Recognition Of Chronic Kidney Disease Research Articles

#2617 Impact of CKD screening in high‑risk populations and guideline-directed therapy on RRT, CV events, and mortality in Europe: an IMPACT CKD analysis

Abstract Background and Aims Despite the rising and substantial burden of chronic kidney disease (CKD), there is a lack of recognition of CKD as a health priority in Europe. This contributes to underdiagnosis of CKD despite the potential for early detection and effective intervention to delay progression to late-stages (associated with costly and resource-intensive renal replacement therapy [RRT; i.e., dialysis and transplantation]). Further, diagnosed patients are undertreated when compared to current and upcoming CKD guidelines, leading to increased risk for progression to RRT and cardiovascular (CV) or other events. Early detection and intervention in high-risk populations, such as those with diabetes mellitus (DM) and hypertension (HTN) have shown cost-effectiveness; however, the broader implications of these strategies on CKD progression and clinical outcomes in a European context remains underexplored. Our study aims to illustrate the clinical benefit of targeted screening followed by an optimal compliance to guideline-directed treatment use to provide insight into potential CKD policies across Europe. Method Four country populations (Germany, Netherlands, Spain, United Kingdom [UK]) were simulated for 10-years (baseline: 2022; simulated years: 2023-2032) using the validated IMPACT CKD model to compare two scenarios: targeted screening for people with DM and/or HTN followed by 90% compliance to guideline-directed therapy versus current practice (i.e., underdiagnosis without screening and low treatment rates). Annual targeted screening was modelled using estimated glomerular filtration rate (eGFR) and urine albumin-creatinine ratio (UACR) testing. Initiation of therapies for people with diagnosed CKD was based on Kidney Disease Improving Global Outcomes guidelines. A 90% compliance to guideline-directed therapies was assumed to approximate maximum clinical benefit. Current practice was modelled based on the observed diagnosed rate without screening and the observed treatment rate in each country. The incremental population initiated on recommended therapies were modelled to experience a multiplicative treatment effect on GFR decline, CV events, and acute kidney injury (AKI) events. The model projected CKD and RRT prevalence, incidence of CV and AKI events with results shown for year 10 (2032), as well as cumulative all-cause mortality over the simulated 10-years. Results Results compare the high-risk population screening followed by guideline-directed treatment scenario to continuation of current practices for the four countries (Fig. 1). The identification of undiagnosed CKD, as well as lower rates of progression due to guideline-directed treatment was associated with a small rise in the number of total CKD patients, with increases in stage 1-2 by 3.5% to 5.0%, and stage 3-5 by 0.2% to 1.2%. There was a reduction in the number of undiagnosed CKD stage 1-2 patients by 49.2% to 71.6%, and stage 3-5 by 60.2% to 69.8%. The largest reductions were predicted for CV events (44.6% to 49.1%) followed by dialysis (22.6% to 41.9%). The strategy resulted in a decrease in cumulative 10-year all-cause mortality between 4.5% to 9.1% in CKD patients. Conclusion The study predicted significant clinical benefits from targeted CKD screening followed by guideline-directed interventions across all four European countries. Notably, this approach was forecasted to reduce undiagnosed CKD cases, dialysis, CV events, and mortality. These findings underscore the potential of acting earlier on CKD to mitigate the future CKD burden.

Global kidney health priorities-perspectives from the ISN-GKHA.

Kidney diseases have become a global epidemic with significant public health impact. Chronic kidney disease (CKD) is set to become the fifth largest cause of death by 2040, with major impacts on low-resource countries. This review is based on a recent report of the International Society of Nephrology Global Kidney Health Atlas (ISN-GKHA) which uncovered gaps in key vehicles of kidney care delivery assessed using World Health Organization building blocks for health systems (financing, services delivery, workforce, access to essential medicines, health information systems and leadership/governance). High-income countries had more centres for kidney replacement therapies (KRT), higher KRT access, higher allocation of public funds to KRT, larger workforces, more health information systems, and higher government recognition of CKD and KRT as health priorities than low-income nations. Evidence identified from the current ISN-GKHA initiative should serve as template for generating and advancing policies and partnerships to address the global burden of kidney disease. The results provide opportunities for kidney health policymakers, nephrology leaders and organizations to initiate consultations to identify strategies for improving care delivery and access in equitable, resource-sensitive manners. Policies to increase use of public funding for kidney care, lower the cost of KRT and increase workforces should be a high priority in low-resource nations, while strategies that expand access to kidney care and maintain current status of care should be prioritized in high-income countries. In all countries, the perspectives of people with CKD should be exhaustively explored to identify core kidney care priorities.

