Risk Factor For Development Of Chronic Kidney Disease Research Articles

Effect of Uric Acid on the Development of Chronic Kidney Disease: The Korean Multi-Rural Communities Cohort Study.

ObjectivesSeveral studies have investigated the effects of serum uric acid (SUA) levels on chronic kidney disease (CKD), with discrepant results. The effect of SUA levels on CKD development was studied in the Korean rural population.MethodsA total of 9695 participants aged ≥40 years were recruited from 3 rural communities in Korea between 2005 and 2009. Of those participants, 5577 who participated in the follow-up and did not have cerebrovascular disease, myocardial infarction, cancer, or CKD at baseline were studied. The participants, of whom 2133 were men and 3444 were women, were grouped into 5 categories according to their quintile of SUA levels. An estimated glomerular filtration rate of <60 mL/min/1.73 m2 at the time of follow-up was considered to indicate newly developed CKD. The effects of SUA levels on CKD development after adjusting for potential confounders were assessed using Cox proportional hazard models.ResultsAmong the 5577 participants, 9.4 and 11.0% of men and women developed CKD. The hazard ratio (HR) of CKD was higher in the highest quintile of SUA levels than in the third quintile in men (adjusted HR, 1.60; 95% confidence interval [CI], 1.02 to 2.51) and women (adjusted HR, 1.56; 95% CI, 1.14 to 2.15). Furthermore, CKD development was also more common in the lowest quintile of SUA levels than in the third quintile in men (adjusted HR, 1.83; 95% CI, 1.15 to 2.90). The effect of SUA was consistent in younger, obese, and hypertensive men.ConclusionsBoth high and low SUA levels were risk factors for CKD development in rural Korean men, while only high levels were a risk factor in their women counterparts.

Prevalence and Risk Factors Associated With Chronic Kidney Disease Among Patients Presenting at a Haemodialysis Unit in Dodoma, Tanzania

Chronic kidney disease (CKD) is a major public health problem worldwide, due to its epidemic proportions and the associated cardiovascular morbidity and mortality. However, data on the burden of CKD among patients attending hospitals in Tanzania are still limited. The aim of this study was to determine the prevalence and risk factors associated with CKD among patients presenting at the University of Dodoma (UDOM) haemodialysis unit in Tanzania.In this retrospective study, we reviewed data of 1,395 patients who presented at the UDOM haemodialysis unit from January 2013 to June 2015. Data were descriptively and inferentially analysed using Stata version 11.0.From January 2013 to June 2015, a total of 1,395 patients presented at the UDOM haemodialysis unit with history of kidney disease. Of these patients, 1244 (89.2%) enrolled into this study, 651 (52.3%) of them were female. Almost two-thirds (n=792, 63.7%) of the patients were found to have CKD, 59.1% with an estimated glomerular filtration rate of <60 mL/min/1.73 m2. Among those who had CKD, 347 (43.8%) had hypertension, 241 (30.4%) had diabetic mellitus, 79 (10.0%) had chronic glomerulonephritis, 70 (8.8%) had hypertension and diabetes mellitus, 38 (4.8%) had HIV/AIDS, and 17 (2.1%) had hepatitis B. The median serum creatinine level was 222 lmol/L (interquartile range [IQR] 126 to 317), urea level was 14.5 mmol/L (IQR 5 to 24), hemoglobin was 11.0 g/dL (IQR 6.2 to 15.7), and body mass index was 27.1 kg/m2 (IQR 17.3 to 36.8). Obesity, diabetes mellitus, and systolic hypertension were associated with developing CKD (P<.001). A total of 116 patients received haemodialysis during the study period.CKD was common among patients presenting in our hospital and is associated with high cardiovascular risk. To that end, patients should be thoroughly evaluated to identify and correct causes of their kidney disease, and efforts should be put in place for early detection and screening as well as advocacy on risk factors for CKD development in Tanzania.

