Traditional Chronic Kidney Disease Risk Factors Research Articles

Metabolically healthy obesity and chronic kidney disease risk: exploring the dynamics.

Obesity represents a prevalent global health concern with significant implications for various diseases, including chronic kidney disease (CKD). Within this landscape, the phenomenon of metabolically healthy obesity has emerged, challenging traditional notions about the health risks associated with excess weight. While traditional CKD risk factors involve obesity, metabolic syndrome, diabetes, and hypertension, the metabolically healthy obese (MHO) subgroup disrupts these assumptions. Our main objective in this study is to integrate existing literature on CKD in MHO individuals. In this endeavor, we delve into the pathophysiological foundations, the transition between obesity phenotypes and their impact on renal health, examine the implications of their metabolic resilience on mortality within a renal context, and explore potential management strategies specifically designed for MHO individuals. Offering a comprehensive overview of the pathophysiology, we cover various factors contributing to the risk of CKD in the metabolically healthy obese setting, including inflammation, cytokines, hemodynamics, and the renin-angiotensin-aldosterone system, gastrointestinal microbiota, diet, exercise, adipose distribution, and lipotoxicity. Through this synthesis, we aim to provide a comprehensive understanding of the risk of CKD in those classified as MHO.

Single-Ancestry versus Multi-Ancestry Polygenic Risk Scores for CKD in Black American Populations.

Chronic kidney disease (CKD) is a risk factor for cardiovascular disease and early death. Recently, polygenic risk scores (PRS) have been developed to quantify risk for CKD. However, African ancestry populations are underrepresented in both CKD genetic studies and PRS development overall. Moreover, European-ancestry derived PRS demonstrate diminished predictive performance in African ancestry populations. This study aimed to develop a PRS for CKD in Black Americans. We obtained score weights from a meta-analysis of genome-wide association studies (GWAS) for estimated glomerular filtration rate (eGFR) in the Million Veteran Program (MVP) and Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study to develop an eGFR PRS. We optimized the PRS risk model in a cohort of Participants from the Hypertension Genetic Epidemiology Network (HyperGEN). Validation was performed in subsets of Black participants of the Trans-Omics in Precision Medicine (TOPMed) Consortium and Genetics of Hypertension Associated Treatment (GenHAT) Study. The prevalence of CKD-defined as stage 3 or higher-was associated with the PRS as a continuous predictor (OR[95% CI]:1.35[1.08,1.68]) and in a threshold-dependent manner. Further, including APOL1 risk status-a putative variant for CKD with higher prevalence among those of sub-Saharan African descent-improved the score's accuracy. PRS associations were robust to sensitivity analyses accounting for traditional CKD risk factors, as well as CKD classification based on prior eGFR equations. Compared with previously published PRS, the predictive performance of our PRS was comparable to a European-ancestry derived PRS for kidney traits. However, both single-ancestry PRS were less predictive than multi-ancestry derived PRS. In this study, we developed a PRS that was significantly associated with CKD with improved predictive accuracy when including APOL1 risk status. However, PRS generated from multi-ancestry populations outperformed single-ancestry PRS in our study.

Ambient Air Pollution and Chronic kidney disease risk in Deltan communities: A Policy Brief, 2023

Chronic kidney disease (CKD) is a persistent, devastating, yet neglected, non-communicable disease in developing and emerging countries. National, regional, and international agencies’ communications and reports on non-communicable diseases intentionally or non-intentionally do not feature CKD. The traditional risk factors for CKD, such as hypertension and diabetes, which have received relatively ample attention, do not sufficiently explain the high burden of CKD in these countries. Ambient air pollution is an emerging significant environmental risk factor for CKD; however, epidemiological data and evidence are lacking for susceptible populations in developing countries. The Niger Delta region of Nigeria is a petrochemical hub known for environmental degradation, including air pollution, and thus, serves as a good case study for investigating the association between air pollution and CKD. This brief is based on the results of a mixed-methods study conducted in four communities situated near an oil and gas refinery in Warri, Nigeria. Air pollutant concentrations measured in partnership with citizen scientists showed that all except one air pollutant (ozone) exceeded the WHO acceptable limits in all four communities. The overall prevalence of CKD was high (12.3%) but even higher (18%) in a socially deprived semi-urban community closest to the oil refinery. Hypertension, diabetes, other behavioral risk factors, and exposures associated with CKD were prevalent among the inhabitants of the four communities. However, public environmental health information and education are lacking. A multifaceted approach is required to mitigate air pollution and the associated health risks in the state. Public inclusion is strongly recommended for the planning and implementation of future interventions. Kidney disease prevention and treatment should be emphasized in health policies and insurance schemes.