Seasonal sensitivity of groundwater dissolved organic matter in recognition of chronic kidney disease of unknown etiology: Optical and molecular perspectives

Chronic kidney disease of unknown etiology (CKDu) has aroused a great concern due to its widespread prevalence in many developing countries. Dissolved organic matter (DOM) has been proved to be associated with CKDu in groundwater. However, the responses of their association to abiotic influencing factors like seasonal variation are not carefully disclosed. Herein, we revealed the seasonal variation of DOM in CKDu related groundwater (CKDu groundwater) and control group (non-CKDu groundwater) collected from Sri Lanka during the dry and wet seasons by excitation-emission matrix spectroscopy and Fourier transform ion cyclotron resonance mass spectrometry. In both CKDu and non-CKDu groundwaters, the input of exogenous DOM during wet season improved the degree of humification and molecular weight of DOM, while oxidative processes during the dry season increased the ratios of oxygen to carbon (O/C). Furthermore, compared with non-CKDu groundwater, more DOM with high O/C enriched in CKDu groundwater during the dry season, indicating stronger oxidative processes in CKDu groundwater. It may result in the enrichment of carboxyl group and induce the enhanced leaching of CKDu-related Si and F−. The receiver operating characteristic (ROC) analysis showed that the CKDu-recognition ability of most optical and molecular indicators was susceptible to seasonal factors and their recognition abilities were stronger in the wet season. The linkage between DOM and CKDu was affected by seasonal factors through the occurrence, mobility, degradation, and toxicity of typical organic molecules (e.g., C17H18O10S). The study provides a new insight into screening pathogenic factors of other endemic diseases related to organic molecules.

Deficiencies in the Recognition and Reporting of Chronic Kidney Disease in Patients With Type 2 Diabetes Mellitus; A Hungarian Nationwide Analysis.

Objectives: Recognition of chronic kidney disease (CKD) is crucial in type 2 diabetes mellitus (T2DM). We conducted a nationwide epidemiological study to evaluate T2DM-associated CKD in Hungary between 2016 and 2020. Methods: Annual incidence and prevalence rates of registered CKD amongst all pharmacologically treated T2DM patients were analyzed in different age-groups by the central database of the Hungarian Health Insurance Fund Management. Statistical methods included Poisson regression, Bonferroni test, Chi-square test. Results: We found 499,029 T2DM patients and 48,902 CKD patients in 2016, and 586,075 T2DM patients and 38,347 CKD patients in 2020. The majority of all prevalent T2DM and CKD patients were older (aged 60-69years: 34.1% and 25.8%; ≥70years: 36.1% and 64.4%, respectively). The annual incidence of T2DM and incidence rates of CKD in T2DM decreased in 2017-2020 (p < 0.001). The annual prevalence of T2DM increased (p < 0.01), the prevalence rates of CKD in T2DM were low and decreased from 9.8% to 6.5% in 2016-2020 (p < 0.001). Conclusion: Incidence and prevalence of T2DM-associated CKD decreased significantly in Hungary in 2016-2020. Lower prevalence rates of CKD may suggest under-recognition and/or under-reporting.

Association of mitochondrial DNA copy number with chronic kidney disease in older adults

