Chronic Kidney Disease Surveillance Research Articles

Organization and Structures for Detection and Monitoring of CKD Across World Countries and Regions: Observational Data From a Global Survey

Rationale & ObjectiveEstablished therapeutic interventions effectively mitigate the risk and progression of chronic kidney disease (CKD). Countries and regions have a compelling need for organizational structures that enable early identification of people with CKD who can benefit from these proven interventions. We aimed to report the current global status of CKD detection programs. Study DesignA multinational cross-sectional survey. Setting & ParticipantsStakeholders, including nephrologist leaders, policymakers, and patient advocates from 167 countries, participating in the International Society of Nephrology (ISN) survey from June to September 2022. OutcomesStructures for the detection and monitoring of CKD, including CKD surveillance systems in the form of registries, community-based detection programs, case-finding practices, and availability of measurement tools for risk identification. Analytical ApproachDescriptive statistics. ResultsOf all participating countries, 19% (n=31) reported CKD registries and 25% (n=40) reported implementing CKD detection programs as part of their national policies. There were variations in CKD detection program, with 50% (n=20) using a reactive approach (managing cases as identified) and 50% (n=20) actively pursuing case-finding in at-risk populations. Routine case-finding for CKD in high-risk populations was widespread, particularly for diabetes (n=152; 91%) and hypertension (n=148; 89%). Access to diagnostic tools, estimated glomerular filtration rate (eGFR) and urine albumin-creatinine ratio (UACR), was limited, especially in low-income (LICs) and lower-middle-income (LMICs) countries, at primary (eGFR: LICs 22%, LMICs 39%, UACR: LICs 28%, LMICs 39%) and secondary/tertiary healthcare levels (eGFR: LICs 39%, LMICs 73%, UACR: LICs 44%, LMICs 70%), potentially hindering CKD detection. LimitationsA lack of detailed data prevented an in-depth analysis. ConclusionThis comprehensive survey highlights a global heterogeneity in the organization and structures (surveillance systems, detection programs and tools) for early identification of CKD. Ongoing efforts should be geared toward bridging such disparities to optimally prevent the onset and progression of CKD and its complications.

Laboratory-based surveillance of chronic kidney disease in people with private health coverage in Brazil

BackgroundAlthough approximately 25% of Brazilians have private health coverage (PHC), studies on the surveillance of chronic kidney disease (CKD) in this population are scarce. The objective of this study was to estimate the prevalence of CKD in individuals under two PHC regimes in Brazil, who total 8,335,724 beneficiaries.MethodsOutpatient serum creatinine and proteinuria results of individuals from all five regions of Brazil, ≥ 18 years of age, and performed between 10/01/2021 and 10/31/2022, were analyzed through the own laboratory network database. People with serum creatinine measurements were evaluated for the prevalence and staging of CKD, and those with simultaneous measurements of serum creatinine and proteinuria were evaluated for the risk category of the disease. CKD was classified according to current guidelines and was defined as a glomerular filtration rate (GFR) < 60 ml/min/1.73 m² estimated by the 2021 CKD-EPI equation.ResultsThe number of adults with serum creatinine results was 1,508,766 (age 44.0 [IQR, 33.9–56.8] years, 62.3% female). The estimated prevalence of CKD was 3.8% (2.6%, 0.8%, 0.2% and 0.2% in CKD stages 3a, 3b, 4 and 5, respectively), and it was higher in males than females (4.0% vs. 3.7%, p < 0.001, respectively) and in older age groups (0.2% among 18-29-year-olds, 0.5% among 30-44-year-olds, 2.0% among 45-59-year-olds, 9.4% among 60-74-year-olds, and 32.4% among ≥ 75-year-olds, p < 0.001) Adults with simultaneous results of creatinine and proteinuria were 64,178 (age 57.0 [IQR, 44.8–67.3] years, 58.1% female). After adjusting for age and gender, 70.1% were in the low-risk category of CKD, 20.0% were in the moderate-risk category, 5.8% were in the high-risk category, and 4.1% were in the very high-risk category.ConclusionThe estimated prevalence of CKD was 3.8%, and approximately 10% of the participants were in the categories of high or very high-risk of the disease. While almost 20% of beneficiaries with PHC had serum creatinine data, fewer than 1% underwent tests for proteinuria. This study was one of the largest ever conducted in Brazil and the first one to use the 2021 CKD-EPI equation to estimate the prevalence of CKD.