Chronic Kidney Disease of Unknown Etiology: A Single-center Cross-sectional Study.

Globally, chronic kidney disease of unknown etiology (CKDu) has been recognized as an emerging cause contributing to the rise in chronic kidney disease (CKD). Nevertheless, in the Kingdom of Saudi Arabia, the epidemiology of CKDu remains understudied. The aim of this study was to assess the epidemiological, clinical, and laboratory characteristics of the CKDu population. From May 2021 to May 2022, a retrospective cross-sectional study was conducted on patients with Stage 4-5 CKD who presented to King Fahd Hospital in Jeddah. On the basis of the cause of CKD, patients were categorized into two groups: those with traditional risk factors for CKD (CKDt) and those without a recognizable cause of CKD (CKDu). Out of a total of 500 patients with Stage 4-5 CKD who were enrolled in the study, 100 patients were found to have CKDu. Compared with the 400 patients with CKDt, the patients in the CKDu group were younger (a mean age of 52.3 years vs. 66.1 years, P <0.001), with the majority in the middle age group of 40-65 years old (68% vs. 43%, P <0.001). They were predominantly males (72% vs. 56%, P = 0.003), with less hyperkalemia (4.29 vs. 5.13, P <0.043), and presented without a previous history of CKD (57% vs. 31%, P = 0.001). Among the 500 patients who were studied, 100 patients (20%) presented with CKDu who were predominantly younger males without a known history of CKD. Further studies on a nationwide scale are warranted.

Is exposure to hydrocarbons associated with chronic kidney disease in young Nigerians? A case-control study.

Although environmental exposure to hydrocarbons has been linked to non-communicable diseases, its association with chronic kidney disease (CKD) is still an emerging area. Epidemiological studies associating CKD with prolonged exposure to hydrocarbons have mostly focused on occupational exposure, with fewer studies on environmental exposure from residing in contaminated areas. The aim of this study was to determine any association between long-term exposure to petrochemical products and the risk of CKD by comparing the residence and occupational history of young patients with CKD and non-CKD controls. A case-control study of 74 cases and 74 age- and sex-matched non-CKD controls was carried out. Cases were patients with CKD who were aged 18-44 years and diagnosed with suspected chronic glomerulonephritis (CGN). Patients were recruited from an outpatient nephrology clinic and medical wards. Patients with CKD from traditional causes were excluded. Data were collected using a pre-tested structured questionnaire adapted from the WHO STEPwise approach to the non-communicable disease risk factor surveillance (STEPS) instrument. To assess exposure, a detailed work history and all residential addresses where the patients have lived for at least 5 years were recorded. 'Exposed' status was regarded as long-term residence in a known oil-polluted area and jobs involving crude oil exploration, processing, transportation and sales, and cleanup of crude oil hazards. Absence of a history of chronic exposure or any form of exposure was regarded as 'less exposed'. There were 52 (70.3%) cases categorized as exposed, compared with 21 (28.4%) controls (p<0.001). There were 34 (45.9%) cases born near petrochemical refineries and plants, compared with 11 (14.9%) controls (p≤0.001). There were 34 (45.9%) cases residing near petrochemical refineries and plants, compared with 8 (10.9%) controls (p≤0.001). When asked 'Do you think you have been significantly exposed to crude oil?', 15 (20.3%) cases and 2 (2.7%) controls answered 'yes' (p≤0.001). Our findings suggest an association between exposure to petrochemicals and CKD in young Nigerians diagnosed with suspected CGN. Exposure is significantly associated with a higher mean age, waist circumference, and blood sugar levels; however, other traditional risk factors for CKD were not considerably more prevalent in this unique patient population. These findings should prompt more emphasis on occupational history, residential history, and other relevant environmental exposures in the assessment of patients at risk for CKD.

Relationships Between Metabolic Body Composition Status and Rapid Kidney Function Decline in a Community-Based Population: A Prospective Observational Study.