Prevalence and Risk Factors Associated With Chronic Kidney Disease Among Patients Presenting at a Haemodialysis Unit in Dodoma, Tanzania

Background:Chronic kidney disease (CKD) is a major public health problem worldwide, due to its epidemic proportions and the associated cardiovascular morbidity and mortality. However, data on the burden of CKD among patients attending hospitals in Tanzania are still limited. The aim of this study was to determine the prevalence and risk factors associated with CKD among patients presenting at the University of Dodoma (UDOM) haemodialysis unit in Tanzania.Methods:In this retrospective study, we reviewed data of 1,395 patients who presented at the UDOM haemodialysis unit from January 2013 to June 2015. Data were descriptively and inferentially analysed using Stata version 11.0.Results:From January 2013 to June 2015, a total of 1,395 patients presented at the UDOM haemodialysis unit with history of kidney disease. Of these patients, 1244 (89.2%) enrolled into this study, 651 (52.3%) of them were female. Almost two-thirds (n=792, 63.7%) of the patients were found to have CKD, 59.1% with an estimated glomerular filtration rate of <60 mL/min/1.73 m2. Among those who had CKD, 347 (43.8%) had hypertension, 241 (30.4%) had diabetic mellitus, 79 (10.0%) had chronic glomerulonephritis, 70 (8.8%) had hypertension and diabetes mellitus, 38 (4.8%) had HIV/AIDS, and 17 (2.1%) had hepatitis B. The median serum creatinine level was 222 lmol/L (interquartile range [IQR] 126 to 317), urea level was 14.5 mmol/L (IQR 5 to 24), hemoglobin was 11.0 g/dL (IQR 6.2 to 15.7), and body mass index was 27.1 kg/m2 (IQR 17.3 to 36.8). Obesity, diabetes mellitus, and systolic hypertension were associated with developing CKD (P<.001). A total of 116 patients received haemodialysis during the study period.Conclusion:CKD was common among patients presenting in our hospital and is associated with high cardiovascular risk. To that end, patients should be thoroughly evaluated to identify and correct causes of their kidney disease, and efforts should be put in place for early detection and screening as well as advocacy on risk factors for CKD development in Tanzania.

White blood cell count predicts the odds of kidney function decline in a Chinese community-based population

BackgroundInflammatory processes are very important in the development of kidney disease. Nevertheless, the association between white blood cell (WBC) count and the risk of renal dysfunction has not been well-established, especially in subjects without chronic kidney disease (CKD). Our study investigated the association between WBC count and kidney function decline in a Chinese community-based population with baseline estimated glomerular filtration rate (eGFR) ≥60 mL/min/1.73 m2.MethodsA total of 3768 subjects who were enrolled in an atherosclerosis cohort in Beijing were included in this study. EGFRs were calculated at baseline and follow-up using the CKD-EPI formula. The outcomes of this study were renal function decline (RFD) (a drop in eGFR stage along with a decline in eGFR of 25% or exceeding 5 mL/min/1.73 m2/year), rapid eGFR decline (an annual decrease in eGFR exceeding 3 mL/min/1.73 m2), and incident CKD (eGFR <60 min/1.73 m2 at follow-up). Multivariate logistic regression models were used to evaluate the associations between WBC count and each outcome.ResultsOn average, the subjects were 56.6 ± 8.5 years old, and 35.9% were male. Of the participants, 48.6% had hypertension and 17.4% had diabetes. The mean (SD) WBC count at baseline was 6.1 ± 1.5 × 109/L. The mean (SD) eGFR at baseline was 101.1 ± 10.6 mL/min/1.73 m2. After 2.3 years follow-up, the incidence rates of RFD, rapid eGFR decline and new CKD were 7.7, 20.9, and 0.8%, respectively. WBC count was significantly related to RFD, rapid eGFR decline and new CKD in the univariate analyses. Even after adjustment for demographic variables, comorbidities, medications and baseline eGFR, these associations remained. Moreover, similar trends in RFD were observed in nearly all subgroups stratified by each confounding variable. The increase in the odds of RFD associated with each 109/L increase in WBC count was significantly greater in subjects not undergoing treatment with lipid-lowering drugs than those not undergoing this treatment (P-interaction: 0.05).ConclusionsIn conclusion, elevated WBC count served as a predictor of the odds of kidney function decline in this population, which supports the hypothesis that systemic inflammation may serve as a risk factor for CKD development.

Risk Factors and Clinical Impact of Chronic Kidney Disease (CKD) after Allogeneic Stem Cell Transplant (allo-SCT)