Urinary growth differentiation factor 15 predicts renal function decline in diabetic kidney disease

Sensitive biomarkers can enhance the diagnosis, prognosis, and surveillance of chronic kidney disease (CKD), such as diabetic kidney disease (DKD). Plasma growth differentiation factor 15 (GDF15) levels are a novel biomarker for mitochondria-associated diseases; however, it may not be a useful indicator for CKD as its levels increase with declining renal function. This study explores urinary GDF15’s potential as a marker for CKD. The plasma and urinary GDF15 as well as 15 uremic toxins were measured in 103 patients with CKD. The relationship between the urinary GDF15-creatinine ratio and the uremic toxins and other clinical characteristics was investigated. Urinary GDF15-creatinine ratios were less related to renal function and uremic toxin levels compared to plasma GDF15. Additionally, the ratios were significantly higher in patients with CKD patients with diabetes (p = 0.0012) and reduced with statin treatment. In a different retrospective DKD cohort study (U-CARE, n = 342), multiple and logistic regression analyses revealed that the baseline urinary GDF15-creatinine ratios predicted a decline in estimated glomerular filtration rate (eGFR) over 2 years. Compared to the plasma GDF15 level, the urinary GDF15-creatinine ratio is less dependent on renal function and sensitively fluctuates with diabetes and statin treatment. It may serve as a good prognostic marker for renal function decline in patients with DKD similar to the urine albumin-creatinine ratio.

Fetal and Perinatal Nephrology: Small but Mighty.

Fetal and Perinatal Nephrology: Small but Mighty.

Establishing a Chronic Kidney Disease (CKD) Surveillance in Cuttack District, Odisha, India

Background: Chronic kidney disease (CKD) is a globalpriority public health concern that accounts forsignificant morbidity and mortality. Unusual occurrence of CKD was reported from Cuttack district ofOdisha. We aim to establish a CKD surveillance system in Cuttack district to estimate the burden of diseaseand help decision-makers through future epidemiological assessments.Method: We focused on CKD patients enrolled in the Narsingpur community health clinics and attendingthe clinics from January to June 2016. We defined a suspected CKD as patientpresenting with any symptomsof loss of appetite, fatigue &amp;weakness, change in urine output, swelling of feet &amp; ankles and blood in urine.A confirmed CKD was defined as a CKD suspect with elevated Serum creatinine (&gt;1.5 mg/dL) and SerumUrea (&gt;40 mg/dL).Besides, we collected relevant data on demography, clinical, laboratory, occupational andfamily history of patients.Results: The CKDsurveillance presented over 320 suspected CKD cases, of which 35 cases were laboratoryconfirmed. The median age was 57 years ranging from 35 -75 years (Mean +SD= 56+9.1), 71% of cases weremales and agriculture was the commonest occupation. Laboratory finding shows fasting blood glucose of147.4 mg/dl (Range 84-249), Serum Creatinine 3.59 mg/dl (Range 2.2-7.9), Serum Urea 76.6 mg/dl (Range14.1-137), Urine Creatinine 6.0 mg/24 hrs (Range, 4.4-7.3) and Urine Albumin 7.6 mg/dl (Range 7.2-8.4).The majority of patients (57%, 20/35) were in CKD stage 3 (GFR, between 60 and 89 ml/min/1.73m2).Conclusion:The CKD surveillance system supported CKD patient’s analysis by age, gender, geographicaldistribution and socio-demographic profile. Further, the analysis involved analysing patient’s clinicalcharacteristics, CKD staging, associated co-morbidities and treatment modalities.The surveillancesystem established a scientific platform for primary prevention, early detection, and treatment strategiesimplementation. The platform eventuallyhelped the decision-makers increase awareness, decrease CKDmorbidity &amp; mortality throughmore efficient resource utilization.