BackgroundMitochondrial dysfunction in kidney cells has been implicated in the pathogenesis of chronic kidney disease (CKD). Estimation of mitochondrial DNA copy number (mtDNA-CN) is considered a convenient method for representing mitochondrial function in large samples. However, no study has investigated the association between mtDNA-CN and CKD in older adults with the highest prevalence. The objective is to examine cross-sectional and prospective associations between mtDNA-CN values and CKD risk in older adults to determine whether mtDNA-CN represents a novel potential biomarker for the recognition of CKD risk.Patients and methodsIn a Chinese community-based cohort of over 65-year-olds, we included 14,467 participants (52.6% females). CKD was defined by eGFR < 60 mL/min/1.73 m2 or ICD-10 codes (patients = 3831 (26.5%)). Participants had peripheral blood levels of mtDNA-CN calculated from probe intensities of the Axiom CAS Array.ResultsThe risk of CKD prevalence decreased with mtDNA-CN per 1-SD increment, independent of established risk factors for older CKD (odds ratio [OR] per SD 0.90, 95% confidence interval [CI] 0.86, 0.93, P < 0.001), and has comparable strength of association with these established risk factors. Furthermore, the progression of kidney function was stratified according to the worsening of eGFR categories. The risk of kidney function progression to a more severe stage gradually decreased as the mtDNA-CN increased (P trend < 0.001). Non-CKD participants in the highest quartile of mtDNA-CN had a lower risk of developing CKD compared to the lowest quartile within 2 years of follow-up, reducing the risk of CKD by 36% (95% CI 0.42, 0.97; P = 0.037).ConclusionsBased on the analysis of the largest sample to date investigating the association between mtDNA-CN and CKD in older adults, higher levels of mtDNA-CN were found to be associated with a lower risk of CKD, suggesting that a reduced level of mtDNA-CN is a potential risk factor for CKD.

Hybrid classification framework for chronic kidney disease prediction model

ABSTRACT ‘Chronic kidney disease (CKD) – or chronic renal failure (CRF) is a term that encompasses all degrees of decreased kidney function, from damaged–at risk through mild, moderate, and severe chronic kidney failure’. As a risky factor, the disease has steadily turned out to be a major cause of death and morbidity. Accordingly, ultrasound (US) is significant in enhancing the rates of early recognition of CKD. Here, a new CKD detection model is introduced that includes ‘(1) Pre-processing (2) segmentation (3) Feature extraction, and (4) Classification’. Improved Gaussian filtering is used for pre-processing, and watershed-based segmentation is carried out. Additionally, features like the ROI, mean intensity, and the projected Local Vector Pattern (LVP) are retrieved. The ‘Optimized Neural Network (NN) and Long Short-Term Memory (LSTM)’ are then provided the output of the features. Additionally, using Self Updated Cat Swarm Optimization, the weights of NN are adjusted in order to increase the classifier's prediction accuracy (SU-CSO). The categorized output is then calculated by averaging the results from the improved NN and LSTM. Lastly, it is demonstrated that the proposed strategy is superior to other options.

#5228 ASSESSING ACCURACY OF POINT-OF-CARE CREATININE AND POTASSIUM TESTING IN A MULTI-ETHNIC SOUTH LONDON POPULATION

Abstract Background and Aims Point-of-care (POC) testing allows rapid analysis of blood samples without delay of laboratory testing. For patients with chronic kidney disease (CKD), this allows for instant identification of changes in kidney function, such as acute kidney injury or hyperkalaemia, and assists in timely decision-making in outpatient or community settings (e.g. commencing or up-titrating medications dependent on renal function). It also provides an opportunity for early recognition of CKD in high-risk populations by providing screening in more convenient and trusted settings. To achieve these aims, it essential to confirm that POC systems can produce accurate results in real world settings with diverse patient populations. This pilot validation study assessed accuracy of the Siemens Epoc Blood Analysis System venous creatinine and potassium compared with laboratory assays in a diverse UK renal patient population. Method Venous blood samples from 57 patients, aged ≥ 18 years old and receiving care at a London teaching hospital, were analysed using the Siemens Epoc Blood Analysis System. POC-Creatinine (POC-Cr) and Potassium (POC-K) measurements were compared with laboratory (IDMS-traceable Siemens enzymatic and Roche) assays. Demographics (age, ethnicity and sex) were recorded for each patient. Passing-Bablock regression analysis were used to compare the results using both methods. Comparison between testing methods was assessed using a Bland-Altman plot. Limits of agreement were compared with CLIA criteria for acceptable performance for creatinine and potassium. Results The mean age was 55.6 ± 15.3 years old and 64.9% were male (n = 37). The majority of patients were of White (N = 23; 40.4%), Black (N = 21; 36.8%) or South Asian (N = 9; 15.8%) ethnicity respectively. Median POC-Cr was 216 μmol/L (interquartile range (IQR) 111, 396 μmol/L) versus median venous creatinine 212 μmol/L (IQR 114, 380 μmol/L). The median bias for creatinine was +1.0 (IQR -3.0, +8.0). Limits of agreement on Bland-Altman plot were +36.5μmol/L and – 34.4μmol/L (Figure 1). Overall, there remained a strong positive correlation between POC-Cr and IDMS-traceable enzymatic creatinine assays (R = 0.997; P&amp;lt;0.0001) (Figure 2). Median POC-K was 4.3 mmol/L, IQR 4.0, 4.8 mmol/L versus median venous potassium 5.0, IQR 4.3, 5.3 mmol/L. The median bias for potassium was +0.4 (IQR +0.2, +0.5). Limits of agreement on Bland-Altman plot were +0.16mmol/L and – 0.91mmol/L (Figure 3). A strong positive correlation between POC-K and laboratory potassium assays was also confimed (R = 0.937; P&amp;lt;0.0001) (Figure 4). Conclusion There was strong positive correlation between POC and laboratory analysis of venous creatinine, comparable to product literature (R = 0.997 vs 0.998). Limits of agreement were outside the CLIA criteria for acceptable performance (+/- 27μmol/L). POC and laboratory potassium levels were also strongly correlated and comparable to product literature (R = 0.937 vs 0.997). Limits of agreement were outside the CLIA criteria for acceptable performance (+/- 0.5mmol/L). This discrepancy is likely due to haemolysis in some blood samples and small sample size. Overall, this pilot study demonstrated a strong correlation between POC and laboratory testing. Larger scale evaluation is still required in a multi-ethnic population, prior to assessing feasibility in community-led protocolized pathways.