Background: Although the number of long-term survivors after allo-SCT has been increasing with the recent improvements of transplant procedures, late complications have emerged as an important unsolved issue in these transplant recipients. CKD is generally recognized as a stage prior to end-stage renal disease, which requires renal replacement therapy, and the incidence of CKD among transplant recipients has been reported to be around 30%. We recently reported that administration of low-dose carperitide in the early phase of transplant had the potential to prevent development of CKD after allo-SCT. However, risk factors for CKD after allo-SCT have not been fully elucidated, so that suitable candidates for this preventive approach are unclear. To this end, this retrospective study was conducted. Patients and methods: In this study, 149 consecutive patients who underwent allo-SCT for the first time at Gunma University and Saiseikai Maebashi Hospital between 2006 and 2013 and survived without a relapse of underlying disease three months after transplant were included. There was no restriction on underlying disease, donor source, or conditioning regimen. CKD was defined as estimated glomerular filtration rate (eGFR) of less than 60 ml/min/1.73 m2 lasting more than three months, according to the KDIGO guideline. Overall survival (OS) was defined as the interval from the date of transplant to the date of death. Non-relapse mortality (NRM) was defined as any death without a relapse of underlying disease. Fisher’s exact test was used for comparison of binary variables. Cumulative incidences (CIs) of CKD were compared using the stratified Gray test, considering death without the event as a competing risk. The Fine-Gray proportional hazard model was used for multivariate analysis of risk factors for CKD. In the analysis of OS and NRM, CKD was treated as a time-dependent covariate. P < 0.05 was considered significant. Results: Of the 149 transplant recipients included in this study, 80 were male and 69 were female. The median age was 48 years (range, 18-72 years), and the median baseline eGFR was 92.2 ml/min/1.73 m2 (range, 19.4 - 172.8 ml/min/1.73 m2). Underlying diseases were acute myeloid leukemia in 77 patients, acute lymphoblastic leukemia in 39, and myelodysplastic syndrome in 20. Stem cell donors were related donors in 30 patients, unrelated donors in 78, and cord blood in 41, and almost all patients were conditioned with total body irradiation (TBI)-containing myeloablative conditioning (MAC) regimens. The 2-year cumulative incidence of CKD after transplant was 35.6%. On univariate analysis, age > 50 years, baseline eGFR < 90 ml/min/1.73 m2, use of FK506 for GVHD prophylaxis, prolonged calcineurin inhibitor use (> 6 months), and acute kidney injury (AKI) development within 90 days after transplant were significant risk factors for CKD development. Multivariate analysis showed that age > 50 years (hazard ratio [HR] = 3.322; p-value < 0.001), baseline eGFR < 90 ml/min/1.73 m2 (HR = 2.088; p-value = 0.018), use of MAC regimens (HR = 2.122; p-value = 0.035), prolonged calcineurin inhibitor use (HR = 2.078; p-value = 0.035), and AKI development within 90 days after transplant (HR = 2.697; p-value < 0.001) were independent risk factors for CKD development, but disease type, disease risk, donor type, HLA mismatch, TBI-containing conditioning regimen, transplant year, acute GVHD, and chronic GVHD were not. CKD development showed no significant impact on OS (HR = 1.063; p-value = 0.823), and CKD development was not associated with increased NRM (HR = 1.439; p-value = 0.335). Conclusion: These findings suggest that transplant recipients with some of the features mentioned above, including higher age, lower baseline eGFR, and use of MAC regimens, should be recognized as patients at high risk for CKD at the time of transplant. Thus, we plan to conduct a prospective trial to explore whether low-dose carperitide treatment can reduce the incidence of CKD after allo-SCT among such high-risk transplant recipients. DisclosuresNo relevant conflicts of interest to declare.

Prevalencia de enfermedad renal en niños aparentemente sanos con antecedente familiar de terapia de reemplazo renal

BackgroundHaving a first- or second-degree relative with chronic kidney disease (CKD) has been reported as a risk factor for CKD development. The aim of the study was to determine the prevalence of CKD in children with a first- or second-degree relative undergoing renal replacement therapy (hemodialysis or renal transplant). MethodsA screening study was performed in asymptomatic children with a family history of CKD in a first- or second-degree relative undergoing renal replacement therapy. Informed consent was obtained in all cases. A clinical examination was performed. Blood and urine samples were obtained for serum creatinine, serum electrolytes, urinalysis, and microalbumin/creatinine ratio. ResultsThere were 45 subjects included with a median age of 9.6 years; 24 (53%) were male. Urinary abnormality/CKD was observed in 11 subjects (24.4%). The most common urinary abnormalities were hematuria (6/11) and microalbuminuria (4/11). Stage 2 CKD was found in seven subjects and four subjects with stage 1 CKD. ConclusionsThe study of families of patients undergoing renal replacement therapy is useful to identify children in early stages of kidney disease.

C reactive protein and long-term risk for chronic kidney disease: a historical prospective study.