COVID-19 and Kidney Disease Disparities in the United States

Racial, ethnic, socioeconomic, age, and sex-related health disparities in kidney disease are prominent in the United States. The Coronavirus Disease 2019 (COVID-19) pandemic has disproportionately affected marginalized populations. Older adults, people experiencing unstable housing, racial and ethnic minorities, and immigrants are potentially at increased risk for infection and severe complications from COVID-19. The direct and societal effects of the pandemic may increase risk of incident kidney disease and lead to worse outcomes for those with kidney disease. The rapid transition to telemedicine potentially limits access to care for older adults, immigrants, and people experiencing unstable housing. The economic impact of the pandemic has had a disproportionate effect on women, minorities, and immigrants, which may limit their ability to manage kidney disease and lead to complications or kidney disease progression. We describe the impact of COVID-19 on marginalized populations and highlight how the pandemic may exacerbate existing disparities in kidney disease.

CKD in China: Evolving Spectrum and Public Health Implications

Diabetes is the leading cause of kidney failure worldwide, whereas glomerulonephritis has been predominant in developing countries such as China. The prevalence of obesity and diabetes has increased dramatically in developing countries, substantially affecting the patterns of chronic kidney disease (CKD) observed in these regions. Using data from the Hospital Quality Monitoring System to evaluate changes in the spectrum of non-dialysis-dependent CKD in China, we have observed an increase in the percentage of patients with CKD due to diabetes, which has exceeded that of CKD due to glomerulonephritis since 2011, as well as an increase in hypertensive nephropathy and, in some regions, obstructive kidney disease (mostly associated with kidney stones). The growth of noncommunicable diseases under profound societal and environmental changes has shifted the spectrum of CKD in China toward patterns similar to those of developed countries, which will have enormous impacts on the Chinese health care system. There is much to be done regarding public health interventions, including the establishment of a national CKD surveillance system, improvement in the management of diabetes and hypertension, and enhancement of the affordability and accessibility of kidney replacement therapy. Reducing the burden of CKD will require joint efforts from government, the medical community (including practitioners other than nephrologists), and the public.

Big data in nephrology: Are we ready for the change?

Chronic kidney disease (CKD) is a major public health issue worldwide. However, the status of kidney health care needs to be strengthened globally and research evidence in nephrology is relatively limited. The unmet needs in nephrology leave ample space for imagination regarding leveraging big data and artificial intelligence (AI). Big data has potential to drive medical innovation, reduce medical costs and improve health care quality. Compared with other specialties such as cardiology, the scopes of utilizing big data in nephrology need to be enhanced. We reviewed the studies on the application of big data in nephrology, such as disease surveillance, risk prediction and clinical decision support systems (CDSS), and proposed several potential directions of utilizing big data and AI. The efforts including building a CKD surveillance system and collaborative network, implementing a real-world cohort in a cost-effective manner, strengthening the application and transformation of AI and CDSS, and stimulating the activeness of medical imaging in nephrology, could be considered. In the era of big data, a nephrologist would be stronger and smarter if he or she could get intelligent assistance from knowledge or big data-driven CDSS.

Using electronic health record data to establish a chronic kidney disease surveillance system in China: protocol for the China Kidney Disease Network (CK-NET)-Yinzhou Study

IntroductionChronic kidney disease (CKD) is an important public health problem worldwide. However, there are few active disease surveillance systems for it. The China Kidney Disease Network (CK-NET) was established as...

