Risk Factors For Chronic Kidney Disease Research Articles

COVID-19 in discharged patients with diabetes and chronic kidney disease: one-year follow-up and evaluation

PurposeTo evaluate the all-cause mortality rate and renal outcomes in patients with diabetes and chronic kidney disease (CKD) following hospital discharge for COVID-19.MethodsThis single-center prospective observational study included 187 discharged COVID-19 patients with diabetes and CKD, admitted between December 2022 and January 2023 at West China Hospital, Sichuan University. Cox regression analysis was used to assess mortality risk, and logistic regression was applied to identify risk factors for rapid CKD progression after discharge.ResultsDuring the one-year follow-up, the all-cause mortality rate was 26.7%, with a COVID-19-related acute kidney injury (AKI) incidence of 35.3%, and 35.8% of patients experienced rapid CKD progression after discharge. Cox proportional hazards regression indicated that sepsis and mechanical ventilation were major risk factors for post-discharge all-cause mortality. Logistic regression identified baseline eGFR < 60 mL/min/1.73 m² as an independent risk factor for rapid CKD progression.ConclusionsDuring the one-year follow-up period, we observed that patients with diabetes and CKD exhibited higher all-cause mortality and experienced rapid deterioration of kidney function after acute infection with COVID-19. This underscores the importance of ongoing longitudinal follow-up to more accurately track the long-term health effects of COVID-19 on patients with diabetes and CKD.

Body-weight Cycling and Risk of Diabetic Kidney Disease in People With Type 1 Diabetes in the DCCT/EDIC Population.

Intraindividual body-weight variability or cycling is associated with increased risk of chronic kidney disease (CKD) in the general population. We conducted a retrospective analysis of data from the Diabetes Control and Complications Trial (DCCT)/Epidemiology of Diabetes Interventions and Complications (EDIC) studies to assess association between body-weight cycling and the risk of renal events in type 1 diabetes. Four indices of intraindividual body-weight variability were calculated for 1432 participants of DCCT/EDIC taking into account body-weight measurements during the DCCT follow-up (6 ± 2 years). Variability independent of the mean (VIM) was the main index. Six criteria of progression to CKD were studied during DCCT/EDIC follow-up (21 ± 4 years). Hazard ratio (HR) with 95% confidence interval (CI) were computed in Cox analyses for 1 SD of the indices expressed as Z-score. A high VIM was significantly associated with the incidence of a 40% decline in eGFR from baseline values (HR, 1.25; 95% CI, 1.09-1.41; P = .001), doubling of baseline serum creatinine (HR, 1.34; 95% CI, 1.13-1.57; P = .001), CKD stage 3 (HR, 1.36; 95% CI, 1.12-1.63; P = .002), and with a decline in eGFR > 3 mL/min/m2 per year (all analyses adjusted for CKD risk factors at baseline and follow-up, and use of nephroprotective drugs). VIM was also associated with the incidence of moderately and severely increased albuminuria, but associations did not remain significant following adjustment for follow-up covariates. Similar results were observed for the other indices of body-weight cycling. Body-weight cycling is significantly associated with an increased risk of kidney events in people with type 1 diabetes, regardless of body mass index and traditional risk factors.

Ambient PM25 Plus High‐Fat Diet Exacerbated Kidney Injury in Mice by Activating Ferroptosis Mediated TGF‐β1/Smad2 Signaling Pathway