Obesity and metabolic syndrome are strong risk factors for incident chronic kidney disease (CKD). However, the predictive accuracy of metabolic body composition status (MBCS), which combines the status of obesity and metabolic syndrome, for rapid kidney function decline (RKFD) is unclear. The aim of this study was to investigate the relationship between MBCS and RKFD in a healthy population in a prospective community-based cohort study. In the current study, we followed changes in renal function in 731 people residing in northern Taiwan for 5 years. The participants were divided into four groups according to their MBCS, including metabolically healthy normal weight (MHNW), metabolically healthy overweight (MHOW), metabolically unhealthy normal weight (MUNW), and metabolically unhealthy overweight (MUOW). We evaluated traditional risk factors for CKD and metabolic profiles. The primary outcome was RKFD, which was defined as a 15% decline in estimated glomerular filtration rate (eGFR) within the first 4 years, and a reduction in eGFR which did not improve in the 5th year. During the study period, a total of 731 participants were enrolled. The incidence of RKFD was 17.1% (125/731). Multiple Cox logistic regression hazard analysis revealed that age, cerebrovascular accident, eGFR, urine albumin-to-creatinine ratio, use of painkillers, depressive mood, MUNW and MUOW were independent predictors of RKFD. After adjusting for age, sex, eGFR and total cholesterol, the participants with MUNW and MUOW had higher hazard ratios (HRs) for RKFD [HR: 2.19, 95% confidence interval (CI): 1.22–3.95 for MUNW; HR: 1.86, 95% CI: 1.21–2.87 for MUOW] than those with MHNW. Similar results were also observed in subgroup analysis of those aged above 65 years. On the basis of the results of this study, we conclude that MBCS was independently associated with RKFD, especially in the older adults. On the basis of our results, we suggest that MUNW and MUOW should be considered as risk factors for RKFD.

Incidence of and risk factors of chronic kidney disease: results of a nationwide study in Iceland.

ABSTRACTBackgroundInformation on the incidence of chronic kidney disease (CKD) in the general population is scarce. This study examined the incidence and risk factors of CKD stages 1–5 in Iceland, based on multiple markers of kidney damage.MethodsAll serum creatinine (SCr) values, urine protein measurements and diagnosis codes for kidney diseases and comorbid conditions for people aged ≥18 years were obtained from electronic medical records of all healthcare institutions in Iceland in 2008–2016. CKD was defined according to the Kidney Disease: Improving Global Outcomes (KDIGO) criteria as evidence for kidney damage and/or estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2 for >3 months. Alternatively, CKD was defined using age-adapted eGFR thresholds. Mean annual age-standardized incidence of CKD was calculated for persons without CKD at study entry. Risk factor assessment was based on International Classification of Diseases diagnosis codes. Incidence was reported per 100 000 population.ResultsWe retrieved 1 820 990 SCr values for 206 727 persons. Median age was 45 years (range, 18–106) and 47% were men. Mean annual age-standardized incidence of CKD per 100 000 was 649 in men and 694 in women, and 480 in men and 522 in women using age-adapted eGFR thresholds. The incidence reached over 3000 in men and women aged >75 years. Traditional CKD risk factors, such as acute kidney injury, diabetes, hypertension and cardiovascular disease, as well as less well characterized risk factors, including chronic lung disease, malignancy and major psychiatric illness were associated with increased risk of CKD, and the same was true for obesity and sleep apnoea in women.ConclusionThe annual incidence of CKD, with strict adherence to the KDIGO criteria, was <0.7% but markedly lower using age-adapted eGFR thresholds. Apart from acute kidney injury, the observed risk factors comprised chronic and potentially modifiable disorders.

È possibile una gestione “ideale” della pandemia da malattia renale cronica?

Chronic Kidney Disease (CKD) is recognized as one of the major categories of noncommunicable epidemic diseases and in the last decades it has been largely growing in incidence and prevalence all over the world. Ideal management of CKD pandemic should be comprehensive of measures of tertiary, secondary, primary and primordial prevention. So, it should include prompt diagnosis and treatment of traditional and non-traditional risk factors for CKD, optimal conservative treatment for non-dialysis dependent CKD patients and appropriated dialysis therapy or renal transplantation for patients with end-stage renal disease. However, these goals are not easy to obtain on a global scale. It would be possible only by a broad and holistic approach, ranging from good governance to achievement of the sustainable development goals (SDGs).