Surveillance of CKD epidemiology in the US \u2013 a joint analysis of NHANES and KEEP

Chronic Kidney Disease (CKD), is highly prevalent in the United States. Epidemiological systems for surveillance of CKD rely on data that are based solely on the NHANES survey, which does not include many patients with the most severe and less frequent forms of CKD. We investigated the feasibility of estimating CKD prevalence from the large-scale community disease detection Kidney Early Evaluation and Program (KEEP, n = 127,149). We adopted methodologies from the field of web surveys to address the self-selection bias inherent in KEEP. Primary outcomes studied were CKD Stage 3–5 (estimated glomerular filtration rate [eGFR] <60 mL/min/1.73 m2, and CKD Stage 4-5 (eGFR <30 mL/min/1.73 m2). The unweighted prevalence of Stage 4-5 CKD was higher in KEEP (1.00%, 95%CI: 0.94–1.05%) than in NHANES (0.51%, 95% CI: 0.43–0.59%). Application of a selection model that used variables related to demographics, recruitment and socio-economic factors resulted in estimates similar to NHANES (0.55%, 95% CI: 0.50–0.60%). Weighted prevalence of Stages 3–5 CKD in KEEP was 6.45% (95% CI: 5.70–7.28%) compared to 6.73% (95% CI: 6.30–7.19%) for NHANES. Application of methodologies that address the self-selection bias in the KEEP program may allow the use of this large, geographically diverse dataset for CKD surveillance.

Long-term trends in the prevalence of chronic kidney disease and the influence of cardiovascular risk factors in Norway

Surveillance of chronic kidney disease (CKD) prevalence over time and information on how changing risk factors influence this trend are needed to evaluate the effects of general practice and public health interventions. Because very few studies addressed this, we studied the total adult population of a demographically stable county representative of Norway using cross-sectional studies 10 years apart (Nord-Trøndelag Health Study (HUNT)2 and Nord-Trøndelag Health Study (HUNT)3, 65,237 and 50,586 participants, respectively). Thorough quality-control procedures and comparisons of methods over time excluded analytical drift, and multiple imputations of missing data combined with nonattendance weights contributed to unbiased estimates. CKD prevalence remained stable in Norway from 1995 through 1997 (11.3%) to 2006 through 2008 (11.1%). The association of survey period with CKD prevalence was modified by a strong decrease in blood pressure, more physical activity, and lower cholesterol levels. Without these improvements, a 2.8, 0.7, and 0.6 percentage points higher CKD prevalence could have been expected, respectively. In contrast, the prevalence of diabetes and obesity increased moderately, but the proportion of diabetic patients with CKD decreased significantly (from 33.4% to 28.6%). A CKD prevalence of 1 percentage point lower would have been expected without these changes. Thus, CKD prevalence remained stable in Norway for more than a decade in association with marked improvements in blood pressure, lipid levels, and physical activity and despite modest increases in diabetes and obesity.

Risk prediction to inform surveillance of chronic kidney disease in the US Healthcare Safety Net: a cohort study.

BackgroundThe capacity of electronic health record (EHR) data to guide targeted surveillance in chronic kidney disease (CKD) is unclear. We sought to leverage EHR data for predicting risk of progressing from CKD to end-stage renal disease (ESRD) to help inform surveillance of CKD among vulnerable patients from the healthcare safety-net.MethodsWe conducted a retrospective cohort study of adults (n = 28,779) with CKD who received care within 2 regional safety-net health systems during 1996–2009 in the Western United States. The primary outcomes were progression to ESRD and death as ascertained by linkage with United States Renal Data System and Social Security Administration Death Master files, respectively, through September 29, 2011. We evaluated the performance of 3 models which included demographic, comorbidity and laboratory data to predict progression of CKD to ESRD in conditions commonly targeted for disease management (hypertension, diabetes, chronic viral diseases and severe CKD) using traditional discriminatory criteria (AUC) and recent criteria intended to guide population health management strategies.ResultsOverall, 1730 persons progressed to end-stage renal disease and 7628 died during median follow-up of 6.6 years. Performance of risk models incorporating common EHR variables was highest in hypertension, intermediate in diabetes and chronic viral diseases, and lowest in severe CKD. Surveillance of persons who were in the highest quintile of ESRD risk yielded 83–94 %, 74–95 %, and 75–82 % of cases who progressed to ESRD among patients with hypertension, diabetes and chronic viral diseases, respectively. Similar surveillance yielded 42–71 % of ESRD cases among those with severe CKD. Discrimination in all conditions was universally high (AUC ≥0.80) when evaluated using traditional criteria.ConclusionsRecently proposed discriminatory criteria account for varying risk distribution and when applied to common clinical conditions may help to inform surveillance of CKD in diverse populations.Electronic supplementary materialThe online version of this article (doi:10.1186/s12882-016-0272-0) contains supplementary material, which is available to authorized users.