ABSTRACTThe prevalence of chronic kidney disease (CKD) is on the rise globally, posing a significant public health concern. Numerous studies have indicated that the consumption of a high‐fat diet (HFD) can lead to renal injury, a condition closely linked to CKD. Additionally, research has shown that exposure to ambient PM2.5 is associated with an increased risk of CKD, suggesting that PM2.5 may serve as an environmental risk factor for CKD. However, the synergistic impact of PM2.5 and HFD on renal injury remains poorly understood. Therefore, the objective of our study was to investigate the combined effect of PM2.5 and HFD on renal injury. Male C57BL/6J mice were subjected to a 12‐week feeding regimen of either a normal diet or a HFD, while also being exposed to either saline or ambient PM2.5 through intratracheal instillation twice a week. Evaluation of renal function demonstrated that the HFD significantly elevated levels of serum blood urea nitrogen and serum creatinine. Furthermore, the combination of PM2.5 and HFD exhibited a synergistic effect, exacerbating the aforementioned indicators of kidney injury. Masson's trichrome staining revealed that both the HFD and/or PM2.5 induced renal fibrosis, with PM2.5 exacerbating the HFD‐induced renal fibrosis in the mice. In this study, Western blot analysis was conducted to examine the protein expressions of TGF‐β1 and p‐Smad2 in kidney tissues, which were found to be significantly increased in response to a HFD and/or exposure to PM2.5. Additionally, the impact of PM2.5 combined with HFD on renal ferroptosis was investigated. The results revealed that both HFD and PM2.5 led to an elevation in 4‐HNE concentration, a reduction in GSH content, a decrease in GPX4 protein expression, and an increase in ACSL4 protein expression in kidney tissues. Moreover, the combined exposure to PM2.5 and HFD exhibited a synergistic effect on GPX4 alterations in the kidney. Collectively, our findings suggest that the presence of PM2.5 exacerbates the renal injury, oxidative stress, and renal fibrosis induced by a HFD. This detrimental effect may be attributed to the activation of the ferroptosis‐mediated TGF‐β1/Smad2 signaling pathway.

BARIATRIC SURGERY AS AN IMPORTANT STEP TOWARDS KIDNEY TRANSPLANTATION IN PATIENTS WITH MORBID OBESITY AND CHRONIC KIDNEY DISEASE

An analysis of scientificstudies devoted to the problem of bariatric surgery in patients with stages III b-V as chronic kidney disease (CKD) as the main step towardspossible kidney transplantation is presented. Obesity leads to CKD both directly, acting as an independent risk factor, and indirectly, by increasing the risk of diabetes, hypertension and atherosclerosis (i.e., a group of independent risk factors for CKD). CKD with an outcome of chronic renal failure is the second most common cause of mortality and disability in obese patients. In most kidney transplantationcenters, a body mass index (BMI) of more than 40 kg/m2 is a contraindication for to transplantation (refusal to be included on the waiting list); and a BMI of more than 35 kg/m2 is a relative contraindication. In some cases, bariatric surgery is the only way to perform organ transplantation. Direct indications for bariatric surgery in patients with morbid obesity undergoing hemodialysis therapy have been identified. Direct indications for bariatric surgery in patients with morbid obesity undergoing hemodialysis therapy have been identified. The established diet before/after bariatric surgery with the inclusion of protein isolate is not the cause of protein overload in patients with CKD. Bariatric surgery is considered a safe treatment option for obesity in potential kidney transplant candidates, given their continued need for immunosuppressive therapy.

Effects of sarcopenic obesity on incident chronic kidney disease and rapid kidney function decline: evidence from the China health and retirement longitudinal study.

Evidence on the effects of sarcopenic obesity (SO) on incident chronic kidney disease (CKD) and rapid kidney function decline (RKFD) in the Chinese population is limited. This study aimed to prospectively examine the associations of SO with incident CKD and RKFD among middle-aged and older Chinese adults. This prospective cohort study utilized data from the China Health and Retirement Longitudinal Study (CHARLS), a nationally representative longitudinal study of Chinese adults aged 45 and older. The analysis included 4201 individuals from the 2011 wave, with renal outcomes ascertained from the 2015 wave. The effects of SO on incident CKD and RKFD were assessed using logistic regression models. Robustness was tested through subgroup and sensitivity analyses. Over four years of follow-up, 228 cases of incident CKD and 213 cases of RKFD were observed. After multivariable adjustment, participants in the "sarcopenic obesity" group showed a 78% increased risk of incident CKD (odds ratio [OR] 1.78, 95% confidence interval [CI] 1.09-2.90) and a 79% increased risk of RKFD (OR 1.79, 95% CI 1.03-3.13), compared to the "nonsarcopenia without obesity" group. Consistent results were observed across subgroups stratified by gender, education level, marital status, geographic area, lifestyle factors, and comorbidities, with no significant interactions detected. In a population-based cohort of middle-aged and older Chinese adults, SO was independently associated with elevated risks of incident CKD and RKFD, without interaction effects. These findings underscore the importance of timely intervention for SO to prevent adverse kidney outcomes. Key message What is already known on this topic? The relationship between sarcopenic obesity (SO) and the risk of chronic kidney disease (CKD) and renal function decline has been established in Korean and Japanese individuals with type 2 diabetes mellitus. However, it is uncertain if these findings apply to other populations, particularly those without diabetes. Additionally, the influence of diabetes on these associations needs further exploration, and the link between SO and rapid kidney function decline (RKFD) remains unestablished. Evidence regarding the effects of SO on incident CKD and RKFD in the Chinese population is limited, highlighting the necessity for this study to fill these gaps in knowledge. What this study adds This study is the first to prospectively explore the association of SO with incident CKD and RKFD in middle-aged and older Chinese adults. We identified SO as a significant risk factor for increased incidence of both CKD and RKFD. These findings expand the understanding of the impact of SO beyond individuals with diabetes mellitus, indicating that SO is a universal risk factor for adverse kidney outcomes in aging populations, irrespective of demographic and health characteristics. How this study might affect research, practice, or policy This study identifies SO as an independent risk factor for incident CKD and RKFD in middle-aged and older Chinese adults. The findings suggest that SO is a modifiable risk factor for kidney health, underscoring the necessity for timely interventions to prevent adverse kidney outcomes. Given the rising prevalence of SO and kidney disease in aging populations worldwide, these results highlight the importance of incorporating SO management into public health and clinical strategies. Questions pending answer What role do specific lifestyle factors (e.g. diet, physical activity) play in mitigating or exacerbating kidney function decline in individuals with SO? Are there genetic markers that predispose individuals with SO to a higher risk of incident CKD and RKFD? What are the underlying molecular mechanisms linking SO to incident CKD and RKFD?