Associations of CKD risk factors and longitudinal changes in urine biomarkers of kidney tubules among women living with HIV

BackgroundNovel urine biomarkers have enabled the characterization of kidney tubular dysfunction and injury among persons living with HIV, a population at an increased risk of kidney disease. Even though several urine biomarkers predict progressive kidney function decline, antiretroviral toxicity, and mortality in the setting of HIV infection, the relationships among the risk factors for chronic kidney disease (CKD) and urine biomarkers are unclear.MethodsWe assessed traditional and infection-related CKD risk factors and measured 14 urine biomarkers at baseline and at follow-up among women living with HIV in the Women’s Interagency Health Study (WIHS). We then used simultaneously adjusted multivariable linear regression models to evaluate the associations of CKD risk factors with longitudinal changes in biomarker levels.ResultsOf the 647 women living with HIV in this analysis, the majority (67%) were Black, the median age was 45 years and median follow-up time was 2.5 years. Each traditional and infection-related CKD risk factor was associated with a unique set of changes in urine biomarkers. For example, baseline hemoglobin a1c was associated with worse tubular injury (higher interleukin [IL]-18), proximal tubular reabsorptive dysfunction (higher α1-microglobulin), tubular reserve (lower uromodulin) and immune response to injury (higher chitinase-3-like protein-1 [YKL-40]). Furthermore, increasing hemoglobin a1c at follow-up was associated with further worsening of tubular injury (higher kidney injury molecule-1 [KIM-1] and IL-18), as well as higher YKL-40. HCV co-infection was associated with worsening proximal tubular reabsorptive dysfunction (higher β2-microglobulin [β2m]), and higher YKL-40, whereas HIV viremia was associated with worsening markers of tubular and glomerular injury (higher KIM-1 and albuminuria, respectively).ConclusionsCKD risk factors are associated with unique patterns of biomarker changes among women living with HIV, suggesting that serial measurements of multiple biomarkers may help in detecting and monitoring kidney disease in this setting.

Plasma Soluble Urokinase Plasminogen Activator Receptor (suPAR) and CKD Progression in Children

Soluble urokinase plasminogen activator receptor (suPAR) is a novel biomarker associated with incident chronic kidney disease (CKD) and has been identified as an independent risk factor for CKD progression in children, although these findings remain preliminary, limited to a single point in time, and unreplicated in pediatric cohorts. Prospective longitudinal cohort study. 565 participants aged 1 to 16 years enrolled in the Chronic Kidney Disease in Children (CKiD) Study. Plasma suPAR levels, categorized by quartiles, measured at study entry and a 6-month follow-up interval. CKD progression, defined as the initiation of kidney replacement therapy (dialysis or transplantation) or >50% decline in estimated glomerular filtrate rate (eGFR). Associations between plasma suPAR quartiles and risk for CKD progression were estimated using lognormal survival models, adjusting for potential confounders. Participants in the highest suPAR quartile experienced 54% faster progression compared with the lowest quartile after adjustment for demographic and traditional CKD risk factors (P< 0.001). Addition of eGFR to the model attenuated the risk, although those in the highest quartile experienced 33% faster progression compared with the lowest quartile (P= 0.008). Plasma suPAR levels showed little change over 6 months. Potential for residual confounding, reliance on observational data, relatively fewer patients with higher eGFRs for subgroup analysis. Higher suPAR levels are associated with shorter time to kidney replacement therapy or halving of eGFR in children with CKD. This association is attenuated slightly with inclusion of eGFR in regression modeling but remains a significant association for participants with the highest suPAR levels.

Association between prediabetes (defined by HbA1C, fasting plasma glucose, and impaired glucose tolerance) and the development of chronic kidney disease: a 9-year prospective cohort study

BackgroundThe aim of the present study was to investigate the clinical impact of prediabetes on the development of incident chronic kidney disease (CKD) in a Korean adult population, using data from the Korea Genome and Epidemiology Study.MethodsThis prospective cohort study included 7728 Korean adults without baseline CKD and type 2 diabetes. Prediabetes was defined by impaired fasting glucose (IFG), impaired glucose tolerance (IGT), and HbA1C level. CKD was defined as estimated glomerular filtration rate < 60 mL/min/1.73 m2. We assessed the predictive value of prediabetes for the incidence of CKD, and investigated the incidence of cardiovascular disease including coronary artery disease and stroke.ResultsOver a median follow-up period of 8.7 years, 871 of 7728 (11.3%) subjects developed incident CKD. Patients with prediabetes, as defined by IGT or HbA1C, developed incident CKD more frequently than the non-prediabetic group did. The risk of CKD development at follow-up was analyzed according to different prediabetes definitions. Compared with the non-prediabetic group, the IGT- (Hazard ratio [HR] = 1.135, 95% confidence interval [CI] = 1.182–1.310, P = 0.043) and HbA1C-defined prediabetic groups (HR = 1.391, 95% CI = 1.213–1.595, P < 0.001) were significantly associated with incident CKD after adjusting for traditional CKD risk factors; however, IFG was not associated with incident CKD.ConclusionIGT- or HbA1C-defined prediabetes is an independent predictor of incident CKD. The measurement of these parameters might enable early detection of CKD risk, allowing physicians to initiate preventive measures and improve patient outcomes.