Chronic kidney disease in the Top End of the Northern Territory of Australia, 2002-2011: a retrospective cohort study using existing laboratory data.

BackgroundThe Northern Territory of Australia has a very high incidence of treated end-stage kidney disease (ESKD), largely confined to Indigenous Australians living in remote, under-resourced areas. Surveillance of chronic kidney disease (CKD) is still in its infancy in Australia. We estimate the prevalence and rate of progression of measured CKD across a region using inexpensive readily available laboratory information.MethodsUsing a retrospective de-identified extraction of all records with a serum creatinine or urinary albumin-to-creatinine ratio from the single largest ambulatory pathology provider to the Top End of the Northern Territory of Australia between 1st February 2002 and 31st December 2011, the yearly total and age-specific prevalence of measured microalbuminuria, overt albuminuria and estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m2, and the prevalence of progressive CKD, were calculated.ResultsThere was a steady increase in the proportion tested across all health districts in the region, more prominent in non-urban districts. In 2009, the regional adult prevalence of measured microalbuminuria and overt albuminuria was as high as 8.1 %, overt albuminuria alone up to 3.0 % and eGFR < 60 up to 2.3 %. Rates of progressive disease were extremely high, particularly for those with albuminuria (53.1–100 % for those with urinary albumin-creatinine ratio > 300 mg/mmol).ConclusionsThe rates of testing, particularly in districts of high measured prevalence of markers of CKD, are encouraging. However, extremely high rates of progressive CKD are troubling. Further describing the outcomes of CKD in this population would require analysis of linked datasets.Electronic supplementary materialThe online version of this article (doi:10.1186/s12882-015-0166-6) contains supplementary material, which is available to authorized users.

Prevalence and variation of Chronic Kidney Disease in the Irish health system: initial findings from the National Kidney Disease Surveillance Programme.

BackgroundChronic Kidney Disease (CKD) is a major non-communicable chronic disease that is associated with adverse clinical and economic outcomes. Passive surveillance systems are likely to improve efforts for prevention of chronic kidney disease (CKD) and inform national service planning. This study was conducted to determine the overall prevalence of CKD in the Irish health system, assess period trends and explore patterns of variation as part of a novel surveillance initiative.MethodsWe identified 207, 336 adult patients, age 18 and over, with serum creatinine measurements recorded from a provincial database between 2005-2011 in the Northwest of Ireland. Estimated glomerular filtration rates (eGFR) were determined using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation from standardized creatinine measurements and the presence of CKD was defined as eGFR <60 ml/min per 1.73 m2. Age and sex-specific prevalence estimates were determined for each group while generalized estimating equations (GEE) and multivariable logistic regression were used to explore associations using adjusted odds ratios (AOR) and 95% confidence intervals (95% CI).ResultsThe prevalence of CKD in the health system was 11.8% (95% CI 11.8-12.1); 10.9% in men (10.7-11.1) and 12.6% in women (12.4-12.8). This corresponded to a detection rate of 4.5% (5.1% in women and 3.9% in men). The prevalence of CKD was significantly higher in women than in men (12.6% versus 10.9%, P < 0.001), older age groups, and among patients with a history of Acute Kidney Injury (AKI) than without (45.2% versus 10.7%, P < 0.0001). Multivariable analysis identified advancing age, female gender, location of medical supervision, county of residence, and AKI as significant determinants of prevalence.ConclusionThe prevalence of CKD in the Irish health system is 11.8% corresponding to a detection rate of 4.5% in the general population. Demographic, geographic factors and acute kidney injury episodes are important determinants of disease burden. Passive surveillance of CKD is both feasible and desirable within the Irish health system, and offers huge opportunities for targeted prevention programmes and improved clinical outcomes.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2369-15-185) contains supplementary material, which is available to authorized users.