Prognostic value of nighttime blood pressure in patients with chronic kidney disease.

The optimal blood pressure (BP) in patients with chronic kidney disease (CKD) remains uncertain. Therefore, this cohort study aimed to investigate the prognostic value of ambulatory blood pressure (ABP) in patients with CKD and to determine the optimal range for ABP. In total, 1051 hospitalized patients with CKD were enrolled. The prognosis of patients with CKD was evaluated in terms of all-cause death, cardiovascular death, cardiovascular events, and renal events. Our results showed that systolic blood pressure (SBP) had a higher predictive value than diastolic blood pressure in the multivariate-adjusted models. Additionally, nighttime SBP was found to be the best predictor of prognosis in patients with CKD. Furthermore, when dividing the nighttime SBP into quartiles (quartile 1: <110 mmHg, quartile 2: 110-124 mmHg, quartile 3:124-139 mmHg, and quartile 4: ≥139 mmHg). Nighttime SBP ≥ 124 mmHg had an impact on prognosis in patients with CKD, nighttime SBP 124-139 mmHg: total mortality (hazard ratio [HR], 3.017 [95% confidence interval (CI): 1.367-6.660]), cardiovascular death (HR, 2.570 [95% CI, 1.744-6.151]), all cardiovascular events (HR, 2.401 [95% CI, 1.288-4.475]), and 110-124 mmHg had an impact on the renal prognosis (HR, 1.975 [95% CI, 1.311-2.976]). Therefore, nighttime SBP is an independent risk factor for CKD and a significant predictor of prognosis in patients with CKD. Furthermore, the prognosis of patients with CKD improved when the nighttime SBP was maintained below 124 mmHg; however, maintaining it below 110 mmHg can further lower the incidence of renal disease.

ANALYSIS OF HEMODIALYSIS SERVICE UTILIZATION BY JKN PARTICIPANTS IN THE SPECIAL REGION OF YOGYAKARTA: AN ANALYSIS OF BPJS KESEHATAN CLAIM DATA IN 2023

Chronic kidney disease (CKD) has become a serious global health problem with significant socio-economic implications. This study aims to analyze the determinants of the utilization of hemodialysis services for National Health Insurance (JKN) participants in the Special Region of Yogyakarta (DIY) in 2023. The study employs a cross-sectional design to analyze secondary data from the BPJS Kesehatan claim database in 2020, focusing on JKN participants receiving dialysis services at Advanced Referral Health Facilities (FKRTL). Data extraction is followed by analysis using STATA software, which includes univariate and bivariate analyses, multicollinearity and overdispersion tests, model comparison via Akaike Information Criterion (AIC), and multivariate analysis through Poisson regression and Binomial Negative methods. A total of 3,220 participants (0.089%) were enrolled in the study. The highest distribution of participants was in Sleman Regency (36.49%), followed by Bantul (29.53%), and Yogya City (25.96%). From the results of the binomial regression analysis, it was found that the age factor had a significant negative influence (p=0.000) with a coefficient of -0.0046 and an IRR of 0.9954, which means that every increase in age by one year will decrease the frequency of visits by 0.46%. The prevalence of diabetes (3.1%) and hypertension (10.2%) which exceed the national average indicates a high risk factor for CKD in this region is high. The age factor and location of health facilities in SLEMAN Regency significantly affected the frequency, while the segment group, gender, and nursing class rights did not show significant influence.