Impact of Gut Dysbiosis on Neurohormonal Pathways in Chronic Kidney Disease.

Chronic kidney disease (CKD) is a worldwide major health problem. Traditional risk factors for CKD are hypertension, obesity, and diabetes mellitus. Recent studies have identified gut dysbiosis as a novel risk factor for the progression CKD and its complications. Dysbiosis can worsen systemic inflammation, which plays an important role in the progression of CKD and its complications such as cardiovascular diseases. In this review, we discuss the beneficial effects of the normal gut microbiota, and then elaborate on how alterations in the biochemical environment of the gastrointestinal tract in CKD can affect gut microbiota. External factors such as dietary restrictions, medications, and dialysis further promote dysbiosis. We discuss the impact of an altered gut microbiota on neuroendocrine pathways such as the hypothalamus–pituitary–adrenal axis, the production of neurotransmitters and neuroactive compounds, tryptophan metabolism, and the cholinergic anti-inflammatory pathway. Finally, therapeutic strategies including diet modification, intestinal alpha-glucosidase inhibitors, prebiotics, probiotics and synbiotics are reviewed.

Chronic kidney disease progression in kidney transplant recipients: A focus on traditional risk factors.

Kidney transplant recipients are a subset of patients with chronic kidney disease (CKD) that remain at high risk for progression to dialysis and mortality. Recent advances in immunosuppression have only partially improved long-term graft and patient survival. Discovery of new immunosuppressive regimens is a slow and resource-intensive process. Hence, recognition and management of modifiable allogeneic and non-allogeneic risk factors for progression to CKD among kidney transplant recipients is of major interest for improving long-term outcomes. Graft survival is mainly determined by the quality of the allograft and by the patient's alloimmune response, which is influenced by human leukocyte antigen matching and the presence of donor-specific antibodies. Alloimmune responses manifest as acute and chronic forms of cell- and antibody-mediated rejection, which can be worsened by patient non-adherence or under-immunosuppression. However, donor and patient ages, glomerular disease recurrence, time on dialysis, pre-existing cardiovascular burden, medication side-effects and traditional risk factors, such as hypertension, proteinuria, anaemia, dyslipidaemia, diabetes and bone mineral disorder, which can ultimately lead to severe endothelial derangement, also contribute to graft loss and mortality. These traditional risk factors, common to pre-dialysis patients, often are considered of secondary importance when compared to alloimmunity and immunosuppression concerns. In this review article, we focus on the epidemiological, pathophysiological and therapeutic features of non-allogeneic traditional risk factors for CKD. We also discuss the benefit of adopting a multidisciplinary approach to pursue the same therapeutic targets recommended for pre-dialysis patients.

Upper Normal Serum Creatinine Concentrations as a Predictor for Chronic Kidney Disease: Analysis of 14 Years' Korean Genome and Epidemiology Study (KoGES).