CKD.QLD: chronic kidney disease surveillance and research in Queensland, Australia.

BackgroundChronic kidney disease (CKD) is recognized as a major public health problem in Australia with significant mortality, morbidity and economic burden. However, there is no comprehensive surveillance programme to collect, collate and analyse data on CKD in a systematic way.MethodsWe describe an initiative called CKD Queensland (CKD.QLD), which was established in 2009 to address this deficiency, and outline the processes and progress made to date. The foundation is a CKD Registry of all CKD patients attending public health renal services in Queensland, and patient recruitment and data capture have started.ResultsWe have established through early work of CKD.QLD that there are over 11 500 CKD patients attending public renal services in Queensland, and these are the target population for our registry. Progress so far includes conducting two CKD clinic site surveys, consenting over 3000 patients into the registry and initiation of baseline data analysis of the first 600 patients enrolled at the Royal Brisbane and Women's Hospital (RBWH) site. In addition, research studies in dietary intake and CKD outcomes and in models of care in CKD patient management are underway.ConclusionsThrough the CKD Registry, we will define the distribution of CKD patients referred to renal practices in the public system in Queensland by region, remoteness, age, gender, ethnicity and socioeconomic status. We will define the clinical characteristics of those patients, and the CKD associations, stages, co-morbidities and current management. We will follow the course and outcomes in individuals over time, as well as group trends over time. Through our activities and outcomes, we are aiming to provide a nidus for other states in Australia to join in a national CKD registry and network.

Chronic Kidney Disease Surveillance for the United States: A U.S. Centers for Disease Control and Prevention Initative

Chronic Kidney Disease Surveillance for the United States: A U.S. Centers for Disease Control and Prevention Initative

Validating a case definition for chronic kidney disease using administrative data

Administrative data are commonly used for surveillance of chronic medical conditions. The purpose of this study was to determine the validity of an algorithm derived from administrative data for identifying chronic kidney disease (CKD) compared to the reference standard of estimated glomerular filtration rate (eGFR). We identified adults from the province of Alberta with at least two outpatient serum creatinine measurements within a 1-year time period. Validity indices were estimated for CKD using up to 3 years of administrative data (physician billing claims and hospital discharge abstracts) for various case-definition combinations. For each algorithm, the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated against two reference standard definitions of CKD (two eGFR measurements <60 mL/min/1.73m(2) or mean eGFR < 30 mL/min/1.73m(2)). A total of 321 293 eligible subjects were identified. Irrespective of the algorithm, sensitivities for defining CKD (eGFR < 60 mL/min/1.73m(2)) using administrative codes were low. A case-definition algorithm employing two physician claims or one hospitalization within a 2-year period had sensitivity of 19.4%, specificity of 97.2%, PPV of 60.1% and NPV of 84.8% for detecting CKD. Estimates of sensitivity were higher when <30 mL/min/1.73m(2) was used as the reference standard, although PPVs were lower and consistently less than 50%. These results, using eGFR as a reference standard, suggest that administrative data have insufficient sensitivity and PPV for CKD surveillance, although they may be useful when highly specific algorithms are required for research purposes.

121 Chronic Kidney Disease Surveillance for the United States: A Centers for Disease Control and Prevention Initiative

Chronic Kidney Disease Surveillance for the United States: A Centers for Disease Control and Prevention Initiative Elizabeth Hedgeman, Laura Plantinga, Nilka Rios Burrows, Jerry Yee, Neil Powe, Desmond Williams and Rajiv Saran for the CDC CKD Surveillance System. University of Michigan, Ann Arbor, MI; University of California, San Francisco, CA; Centers for Disease Control and Prevention, Baltimore, MD; Henry Ford Health System, Detroit, MI. Chronic kidney disease (CKD) affects 10-15% of the population within the US, yet no comprehensive system has thus far existed to track the disease and its outcomes. In 2006, the Centers for Disease Control and Prevention (CDC), as a major part of its CKD Initiative, funded two teams to jointly develop and implement a CKD surveillance system. A Steering Committee and Advisory Group of external stakeholders provided input toward selection of priority measures and key data sources. Data from national and regional data sources have been analyzed and comprehensive written reports submitted to the CDC since 2008. All findings of the CDC CKD Surveillance System will be available at www.cdc.gov/ckd by early 2011. The website covers priority measures under six major topic areas (burden of disease, awareness, risk factors, health consequences, processes and quality of care and healthcare system capacity for CKD) from a variety a data sources selected to represent the population. Figures and tables of specific measures will be updated regularly including relevant stratifications and time trends. The system will evolve to reflect feedback, scientific advances and changing patterns of disease. We believe that the CDC CKD Surveillance System will heighten awareness and provide timely information to regulatory agencies, research and clinical communities, and the general public, thereby providing a solid basis toward stemming the national epidemic of CKD.