Trends in the prevalence of Chronic Kidney Disease in the United States, 1999-2018.

Chronic Kidney Disease (CKD) is an escalating public health concern in the United States, linked with significant morbidity, mortality, and healthcare costs. Despite known risk factors like age, hypertension, and diabetes, comprehensive studies examining temporal trends in CKD prevalence are scarce. This study aims to analyze these trends using data from the National Health and Nutrition Examination Survey (NHANES). This cross-sectional study analyzed NHANES data spanning 20 years (1999-2018), including 55,081 adults aged 20 years and above. Key renal function indicators like estimated glomerular filtration rate (eGFR) and albumin-to-creatinine ratio (ACR) were assessed, and CKD stages were categorized accordingly. A fluctuating trend in CKD prevalence was observed, with early CKD stages (G1-G3) increasing from 9.28% in 1999-2000 to 12.93% in 2017-2018. Advanced CKD stages (G4-G5) showed a slight increase in prevalence from 0.3% in 1999-2000 to 0.51% in 2017-2018. Notable disparities were observed across age groups, diabetes status, and racial categories. Relatively, the elderly, women, and non-Hispanic whites have a higher prevalence of CKD, while individuals with diabetes have a consistently higher prevalence of early CKD from 1999 to 2018. The increasing prevalence of diabetes during the study period highlights its significant role as a CKD risk factor. The prevalence of CKD in the U.S. has been rising over the period 1999-2018, and varying across demographic groups, underscoring significant disparities and risk factors. These insights are crucial for healthcare planning, policy formulation, and targeted interventions for CKD management.

Global burden of chronic kidney disease due to dietary factors.

We aimed to assess the global impact of chronic kidney disease (CKD) attributable to dietary risk factors. The research utilized data from the Global Burden of Disease Study 2021 to evaluate age-standardized mortality rates (ASMR), disability-adjusted life years (DALYs), and estimated annual percentage changes (EAPCs) linked to CKD resulting from dietary risk factors. From 1990 to 2021, both the ASMR and age-standardized DALY rate (ASDR) for CKD attributable to dietary risk factors exhibited an overall increasing trend globally. The mortality EAPC was 0.65, while the EAPC for DALYs stood at 0.39. Among dietary risk factors examined, a diet high in sugar-sweetened beverages was associated with the most substantial increase in CKD burden. Notably, Central sub-Saharan Africa bore the highest burden of CKD due to dietary risk factors, with an ASMR of 10.24 and an ASDR of 229.23. The increases in ASMR and ASDR were more pronounced in high-income regions, particularly in Latin America and the Caribbean, where the EAPC values for ASMR were 1.45 and 1.05, respectively, and for ASDR were 1.08 and 0.96. Furthermore, the burden of CKD was notably higher among middle-aged and elderly individuals, especially men aged 65 and above. The global disease burden attributed to dietary risk factors for CKD is increasing. A diet high in sugar-sweetened beverages exerted the most significant impact on CKD. There is a high incidence in Central sub-Saharan Africa, as well as in high-income regions and Latin America and the Caribbean.

Energy Expenditure in Chronic Kidney Disease: Affecting Factors and Evaluation Methods.

Chronic kidney disease (CKD) is a chronic health problem whose prevalence is increasing. Nutrition and nutrition-related factors, one of the modifiable risk factors for CKD, are of primary importance. The key to planning optimal nutritional therapy is accurately determining energy requirements and total energy expenditure. Many health problems can accompany CKD, such as protein-energy malnutrition, sarcopenia, etc, and increase the mortality rate. This study aims to present the specific factors affecting energy expenditure specific to CKD in line with the current literature, to discuss the methods used to determine energy expenditure, and to examine these methods according to groups receiving and not receiving renal replacement therapy (hemodialysis, peritoneal dialysis, and renal transplantation).