REVEAL-CKD: PREVALENCE OF UNDIAGNOSED STAGE 3 CHRONIC KIDNEY DISEASE IN PATIENTS WITH DIAGNOSED HYPERTENSION IN CANADA

Objective: Hypertension is a risk factor for and complication of chronic kidney disease (CKD), a progressive condition affecting 11.1% of the global population. Early recognition and diagnosis of CKD is crucial for effective management to slow disease progression and improve patient outcomes. This REVEAL-CKD study assessed the prevalence of, and factors associated with, undiagnosed stage 3 CKD in patients with hypertension. Design and method: REVEAL-CKD is an observational study using secondary data from electronic medical records (EMR) and claims data. Data were extracted from the Canadian Primary Care Sentinel Surveillance Network (CPCSSN) database, that consists of primary care EMR data from approximately 1,500 general practice clinicians across eight provinces and one territory of Canada. The study cohort included patients aged at least 18 years with two consecutive estimated glomerular filtration rate (eGFR) values 30-59 mL/min/1.73m2 recorded 91-730 days apart between 2015-2021. The date of the second qualifying eGFR was the index date. Included patients were required to have hypertension diagnosis code before index. Patients with no CKD diagnosis code before and up to 6 months after index were considered undiagnosed. This study was granted approval by the CPCSSN data access committee (project number: 2022SRE147). Results: Of the 45,914 patients meeting the study inclusion criteria for stage 3 CKD, median age at index date was 77 years (interquartile range [IQR]: 69-84 years) and 19,597 (42.7%) were male. Of these patients, 32,192 (70.1%) also had an existing diagnosis of hypertension. Among patients meeting the criteria for stage 3 CKD and having a diagnosis of hypertension there were 30,523 patients, (94.8%) who did not have a recorded diagnosis of CKD up to 6 months after index. Of these patients, only one fifth was diagnosed with CKD after 4 years. Conclusions: A large proportion of patients in Canada with hypertension and stage 3 CKD do not have a recorded CKD diagnosis, and there is substantial diagnostic delay despite clinical evidence. This likely results in patients not receiving guideline-directed management to reduce the risk of disease progression and adverse clinical outcomes that could have been avoided by early detection of CKD.

What is the prevalence of chronic kidney disease among hypertensive non-diabetic Egyptian patients attending primary healthcare?