Both serum creatinine (sCr) and estimated glomerular filtration rate (eGFR) have been used to assess kidney function in public health check-ups. However, when the sCr is within the normal levels but the eGFR is <60 mL/min/1.73 m2, a dilemma arises, as the patients might progress to chronic kidney disease (CKD) after several years. We aimed to evaluate the association between normal sCr and the risk of incident CKD in the general population. For this, 9445 subjects from the Korean Genome and Epidemiology Study, with normal sCr and eGFR of >60 mL/min/1.73 m2 were analyzed. The subjects were classified into quartiles based on sCr levels. The primary outcome was the development of eGFR <60 mL/min/1.73 m2 on two consecutive measures. During a mean follow-up of 8.4 ± 4.3 years, 779 (8.2%) subjects developed eGFR <60 mL/min/1.73 m2. The incidence of the development of eGFR <60 mL/min/1.73 m2 was higher in the higher quartiles than in the lowest quartile. In multivariable Cox analysis, the highest quartile was associated with an increased risk for the development of eGFR <60 mL/min/1.73 m2 (hazard ratio (HR), 4.71; 95% confidence interval (CI), 3.29–6.74 in females; HR, 12.77; 95% CI, 7.69–21.23 in males). In the receiver operating characteristic curve analysis, adding sCr to the traditional risk factors for CKD improved the accuracy of predicting the development of eGFR <60 mL/min/1.73 m2 (area under the curve, 0.83 vs. 0.80 in females and 0.85 vs. 0.78 in males), and the cutoff value of sCr was 0.75 mg/dL and 0.78 mg/dL in females and males. Cautious interpretation is necessary when sCr is within the normal range, considering that the upper normal range of sCr has a higher risk of CKD development.

Clinical markers to predict progression from acute to chronic kidney disease in Mesoamerican nephropathy

An epidemic of chronic kidney disease (CKD) of unknown etiology, known as Mesoamerican Nephropathy (MeN), has been ongoing in Latin America for at least two decades. MeN primarily affects young adults without traditional CKD risk factors, and agricultural workers are disproportionately afflicted. We previously identified an acute phase of MeN that involves acute kidney injury (AKI) with tubulointerstitial nephritis and systemic inflammation. Because clinical disease progression in MeN is not yet understood, we sought to determine clinical predictors for progression from acute MeN to CKD. Through ongoing surveillance in Nicaragua, local physicians reported cases of acute MeN and CKD among agricultural workers. We analyzed clinical data collected during the acute MeN encounter to identify factors associated with progression to CKD. From February 2015 to May 2017, 586 agricultural workers (median age 27.8 years, 90% male) presented with acute MeN. The majority had a normal baseline creatinine, and leukocyturia (98.8%) and peripheral leukocytosis (80.7%) were common. Ultimately, 49 (8.4%) progressed to CKD, the majority of those within 6 months. CKD was attributed to MeN in all cases, and none had diabetes or hypertension. The strongest predictors of CKD progression were anemia and paresthesias at presentation, while leukocytosis was associated with renal recovery. Clinical markers of acute MeN may help clinicians identify patients at high risk for rapid progression to CKD, which in turn can inform early clinical management. Future studies should seek to determine the underlying etiology of disease and identify optimal interventions to interrupt the pathophysiologic process of MeN.

Management of Renal Disease: utility of a joint HIV-renal clinic

Although there has been a decrease in the incidence of HIV-associated nephropathy, the incidence of chronic kidney disease (CKD) is increasing in patients attending HIV clinics. Traditional risk factors for CKD, including diabetes, hypertension and coinfection with hepatitis C virus, are overrepresented in this population, making it difficult to distinguish the contribution of HIV infection 1. HIV-infected patients are at risk of renal dysfunction caused by HIV and by antiretroviral treatment (ART) toxicity. In particular, tenofovir disoproxil fumarate (TDF) has been associated with proximal renal tubular dysfunction 2. In 2014 locally in Brighton we had a cohort of 2150 HIV-infected patients, 90% of whom were on ART with 910 of 1935 (47.0%) on regimens including TDF. In addition to using a written protocol for monitoring renal function in patients on antiretrovirals (ARVs) and a standardized operating policy for investigation of abnormal blood tests and urinalysis, we run a ‘one-stop shop’ HIV-renal specialist clinic with an HIV physician and renal physician working together seeing referrals from the general HIV clinic. This study aimed to investigate the utility of this clinic and to describe renal disease in this cohort. We reviewed all patient records of patients seen in a specialist HIV-renal clinic between 2012 and 2014. Demographics, HIV history, number of visits, the indication for referral and outcome information were collected using a standardized proforma. Sixty-five patients, with a median age of 51 years (28–88 years) and a median duration of HIV infection of 163 months (20–335 months), were seen. Forty-two were taking TDF for a mean of 55.8 months (9–122 months). A total of 42 of 65 patients were reviewed once with a median number of visits of 1 (1–4). There were 98 appointments, 54 of which were virtual. The did-not-attend (DNA) rate was 11.4%. Referred patients were categorized as having: proteinuria on TDF (38 of 65 patients; 59%), proteinuria not on TDF (12 of 65 patients; 18%) and raised creatinine without proteinuria (15 of 65 patients; 23%). Of the 38 patients on TDF with proteinuria, five (13.2%) had TDF toxicity diagnosed and TDF was discontinued immediately, and 27 continued with close monitoring with a further seven subsequently discontinuing; the total number discontinuing was 12 of 38 (32%). Addition or up-titration of medications for poorly controlled hypertension was the commonest intervention overall in the joint HIV-renal clinic (23 of 65 patients; 35.4%), in particular in the non-TDF proteinuria group (eight of 12 patients; 66.7%). Renal calculi were a frequent contributor to renal dysfunction and four of 65 patients (6%) had a new glomerular diagnosis after undergoing renal biopsy [two had focal segmental glomerulosclerosis, one had immunoglobulin A (IgA) nephropathy and one had glomerulonephritis with granulomata]. In four patients (6%), the creatinine rise was attributed to nonsteroidal anti-inflammatory drug (NSAID), creatine or protein supplement usage. TDF toxicity was the commonest reason for referral but only a minority of referred patients (13.2%) needed to discontinue immediately. Optimizing blood pressure control was the most frequent outcome, suggesting that this is an underappreciated priority among HIV physicians.