Determinants of Chronic Kidney Disease among Young Adults attending a Tertiary Care Hospital in Madurai- A Case-Control Study

Introduction: As with other non-communicable diseases, chronic kidney disease (CKD) also is in a way at the top among the younger population. Apart from diabetes, hypertension, old age, family history of CKD other risk factors like smoking, alcohol, pesticide exposure, heavy metals also made them vulnerable to CKD. The focus on CKD in younger age groups is often overlooked; therefore, this study has been planned to address this gap. Objective: To determine the risk factors for chronic kidney disease among young adult patients &lt;40 years of age. Method: An unmatched case control study was conducted in district hospital in Madurai. The study compared patients with chronic kidney disease aged under 40 (cases) from the Nephrology ward and outpatient with similar-aged controls without CKD from the Medicine ward, using routine eGFR calculations for diagnosis. The calculated sample size was 76, which was rounded up to 100 participants in both the case and control groups. Data collection was done by using semi-structured questionnaire. Univariate and multivariate analysis were used to predict the risk factors for young CKD patients. Results: The study predicted that rural population (OR-5.236, 95% CI-2.489- 11.014), family history of CKD (OR-29.590, 95% CI- 3.351-261.243), hypertension (OR-5.005, 95% CI-2.014-12.437), history of taking alternative medicine (OR- 5.136, 95% CI-1.745-15.117), and recurrent urinary tract infection (OR-11.460, 95% CI-2.288-57.444) were significantly associated risk factors for CKD. Conclusion: This study predicted hypertension, rural population, family history of CKD, history of recurrent urinary tract infection, alcohol consumption as significant risk factors for CKD. Hypertension, history of recurrent urinary tract infection, alcohol consumption were modifiable risk factors. By controlling these modifiable risk factors, the burden of CKD can be reduced. In addition this study predicted that, rural population was more vulnerable to CKD, so the screening service to these populations through primary health care approach is essential.

Prevalence of chronic kidney disease and risk factors in adults with hypertension in China

Objective: To understand the prevalence of chronic kidney disease (CKD) and influencing factors in adults with hypertension in China and provide evidence for the management of CKD in hypertension patients. Methods: The prevalence data of CKD in hypertension patients in China were collected from China Chronic Disease and Risk Factor Surveillance in 2018, the data of 68 829 hypertension patients were analyzed. After complex weighting, the prevalence of CKD in the study population was compared. A multivariate logistic regression model was used to explore the influencing factors of CKD in adults with hypertension. Results: The prevalence of CKD in the hypertension patients was 18.2% (95%CI: 17.4%-19.0%) and increased with age, and the prevalence was 16.4% in men and 20.6% in women (P<0.001). In different age groups, CKD at stage G1 mainly occurred in those aged 18-44 and 45-59 years, with the prevalence of 10.8% and 7.8%, respectively, while CKD at stages G2 and G3a mainly occurred in those aged >60 years, with the prevalence of 9.4% and 9.7%. Multivariate logistic regression results showed that in the hypertension patients, being aged ≥60 years, being women, smoking (including current and ever smoking), physical inactivity, being underweight or obese, and suffering from diabetes, dyslipidemia and hyperuricemia were the potential risk factors for CKD (all P<0.05). Conclusion: The prevalence of CKD was higher in people with hypertension than in general population in China, and age, gender, smoking status, physical activity level, and suffering from diabetes, dyslipidemia, and hyperuricemia or not were significant influencing factors. It is necessary to strengthen health education and kidney function testing in adults with hypertension and develop comprehensive CKD prevention and control measures targeting high-risk population.

Plasma myeloperoxidase interactions with cadmium, lead, arsenic, and selenium and their impact on chronic kidney disease.