Influence of Coronary Risk Factors on Coronary Events in Japanese High-Risk Hypertensive Patients - Primary and Secondary Prevention of Ischemic Heart Disease in a Subanalysis of the Candesartan Antihypertensive Survival Evaluation in Japan (CASE-J) Trial -

The Candesartan Antihypertensive Survival Evaluation in Japan (CASE-J) trial was conducted to compare the effects of candesartan and amlodipine on cardiovascular events in Japanese high-risk hypertensive patients. The aim of the present subanalysis was to evaluate the influence of coronary risk factors on coronary events in these patients as an observational study irrespective of allocated drugs. The adjusted hazard ratios (HRs) of the association of baseline risk factors including gender, age, allocated drugs, body mass index, systolic/diastolic blood pressure (SBP/DBP), diabetes mellitus (DM), hyperlipidemia (HL), smoking, left ventricular hypertrophy, previous ischemic heart disease (IHD), previous cerebrovascular events, and chronic kidney disease (CKD) with coronary events in 4,703 patients who were enrolled in the CASE-J trial, were examined. The coronary events occurred in 83 patients, and were significantly associated with previous IHD, DM, male sex, CKD, and low DBP. Significant predictors were previous IHD (HR, 3.89), DM (HR, 3.10), male sex (HR, 1.81), CKD (HR, 1.60), and low DBP (HR, 1.36), respectively. In 4,107 patients without previous IHD, DM (HR, 4.88), HL (HR, 2.67), and DBP (HR, 1.39) were significantly associated with the risk of coronary events, while male sex (HR, 3.03), CKD (HR, 2.44), and DM (HR, 2.15) were in 596 patients with previous IHD. DM is the important factor in both primary and secondary prevention of coronary events. Comprehensive risk management including surveillance of DM, CKD and HL is needed for preventing coronary events, in addition to blood pressure control.

Development and Validation of an Electronic Health Record–Based Chronic Kidney Disease Registry

Chronic kidney disease (CKD) is increasing, and outcomes-related research from diverse health care settings is needed to target appropriate efforts and interventions. We developed an electronic health record (EHR)-based CKD registry at the Cleveland Clinic and validated comorbid conditions. Patients who had at least one face-to-face outpatient encounter with a Cleveland Clinic health care provider and (1) had two estimated GFR values <60 ml/min per 1.73 m(2) >90 days apart as of January 1, 2005 and/or (2) were patients with International Classification of Diseases-9 (ICD-9) diagnosis codes for kidney disease were included. Our registry includes 57,276 patients (53,399 patients met estimated GFR criteria and 3877 patients met ICD-9 diagnosis code criteria) as of March 2010. Mean age was 69.5 ± 13.4 years, with 55% women and 12% African Americans. Medicare is the primary insurer for more than one half of the study cohort. The κ statistics to assess the extent of agreement between the administrative dataset extracted from the EHR and actual EHR chart review showed substantial agreement (>0.80) for all conditions except for coronary artery disease and hypertension, which had moderate agreement (<0.60). Development of an EHR-based CKD registry is feasible in a large health system, and the comorbid conditions included in the registry are reliable. In addition to conducting research studies, such a registry could help to improve the quality of care delivered to CKD patients and complement the ongoing nationwide efforts to develop a CKD surveillance project.