Kidney Disease in Women is Associated with Disadvantaged Childhood Socioeconomic Position

Background: Socioeconomic position (SEP) is an important determinant of health and it is dynamic across the entire lifespan. We sought to investigate the relationship between life-course SEP and chronic kidney disease (CKD) using 3 conceptual models: critical period, pathway and accumulation. Methods: Cross-sectional analysis of 4,996 participants from The Irish Longitudinal Study on Ageing, a nationally representative cohort of community-dwelling adults aged ≥50 years. We defined childhood and adulthood SEP according to father’s and respondent’s occupation respectively. SEP was categorised as high (reference), intermediate, low and never worked. CKD was defined as a glomerular filtration rate < 60 mL/min/1.73 m² estimated from the combination of creatinine and cystatin C. We used logistic regression to estimate the age-adjusted association between SEP and CKD separately in men and women. Results: Low childhood SEP was strongly associated with CKD in women, after adjusting for adulthood SEP (OR 1.90 [95% CI 1.24–2.92]), supporting the critical period hypothesis. This association was not explained by traditional CKD risk factors. Women who experienced low childhood SEP and whose circumstances improved in adulthood also had increased odds of CKD, further supporting a critical period effect in childhood. There was comparatively less evidence in support of the pathway or accumulation models. We did not observe a statistically significant association between SEP and CKD in men. Conclusions: Our findings suggest that women exposed to disadvantaged SEP in childhood represent an at-risk group in whom there may be opportunities for identification of CKD and facilitation of health-promoting behaviours from an early age.

Higher Prevalence and Faster Progression of Chronic Kidney Disease in Human Immunodeficiency Virus-Infected Middle-Aged Individuals Compared With Human Immunodeficiency Virus-Uninfected Controls.

Human immunodeficiency virus (HIV)-infected individuals are at increased risk of chronic kidney disease (CKD). Human immunodeficiency virus infection, traditional CKD risk factors, and combination antiretroviral therapy (cART) may all contribute. We compared prevalence of renal impairment (estimated glomerular filtration rate [eGFR] <60 mL/min/1.73m2), albuminuria (albumin/creatinine ratio ≥3 mg/mmol), and proximal renal tubular dysfunction (retinol-binding protein/creatinine ratio >2.93μg/mmol and/or fractional phosphate excretion >20% with plasma phosphate <0.8 mmol/L) in 596 HIV-infected and 544 HIV-uninfected AGEhIV Cohort Study participants. We also assessed whether being HIV-infected on cART, with follow-up censored when cART regimen was modified, was associated with greater eGFR decline or worsening albuminuria (increase ≥10%/year with change in albuminuria category). Human immunodeficiency virus infection was independently associated with renal impairment (adjusted odds ratio [aOR] = 2.1; 95% confidence interval [CI] = 1.0-4.4), albuminuria (aOR = 5.8; 95% CI = 3.7-9.0), and proximal renal tubular dysfunction (aOR = 7.0; 95% CI = 4.9-10.2]). Among 377 HIV-infected and 479 HIV-uninfected individuals (median follow-up = 3.9/4.1 years, respectively) included in longitudinal analyses, being HIV-infected and remaining on unmodified cART was independently associated with greater eGFR decline (-0.56; 95% CI = -0.87 to -0.24 mL/min/1.73m2/year) and worsening albuminuria (aOR = 2.3; 95% CI = 1.3-4.0). In these middle-aged individuals, HIV infection was independently associated with renal impairment, albuminuria, and proximal renal tubular dysfunction. Human immunodeficiency virus-infected individuals on cART (predominantly containing tenofovir disoproxil fumarate) were also more likely to experience eGFR decline and worsening albuminuria compared with HIV-uninfected individuals.