Myeloperoxidase (MPO) is an oxidative stress biomarker, with elevated MPO levels linked to chronic kidney disease (CKD) progression. Metal exposure is a risk factor for CKD, and is also correlated to MPO expression, with specific MPO genotypes linked to MPO expression. Therefore, we examined whether MPO plasma levels or MPO polymorphisms were linked to CKD, and explored whether these factors modified associations between CKD and metal concentrations. Accordingly, we recruited 395 age- and sex-matched controls and 215 patients with CKD (persistent estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2 for a minimum of 12 weeks without hemodialysis). We identified no associations between several MPO genotypes and CKD. However, after multivariate adjustment, plasma MPO concentrations were positively correlated with CKD odds ratio (OR) = 5.87 (95 % confidence interval [CI]: 3.14-10.96). Significant additive interactions were observed between high plasma MPO concentrations and elevated blood cadmium (Cd) and lead (Pb) levels, and total urinary arsenic (As), or low plasma selenium (Se) concentrations, leading to increased ORs for CKD, with significant synergy indices recorded. High plasma MPO concentrations also showed multiplicative interactions with elevated blood Pb levels or low plasma Se concentrations, which increased the ORs for CKD (p-values = 0.005 and 0.009, respectively). Our study is the first to show a significant interaction between plasma MPO concentration and metals affecting the OR of CKD.

Lupus Nephritis and Chronic Kidney Disease: A Scoping Review.

Prevention of end-stage kidney disease (ESKD) is a major objective in the management of patients with lupus nephritis (LN). Chronic kidney disease (CKD) of variable severity is common in these patients, but recent literature has mostly focused on novel immunosuppressive treatments for acute LN, while the data on CKD is relatively limited. This scoping review aims to summarise available data on the prevalence and risk factors for CKD in patients with LN. PubMed and Web of Science databases were systematically searched on the 1st November 2024 for 'real world' SLE and LN cohorts with longitudinal follow-up which reported the outcome of CKD or CKD progression and its associated risk factors. Fifteen studies were included. The prevalence of CKD ranged from below 10% to almost 50% across diverse LN and SLE cohorts. Major risk factors for CKD or CKD progression included renal impairment at presentation, renal function at 1 year post-treatment, delayed diagnosis, established chronic pathological lesions on kidney biopsy, unsatisfactory treatment response, nephritic flares, hypertension, and persistent proteinuria during follow-up. Many of the identified risk factors are amenable to therapeutic intervention. CKD not only contributes to morbidity and mortality and inferior quality of life, but also influences the choice of therapy and optimal dosing of medications. Attention to immunomodulatory medications for disease control, and non-immune strategies for renoprotection and prevention of CKD complications, are both important in the management of patients with LN to reduce their life-time risk of ESKD.

The Needs of Public Health Mitigation as The Impact of Earthquake Disasters in North Sulawesi Region, Indonesia

North Sulawesi is located on a megathrust system and is very vulnerable to destructive earthquake events. Therefore, disaster mitigation from a health perspective must be carried out. Good knowledge will shape a positive attitude as a response that will determine actions in providing effective and optimal health services during a disaster. However, so far, the level of knowledge, attitudes, and actions of doctors in community health centers in North Sulawesi in facing disasters has never been evaluated, so the readiness of doctors in community health centers in facing disasters is still not well understood. One of the effects after a disaster is kidney failure (CKD) due to the lack of fluids needed by the body, making it one of the unavoidable effects of a disaster. Chronic Kidney Disease (CKD) is one of the diseases whose number and prevalence are significant both globally, nationally, and locally in North Sulawesi. The purpose of this research is to: 1) explore the perceptions and experiences of the community regarding the risk factors for CKD, 2) develop and test the effectiveness of a disaster-based education program in increasing community knowledge about CKD prevention. The design used is a multistage mixed method. The research began with the collection of qualitative data through in-depth interviews, followed by the development of an educational program and the experimental testing of the educational program. This research was conducted in Kuwil Village, North Minahasa Regency. A total of 15 participants were involved in the interviews and 38 participants in the experimental phase. Qualitative data is analyzed thematically, while quantitative data is analyzed descriptively through comparison. The results of the qualitative analysis yielded 2 themes. The first theme is the disparity in public knowledge about CKD, and the second theme is the public's efficacy regarding the prevention and impact of CKD. The analysis results using the paired t-test obtained a p-value of 0.000, which means that the disaster-based education program is effective in increasing public knowledge about CKD and its prevention. Having sufficient knowledge and adequate sources of information can help the community in making healthy lifestyle choices, especially in preventing the occurrence of CKD. Disaster-based education programs can be one of the approaches that community health centers can take to improve public literacy regarding CKD prevention.

Blood-based epigenetic biomarkers associated with incident chronic kidney disease in individuals with type 2 diabetes.