ABSTRACT Background Although chronic kidney disease (CKD) is considered the major cause of morbidity and mortality in hypertension, the recognition and prevention of CKD remain deficient. CKD is one of the major health challenges in Egypt. CKD affects approximately 13% of the adult population, resulting in significant morbidity, mortality, and health care costs. Patients with more progressive stage 3 or stage 4 CKD experience a high rate of cardiovascular events and death compared to earlier stages of CKD. Aim This study was performed to determine the prevalence and risk factors of CKD among hypertensive non-diabetic patients attending primary health care (PHC) centers in Cairo. Methodology The study type is a cross-sectional study. Study setting: Two PHC centers: Saraya El-kobba and El-Sharabya. Sampling method: Recruitment of participants was done in one day weekly. Any known essential hypertensive patients aged 18 or more registered in the two PHC centers in Cairo. Results The prevalence of CKD was 33% among the hypertensive non-diabetic patients. Among CKD participants, the prevalence is more common in females (59.7%) than males (40.3%), in those who completed primary education and in the illiterates and low socioeconomic class. Surprisingly, it is more common in patients with positive family history of CKD and patients with ischemic heart disease and the antihypertensive drugs use. Conclusion CKD has a high prevalence among hypertensive non-diabetic patients, and it has a significant morbidity and mortality among those patients.

National health policies and strategies for addressing chronic kidney disease: Data from the International Society of Nephrology Global Kidney Health Atlas.

National strategies for addressing chronic kidney disease (CKD) are crucial to improving kidney health. We sought to describe country-level variations in non-communicable disease (NCD) strategies and CKD-specific policies across different regions and income levels worldwide. The International Society of Nephrology Global Kidney Health Atlas (GKHA) was a multinational cross-sectional survey conducted between July and October 2018. Responses from key opinion leaders in each country regarding national NCD strategies, the presence and scope of CKD-specific policies, and government recognition of CKD as a health priority were described overall and according to region and income level. 160 countries participated in the GKHA survey, comprising 97.8% of the world's population. Seventy-four (47%) countries had an established national NCD strategy, and 53 (34%) countries reported the existence of CKD-specific policies, with substantial variation across regions and income levels. Where CKD-specific policies existed, non-dialysis CKD care was variably addressed. 79 (51%) countries identified government recognition of CKD as a health priority. Low- and low-middle income countries were less likely to have strategies and policies for addressing CKD and have governments which recognise it as a health priority. The existence of CKD-specific policies, and a national NCD strategy more broadly, varied substantially across different regions around the world but was overall suboptimal, with major discrepancies between the burden of CKD in many countries and governmental recognition of CKD as a health priority. Greater recognition of CKD within national health policy is critical to improving kidney healthcare globally.

Renal Survival of Chronic Kidney Disease Patients in a Tertiary Referral Hospital in Malaysia.

Chronic kidney disease (CKD) represents a major public health issue, which then progresses to end-stage renal disease (ESRD) sooner or later. This retrospective cohort study aimed to determine the renal survival time of CKD patients. In total, 247 CKD patients in one of the tertiary referral hospitals in Malaysia between January 2005 and December 2015 were enrolled. All CKD patients were included if they were dependent on dialysis. Patients who were transferred out and those with incomplete records were excluded from the study. The renal survival time was calculated from the time of the first diagnosis of CKD to a confirmed ESRD diagnosis or the use of dialysis. In total, 193 (78.1%) CKD patients progressed to ESRD. The mean age of the ESRD patients was 53 years old. The majority of ESRD patients were male (57.0%) and of Malay ethnicity (89.6%). The most common comorbidities among ESRD patients were hypertension (92.2%) and diabetes mellitus (85.5%). The majority of patients were in Stage IV and V (97.9%). The overall renal survival time of CKD patients who develop ESRD was 26 months (95% confidence interval: 20.41, 31.59). Patients who smoked (P = 0.001), had hyperlipidemia (P <0.001) and consumed lipid-lowering agents (P = 0.004) had a significant P-value in the log-rank test. The progression of CKD from diagnosis to ESRD was within 2 years. Therefore, early recognition of CKD is important to improve patients' outcomes and prolong their renal survival time.

Associations and mitigations: an analysis of the changing risk factor landscape for chronic kidney disease in primary care using national general practice level data

ObjectivesEarly recognition of chronic kidney disease (CKD) should be achieved by every modern healthcare system. The objective of this study was to investigate CKD risk factor trends in England using...

Urinary Exosomal MicroRNAs as Biomarkers for Obesity-Associated Chronic Kidney Disease.