Hepatitis C co-infection is associated with an increased risk of incident chronic kidney disease in HIV-infected patients initiating combination antiretroviral therapy

BackgroundCombination antiretroviral therapy (cART) has reduced mortality from AIDS-related illnesses and chronic comorbidities have become prevalent among HIV-infected patients. We examined the association between hepatitis C virus (HCV) co-infection and chronic kidney disease (CKD) among patients initiating modern antiretroviral therapy.MethodsData were obtained from the Canadian HIV Observational Cohort for individuals initiating cART from 2000 to 2012. Incident CKD was defined as two consecutive serum creatinine-based estimated glomerular filtration (eGFR) measurements <60 mL/min/1.73m2 obtained ≥3 months apart. CKD incidence rates after cART initiation were compared between HCV co-infected and HIV mono-infected patients. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using multivariable Cox regression.ResultsWe included 2595 HIV-infected patients with eGFR >60 mL/min/1.73m2 at cART initiation, of which 19% were HCV co-infected. One hundred and fifty patients developed CKD during 10,903 person-years of follow-up (PYFU). The CKD incidence rate was higher among co-infected than HIV mono-infected patients (26.0 per 1000 PYFU vs. 10.7 per 1000 PYFU). After adjusting for demographics, virologic parameters and traditional CKD risk factors, HCV co-infection was associated with a significantly shorter time to incident CKD (HR 1.97; 95% CI: 1.33, 2.90). Additional factors associated with incident CKD were female sex, increasing age after 40 years, lower baseline eGFR below 100 mL/min/1.73m2, increasing HIV viral load and cumulative exposure to tenofovir and lopinavir.ConclusionsHCV co-infection was associated with an increased risk of incident CKD among HIV-infected patients initiating cART. HCV-HIV co-infected patients should be monitored for kidney disease and may benefit from available HCV treatments.

Community screening for pre-hypertension, traditional risk factors and markers of chronic kidney disease in Ondo State, South-Western Nigeria.

Chronic kidney disease (CKD) has become an epidemic with many recognised risk factors. However, the role of pre-hypertension in CKD is yet to be fully studied in our environment. We set out to determine the magnitude of pre-hypertension and traditional CKD risk factors. We also determined their relationships to proteinuria. This was a descriptive, cross-sectional study conducted in two urban local government areas (Akure South and Ondo West) in Ondo State, Southwest Nigeria in March 2014. A total of 1,183 adults (M:F, 0.63:1) were studied. Their bio-data, history of cigarette smoking, alcohol intake, herbal usage, non-steroidal anti-inflammatory drugs (NSAIDs), diabetes and hypertension were obtained. A total of 1,183 adults (M:F, 0.63:1) blood pressure (BP) and anthropometry were determined. Urinalysis was conducted using Combi-Uriscreen® 10SL. Data were analysed using the Statistical Package for the Social Sciences version 20.0. A total of 1183 adults (M:F, 1:1.6) were studied with a mean age of 44.7 ± 17.4 years. Their mean systolic BP, diastolic BP and body mass index were 129.6 ± 23.7 mmHg, 79.8 ± 14 mmHg and 26.2 ± 5.8 kg/m2, respectively. Pre-hypertension was present in 32.3% of the subjects, while hypertension was present in 43.4% of the subjects; 6.2% gave history of diabetes, 4.5% smoked cigarette, 68.3% used herbs and 44.1% used NSAIDs. Proteinuria was present in 25.9% of the subjects, while haematuria was present in 1.7% of the subjects. BP and age showed significant association to proteinuria. Pre-hypertension and known risk factors of CKD are prevalent in the people of Ondo State, Nigeria. Individuals with persistent pre-hypertension should be routinely screened for CKD and referred to the Nephrologist for early intervention.