There is an increasing need for new biomarkers improving prediction of chronic kidney disease (CKD) in individuals with type 2 diabetes (T2D). We aimed to identify blood-based epigenetic biomarkers associated with incident CKD and develop a methylation risk score (MRS) predicting CKD in newlydiagnosed individuals with T2D. DNA methylation was analysed epigenome-wide in blood from 487 newly-diagnosed individuals with T2D, of whom 88 developed CKD during 11.5-year follow-up. Weighted Cox regression was used to associate methylation with incident CKD. Weighted logistic models and cross-validation (k=5) were performed to test if the MRS could predict CKD. Methylation at 37 sites was associated with CKD development, based on FDR&amp;lt;5% and absolute methylation differences ≥5% between individuals with incident CKD and those free of CKD during follow-up. Notably, 15 genes annotated to these sites, e.g., TGFBI, SHISA3, and SLC43A2 (encoding LAT4), have been linked to CKD or related risk factors including blood pressure, BMI, or eGFR. Using a MRS including 37 sites and cross-validation for prediction of CKD, we generated ROC curves with AUC=0.82 for the MRS and AUC=0.87 for the combination of MRS and clinical factors. Importantly, ROC curves including the MRS had significantly better AUCs versus the one only including clinical factors (AUC=0.72). The combined epigenetic biomarker had high accuracy in identifying individuals free of future CKD (negative predictive value=94.6%). We discovered a high-performance epigenetic biomarker for predicting CKD, encouraging its potential role in precision medicine, risk stratification, and targeted prevention in T2D.

Does metabolic dysfunction-associated fatty liver disease increase the risk of chronic kidney disease? A meta-analysis of cohort studies

ObjectiveMetabolic dysfunction-associated fatty liver disease (MAFLD) has been used to characterize patients with fatty liver and metabolic dysfunction. The association between MAFLD and chronic kidney disease (CKD) remains undefined. We present high-quality evidence obtained from cohort studies examining if MAFLD leads to an increased risk of CKD.MethodsPubMed, CENTRAL, Embase, Scopus, and Web of Science were searched from the earliest possible date to 17th May 2024 for cohort studies examining the link between MAFLD and CKD.ResultsEight studies with nine cohorts were included. Pooled analysis of all nine cohorts showed that MAFLD was an independent predictor of CKD (HR: 1.38 95% CI: 1.24, 1.53 I2 = 95%). No change in results was noted on sensitivity analysis. We also noted no change in the significance of effect size on subgroup analysis based on study design (prospective or retrospective), country of origin (China, Korea, Japan, or UK), the incidence of CKD in the cohort (> 10% or ≤ 10%) and if the study adjusted for cardiovascular disease, diabetes, hypertension, and smoking status. Further, meta-analysis showed that MAFLD was still a risk factor for CKD in men (HR: 1.38 95% CI: 1.22, 1.56 I2 = 86%), women (HR: 1.51 95% CI: 1.25, 1.82 I2 = 87%), overweight (HR: 1.41 95% CI: 1.20, 1.66 I2 = 89%) and non-overweight cohorts (HR: 1.35 95% CI: 1.20, 1.53 I2 = 9%).ConclusionMAFLD is an independent predictor of CKD. The association seems persistent irrespective of sex, body mass index, and other CKD risk factors.

The association of RBP4 with chronic kidney diseases in southern Chinese population.

Retinol binding protein 4 (RBP4), as a novel adipokine, has been proven to be highly related to insulin resistance, obesity, diabetes, hypertension, hyperuricemia and other metabolic diseases, which are all risk factors for chronic kidney disease (CKD). However, there is a lack of sufficient studies to explore the relationship between RBP4 and CKD, and no reports have described the predictive value of RBP4 for CKD. This study was designed to clarify the relationship between RBP4 and CKD and its potential predictive value. Our team has conducted a large-scale cross-sectional survey that contained 2117 individuals on the southern coast of China. Correlation test, logistic regression analysis were used to evaluate the association between RBP4 and CKD. Receiver operating characteristic (ROC) were used to evaluate the optimal cut-off and predictive value of RBP4 for predicting CKD. By using the quartile grouping method, the population was divided into four groups according to the RBP4 level. As the RBP4 level increased, the prevalence of CKD also gradually increased among different groups. RBP4 was also correlated with various metabolic risk factors, such as blood glucose, blood lipids, blood pressure, waist circumference, uric acid, and with kidney function indicators such as creatinine, urine protein. Logistic regression analysis found that after adjusting for confounders, RBP4 remained significantly associated with CKD, independent of metabolic risk factors. ROC analysis showed that RBP4 as a single index, AUC (0.666) was superior to Scr, FBG, Log HOMA-IR, WC, TG, VLDL-C, UA, HDL-C, LDL-C, and that combining RBP4 indicator and other common risk factors of CKD can improve the accuracy for predicting CKD. This study found that the RBP4 was strongly correlated with CKD, RBP4 may become a valuable marker and have strong power for predicting CKD.