The early detection of chronic kidney disease (CKD) is key to reducing the burden of disease and rising costs of care. This need has spurred interest in finding new biomarkers for CKD. Ideal bi-omarkers for CKD should be: easy to measure; stable; reliably detected, even when interfering substances are present; site-specific based on the type of injury (tubules vs. glomeruli); and its changes in concentration should correlate with disease risk or outcome. Currently, no single can-didate biomarker fulfills these criteria effectively, and the mechanisms underlying kidney fibrosis are not fully understood; however, there is growing evidence in support of microRNA-mediated pro-cesses. Specifically, urinary exosomal microRNAs may serve as biomarkers for kidney fibrosis. In-creasing incidences of obesity and the recognition of obesity-associated CKD have increased interest in the interplay of obesity and CKD. In this review, we provide: (1) an overview of the current scope of CKD biomarkers within obese individuals to elucidate the genetic pathways unique to obesi-ty-related CKD; (2) a review of microRNA expression in obese individuals with kidney fibrosis in the presence of comorbidities, such as diabetes mellitus and hypertension; (3) a review of thera-peutic processes, such as diet and exercise, that may influence miR-expression in obesity-associated CKD; (4) a review of the technical aspects of urinary exosome isolation; and (5) future areas of research.

1213-P: REVEAL-CKD: Undiagnosed Chronic Kidney Disease in Patients with Type 2 Diabetes in Germany and France

Background: Early recognition of chronic kidney disease (CKD) is crucial to slow its progression, yet underdiagnosis remains high. This study assesses prevalence of and factors associated with undiagnosed stage 3 CKD in patients with pre-existing type 2 diabetes (T2D) . Methods: REVEAL-CKD is a multi-national secondary data study. Data were extracted from THIN (Cegedim Health Data, France) and Disease Analyzer (IQVIA, Germany) . Patients were aged ≥18 years with 2 consecutive estimated glomerular filtration rate (eGFR) results 30-59 mL/min/1.73 m2 recorded 90-730 days apart in 2015-2021. T2D was identified by a diagnosis code before 2nd eGFR. Patients with no CKD code before 1st eGFR and ≤6 months after 2nd eGFR were considered undiagnosed. Results: The cohorts included 3,532 patients with T2D and stage 3 CKD in France and 6,935 in Germany. In both cohorts, undiagnosed CKD was high (94% and 74%, respectively) , and was greater in those aged ≥65 years and in females. In patients with additional pre-existing comorbidities undiagnosed CKD remained high, ranging between 65% - 96% (Table 1) . Conclusion: A high prevalence of undiagnosed CKD in patients with T2D was observed for France and Germany. Older patients and females were particularly vulnerable to undiagnosed CKD. Considerable opportunities exist to increase early identification and proactive management of CKD to slow progression and improve outcomes. Disclosure M.P. Schneider: Consultant; AstraZeneca. J.B. Virgitti: Advisory Panel; AstraZeneca, Lilly, Novo Nordisk. E. Peach: Employee; AstraZeneca. Stock/Shareholder; AstraZeneca. S. Barone: Employee; AstraZeneca. M. Arnold: Employee; AstraZeneca. N. Tangri: Consultant; AstraZeneca, Bayer AG, Boehringer Ingelheim International GmbH, Janssen Pharmaceuticals, Inc., Otsuka America Pharmaceutical, Inc., Pulsedata, Renibus, Tricida, Inc. Stock/Shareholder; Clinpredict, Klinrisk.

FC006: Sex Differences in the Recognition, Monitoring and Management of Chronic Kidney Disease in Health Care

