unexposed” population groups in many countries.