The Correlation of Serum Adropin with Cardiovascular Risk Factors in the Experimental Rat Model of Chronic Kidney Disease and Its Implication in the Ameliorative Effect of Angiotensin-Converting Enzyme Inhibitors.

The risk of cardiovascular disease (CVD) in patients with chronic kidney disease (CKD) is estimated to be far greater than that in the general population. Adropin regulates endothelial function and may play a role in the pathogenesis of CVD. Angiotensin-converting enzyme inhibitor (ACEI) treatment was reported to have a protective effect on both renal and cardiovascular function. This study investigated whether adropin is associated with renal and cardiovascular outcomes after using ACEI treatment in CKD rats. In 2021, in Zagazig, Egypt, rats were assigned to: GI, control group (n=8); GII, CKD group (n=8), and GIII, CKD+captopril group (n=8), in which CKD rats received 100 mg/Kg/day captopril orally. Adropin levels, renal function, blood pressure, and various CVD risk factors were measured. Renal, cardiac, and aortic tissues were examined histologically and immunohistochemically to detect the expression of vascular endothelial growth factor receptor-2 (VEGFR-2). To analyze data, ANOVA and Pearson's correlation tests were used (SPSS version 18, P<0.05 is significant). Adropin was significantly lower in GII than in GI and GIII (P<0.001). Adropin in GII and GIII was negatively correlated with atherogenic index (P=0.019 and P=0.001, respectively), atherogenic co-efficient (P=0.012 and P=0.013, respectively), troponin I (P=0.021 and P=0.043, respectively), and nitric oxide (P=0.025 and P=0.038, respectively). VEGFR-2 expression decreased in GII and was elevated in GIII (P<0.001). Adropin levels were significantly correlated with most CVD risk factors in CKD and captopril-treated CKD rats, indicating a role for adropin in the pathogenesis of CVD in CKD. It also refers to its implication in the ameliorative effect of ACEI treatment, possibly by affecting VEGFR-2 and nitric oxide release.

Coexisting Tubulointerstitial Inflammation and Damage Is a Risk Factor for Chronic Kidney Disease in Patients With Lupus Nephritis.

This study aims to determine whether the concurrent presence of tubulointerstitial inflammation (TII) and tubulointerstitial damage (TID) predicts the progression of chronic kidney disease (CKD) in patients with lupus nephritis (LN). Data from 175 LN patients, collected at the time of renal biopsy, were analyzed. Patients were stratified into two groups based on the presence or absence of coexisting TII/TID. Uni- and multivariable Cox proportional hazard regression models were utilized to identify independent risk factors for CKD in LN patients. Of 175 patients, 110 (62.9%) exhibited coexisting TII/TID, whereas 65 (37.1%) did not. Patients with coexisting TII/TID tended to be older and presented with higher levels of ESR and 24-h proteinuria, as well as lower levels of eGFR and hemoglobin compared to those without coexisting TII/TID. Over a mean follow-up period of 89.9 months, CKD and end-stage renal disease occurred more frequently in patients with coexisting TII/TID. Notably, the presence of coexisting TII/TID was associated with a higher risk of CKD progression, with adjusted hazard ratios of 2.667 (95% CI: 1.333, 5.335, p = 0.006) for all LN patients, 3.265 (95% CI: 1.451, 7.345, p = 0.004) for those with class III, IV, and V LN, and 3.045 (95% CI: 1.289, 7.195, p = 0.011) for those with class III, IV, V LN, and eGFR ≥ 30 mL/min/1.73 m2. LN patients with coexisting TII/TID are at a heightened risk of kidney function deterioration at LN onset and subsequent development of CKD over the long term.