Abstract BACKGROUND AND AIMS Sex-specific differences exist in the population prevalence of chronic kidney disease (CKD), progression rates and health outcomes. Recognition, diagnosis and monitoring are central processes in the management of patients with CKD, but it is unknown whether these processes differ between men and women. METHOD This is an observational cohort study of all adult individuals (n = 227 847) with at least one eGFR (from serum creatinine) &amp;lt;60 mL/min/1.73 m2 during outpatient routine care in Stockholm, Sweden, 2009–2017. Through logistic regression, we evaluated differences by sex in carrying an ICD-10 code for CKD and provision of recommended medications (renin–angiotensin system inhibitors [RASi] and statins) at inclusion. Through Cox regression, we evaluated potential sex differences in receiving a CKD diagnosis, referral to nephrology care and performance of laboratory monitoring (creatinine and albuminuria) in the next 18 months from inclusion. We also explored time-trends, comparing the above-mentioned nephrology care indicators among 70–80 000 unique eligible individuals per calendar year (in total 695 632 observations), thus allowing participants to contribute to different calendar year-cohorts. RESULTS We identified more women (55%) than men (45%) with probable CKD (eGFR &amp;lt; 60 mL/min/1.73 m2). Women were generally older than men (median 77 versus 74 years), but eGFR was similar between sexes (51 mL/min/1.73 m2). More men than women had diabetes or myocardial infarction, but there was similar prevalence of hypertension. At inclusion and compared with men, women had lower risk of carrying an ICD-10 code for CKD (odds ratio [OR]: 0.47, 95% CI: 0.45–0.49) and were less likely to receive RASi (OR: 0.55; 0.50–0.61, among patient with albuminuria A3) or statins (OR: 0.64; 0.63–0.66, among patients ≥ 50 years), despite the presence of clear indications. In subsequent time-to-event analyses, women were less likely to receive a CKD diagnosis (hazard ratio [HR]: 0.43; 0.42–0.45) and visit a nephrologist (HR: 0.46; 0.43–0.48) regardless of CKD severity, presence of albuminuria or criteria for referral. Women were also less likely to undergo monitoring of creatinine or albuminuria, even among participants with diabetes (HR: 0.75; 0.74–0.76) or hypertension (HR: 0.76; 0.75–0.78). Multivariable adjustment including comorbidities, eGFR and indication for referral showed some attenuation of the effect, but a sex difference remained. Although in absolute terms there has been a gradual improvement in all nephrology care indicators over time, the observed sex gap persisted throughout. CONCLUSION We found profound sex differences in the detection, recognition, monitoring and management (including referrals) of CKD in healthcare, also across high-risk groups and indications.

MO559: The Dietary Intake of Chronic Kidney Disease According to Stages: Findings From the Korean National Health and Nutritional Examination Survey

Abstract BACKGROUND AND AIMS Appropriate dietary adjustment in patients with chronic kidney disease (CKD) is important, and nutritional guidelines recommend different dietary management depending on the CKD stage. However, there is no study, to our knowledge, of the characteristics of dietary intake according to CKD stages. METHOD We tried to assess the comparison of nutritional intake according to CKD stages. A cross-sectional study was conducted to reveal the characteristics of dietary intake among CKD patients based on the Korean National Health and Nutritional Examination Survey between 2011 and 2014. Based on Kidney Disease Improving Global Outcomes guidelines, we stratified CKD into five groups (I, II, IIIa, IIIb and IV–V) and investigated the characteristics of dietary intake, such as energy, water, protein, fat, carbohydrate, sodium, potassium, calcium and phosphorus, according to stage of CKD. We also explored nutritional intake according to CKD stage among patients with early CKD (stage I and II) and advanced CKD (stage IIIa, IIIb and IV–V). RESULTS Of 16 878 participants, 14 952 were classed as non-CKD (88.61%) and 1926 (11.39%) as CKD. Of 16 878 participants, 14 952 were classed as non-CKD (88.61%) and 1926 (11.39%) as CKD. Intake of energy, water, protein, fat, carbohydrate, sodium, potassium, calcium, and phosphorus tended to be decreased as CKD progressed. In early CKD stage, intake of energy, water, protein, fat, carbohydrate, potassium, and phosphorus seemed to be statistically significant decreased as CKD progressed. In advanced CKD stage, intake of sodium and potassium seemed to be decreased as CKD progressed, but the intake of energy was about to be lower limit. CONCLUSION Appropriate dietary education and CKD recognition are needed to improve nutritional intake depending on the CKD stage.

Is Dapagliflozin future for CKD?

Dapagliflozin belongs to the latest class of anti-diabetic medication Sodium-glucose co-transporter two inhibitors (SGLT2i). The drug is mainly used in type 2 diabetes (T2D) by preventing the reabsorption of glucose in the proximal tubule of the kidney causing glycosuria and regulating blood glucose levels. It is a well-tolerated drug with rare side effects including hypoglycemia, diabetic ketoacidosis, genital and urinary tract infections. The drug gain popularity through its effect in lowering cardiovascular and renal events in patients with T2D through mechanisms independent of lowering blood glucose levels. (1) Adding to its benefits, Wheeler et al stated that Dapagliflozin decreases the risk of renal and cardiovascular events and reduces overall mortality in diabetic and non-diabetics with chronic kidney disease (CKD). Reduction in non-cardiovascular deaths was the critical factor to improve the mortality rates, most common among which were infections and malignancies. (3) Another 2021 publication of the European Heart Journal also showed that Dapagliflozin significantly reduces mortality in patients suffering from CKD with or without type 2 diabetes. Reduction in non-cardiovascular deaths was the key factor in improving the mortality rates, most common among which were infections and malignancies. (4) The prevalence of CKD in South Asian countries is relatively high. Pakistan tops the list with the highest prevalence of 21.2%. (4) Dapagliflozin has been approved for use in Pakistan in the year 2017.(5) Also, the more compelling pieces of evidence and greater recognition of CKD, and greater use of SGLT2 inhibitors in non-diabetics in clinical practice are imperative for the many people who stand to benefit from longer and healthier lives. The drug is opening new horizons for the treatment of CKD. Continue..