C reactive protein (CRP) is an acute phase reactant that primarily produced by hepatocytes yet may be locally expressed in renal tubular cells. We assessed the association of CRP and the risk for chronic kidney disease (CKD) development. Historical prospective cohort study was conducted on subjects attending a screening center in Israel since the year 2000. Subjects with an estimated GFR (eGFR) above 60 ml/min/1.73 m(2) at baseline were included, and high sensitive (hs) CRP levels as well as eGFR were recorded for each visit. Follow up continued for at least 5 years for each subject until 2013. Risk for CKD at end of follow up was assessed in relation to mean hs-CRP levels of each subject. The confounding effects of other predictors of CKD were examined. A logistic regression model treating CRP as a continuous variable was further applied. Out of 4,345 patients, 42 (1%) developed CKD in a mean follow up of 7.6 ± 2 years. Elevated levels of CRP were associated with greater risk for CKD (crude OR 4.17, 95% CI 1.46-11.89). The OR for the association of CRP with CKD when controlling for age and gender was 5.2 (95% CI 1.7-16.2). When controlling for established renal risk factors, elevated CRP levels remained significantly associated with greater risk for CKD (OR 5.42, 95% CI 1.76-16.68). When applying logistic regression models treating CRP as a continuous variable, for patients with diabetes mellitus (DM), hypertension (HTN) or eGFR between 60-90 ml\min\1.73 m(2), the predictive role of CRP for CKD was highly significant. Elevated CRP level is an independent risk factor for CKD development. In patients with DM, HTN or baseline eGFR between 60-90 ml\min\1.73 m(2) its predictive role is enhanced.

Changes in waist circumference and incidence of chronic kidney disease

Many studies have evaluated the association of anthropometric indices with chronic kidney disease (CKD), but the association of waist circumference(WC) changes with CKD incidence is less clear. We evaluated the effect of WC changes on CKD incidence in participants of the Tehran Lipid and Glucose Study (TLGS). The risk of CKD incidence was evaluated in three serial phases with interval censoring. A group of 8,183 (46·5% men) participants, mean age 47·4 years, free of previous CKD, were followed. Waist changes were divided into four groups: (i)decrease in WC; (ii) reference group; (iii)mild to moderate increase in WC and (iv)severe increase in WC. Glomerular filtration rate(GFR) was estimated using the MDRD equation. In 8,183 participants, mean GFR was higher in men (77·1 vs. 74·4 mL/min/1·73 m2, P<0·001). During the 9 years of follow-up, 1477 new cases of CKD occurred(1026 in women). WC changes were not associated with the development of CKD in women. In men, decrease in WC was not related to lower risk of CKD (HR: 0·90, 95% CI 0·6-1·4), whereas a mild to moderate increase in WC was associated with a 70% (HR: 1·7, 95% CI 1·3-2·2) higher risk of CKD even after adjusting for covariates (HR: 1·6, 95% CI 1·2-2·2). Severe increase in WC was associated with a fourfold risk of CKD in comparison with reference group (HR: 3·7, 95% CI 2·7-5·1). Changes in WC are not independent risk factors for CKD development in women, whereas waist gain can adversely influence the development of CKD in men.

Metabolic syndrome component combinations and chronic kidney disease: The severance cohort study

ObjectivesThe effects of ethnicity and gender can produce varying results when evaluating risk of chronic kidney disease (CKD) development and metabolic syndrome (MetS) components. The risks of specific MetS component combinations and incident CKD are unclear. The aim of this study was to investigate the relationship between the combination of MetS components and CKD. MethodsThis prospective cohort study included 15,401 participants. Koreans 20–84 years of age were followed for 5.2 years. The NCEP-ATP III definition of MetS was used. CKD was defined as an estimated glomerular filtration rate of <60ml/min/1.73m2 by the simplified Modification of Diet in Renal Disease equation. ResultsThe incidence rate per 1000 person-years of CKD was determined in men (13.8) and women (14.1) with MetS. In a multivariate Cox proportional hazard model controlling for age and lifestyle variables, increased CKD risk in men (hazard ratio 1.45, 95% confidence interval 1.20–1.76) and women (1.52, 1.19–1.93) with Mets was found compared to those without MetS. Incidence and HRs for CKD elevated with increasing numbers of MetS components in men and women (P for trend <0.0001). The risks associated with MetS varied by combination of causative factors. High blood pressure (BP) and low high-density lipoprotein (HDL) were more likely to be associated with risk of CKD development. ConclusionsBP and HDL were the leading risk factors for CKD development in healthy Koreans. The association between MetS and kidney dysfunction were significantly independent of traditional cardiovascular risk factors.