Disparities in Chronic Kidney Disease Progression by Medicare Advantage Enrollees

Introduction: The prevalence of chronic kidney disease (CKD) in Medicare beneficiaries has quadrupled in the past 2 decades, but little is known about risk factors affecting the progression of CKD. This study aims to understand the progression in Medicare Advantage enrollees and whether it differs by provider recognition of CKD, race and ethnicity, or geographic location. In a large cohort of Medicare Advantage (MA) enrollees, we examined whether CKD progression, up to 5 years after study entry, differed by demographic and clinical factors and identified additional risk factors of CKD progression. Methods: In a cohort of 1,002,388 MA enrollees with CKD stages 1–4 based on 2013–2018 labs, progression was estimated using a mixed-effects model that adjusted for demographics, geographic location, comorbidity, urine albumin-to-creatinine ratio, clinical recognition via diagnosed CKD, and time-fixed effects. Race and ethnicity, geographic location, and clinical recognition of CKD were interacted with time in 3 separate regression models. Results: Mean (median) follow-up was 3.1 (3.0) years. Black and Hispanic MA enrollees had greater kidney function at study entry than other beneficiaries, but their kidney function declined faster. MA enrollees with clinically recognized CKD had estimated glomerular filtration rate levels that were 18.6 units (95% confidence interval [CI]: 18.5–18.7) lower than levels of unrecognized patients, but kidney function declined more slowly in enrollees with clinical recognition. There were no differences in CKD progression by geography. After removal of the race coefficient from the eGFR equation in a sensitivity analysis, kidney function was much lower in all years among Black MA enrollees, but patterns of progression remained the same. Discussion/Conclusions: These results suggest that patients with clinically recognized CKD and racial and ethnic minorities merit closer surveillance and management to reduce their risk of faster progression.

Multicomponent intervention to improve blood pressure management in chronic kidney disease: a protocol for a pragmatic clinical trial

IntroductionThe purpose of this study is to incorporate behavioural economic principles and user-centred design principles into a multicomponent intervention for the management of uncontrolled hypertension (HTN) in chronic kidney disease...

The dietary intake of chronic kidney disease according to stages: Findings from the Korean National Health and Nutritional Examination Survey.

Appropriate dietary adjustment in patients with chronic kidney disease (CKD) is important, and nutritional guidelines recommend different dietary management depending on the CKD stage. However, there is no study, to our knowledge, of the characteristics of dietary intake according to CKD stages. We tried to assess the comparison of nutritional intake according to CKD stages. A cross-sectional study was conducted to reveal the characteristics of dietary intake among patients with CKD based on the Korean National Health and Nutritional Examination Survey between 2011 and 2014. Of 16,878 participants, we classified non-CKD (n = 14,952) and CKD (n = 1,926), which was stratified into five groups (I, II, IIIa, IIIb, and IV–V). We investigated the characteristics of dietary intake, such as energy, water, protein, fat, carbohydrate, sodium, potassium, calcium, and phosphorus, according to stage of CKD. We also explored nutritional intake according to CKD stage among patients with early CKD (stage I and II) and advanced CKD (stage IIIa, IIIb, and IV–V). Intake of majority of nutrients and energy tended to be decreased as CKD progressed. In early CKD stage, intake of energy, water, protein, fat, carbohydrate, potassium, calcium and phosphorus seemed to be statistically significant decreased as CKD progressed. In advanced CKD stage, intake of potassium and calcium seemed to be decreased as CKD progressed, but the intake of energy was about to be lower limit. Appropriate dietary education and CKD recognition are needed to improve nutritional intake depending on the CKD stage.