Feasibility of evaluation of the natural history of kidney disease in the general population using electronic healthcare records

Abstract Background Knowledge about the nature of long-term changes in kidney function in the general population is sparse. We aim to identify whether primary care electronic healthcare records capture sufficient information to study the natural history of kidney disease. Methods The National Chronic Kidney Disease Audit database covers ∼14% of the population of England and Wales. Availability of repeat serum creatinine tests was evaluated by risk factors for chronic kidney disease (CKD) and individual changes over time in estimated glomerular filtration rate (eGFR) were estimated using linear regression. Sensitivity of estimation to method of evaluation of eGFR compared laboratory-reported eGFR and recalculated eGFR (using laboratory-reported creatinine), to uncover any impact of historical creatinine calibration issues on slope estimation. Results Twenty-five per cent of all adults, 92% of diabetics and 96% of those with confirmed CKD had at least three creatinine tests, spanning a median of 5.7 years, 6.2 years and 6.1 years, respectively. Median changes in laboratory-reported eGFR (mL/min/1.73 m2/year) were −1.32 (CKD) and −0.60 (diabetes). Median changes in recalculated eGFR were −0.98 (CKD) and −0.11 (diabetes), underestimating decline. Magnitude of underestimation (and between-patient variation in magnitude) decreased with deteriorating eGFR. For CKD Stages 3, 4 and 5 (at latest eGFR), median slopes were −1.27, −2.49 and -3.87 for laboratory-reported eGFR and −0.89, −2.26 and −3.75 for recalculated eGFR. Conclusions Evaluation of long-term changes in renal function will be possible in those at greatest risk if methods are identified to overcome creatinine calibration problems. Bias will be reduced by focussing on patients with confirmed CKD.

Download Full-text

An observational claims data analysis on the risk of maternal chronic kidney disease after preterm delivery and preeclampsia

Scientific Reports ◽

10.1038/s41598-021-92078-2 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Maren Goetz ◽

Mitho Müller ◽

Raphael Gutsfeld ◽

Tjeerd Dijkstra ◽

Kathrin Hassdenteufel ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Preterm Birth ◽

Kidney Disease ◽

Preterm Delivery ◽

Claims Data ◽

Maternal Risk ◽

Live Births ◽

Increased Risk ◽

History Of

AbstractWomen with complications of pregnancy such as preeclampsia and preterm birth are at risk for adverse long-term outcomes, including an increased future risk of chronic kidney disease (CKD) and end-stage kidney disease (ESKD). This observational cohort study aimed to examine the risk of CKD after preterm delivery and preeclampsia in a large obstetric cohort in Germany, taking into account preexisting comorbidities, potential confounders, and the severity of CKD. Statutory claims data of the AOK Baden-Wuerttemberg were used to identify women with singleton live births between 2010 and 2017. Women with preexisting conditions including CKD, ESKD, and kidney replacement therapy (KRT) were excluded. Preterm delivery (< 37 gestational weeks) was the main exposure of interest; preeclampsia was investigated as secondary exposure. The main outcome was a newly recorded diagnosis of CKD in the claims database. Data were analyzed using Cox proportional hazard regression models. The time-dependent occurrence of CKD was analyzed for four strata, i.e., births with (i) neither an exposure of preterm delivery nor an exposure of preeclampsia, (ii) no exposure of preterm delivery but exposure of at least one preeclampsia, (iii) an exposure of at least one preterm delivery but no exposure of preeclampsia, or (iv) joint exposure of preterm delivery and preeclampsia. Risk stratification also included different CKD stages. Adjustments were made for confounding factors, such as maternal age, diabetes, obesity, and dyslipidemia. The cohort consisted of 193,152 women with 257,481 singleton live births. Mean observation time was 5.44 years. In total, there were 16,948 preterm deliveries (6.58%) and 14,448 births with at least one prior diagnosis of preeclampsia (5.61%). With a mean age of 30.51 years, 1,821 women developed any form of CKD. Compared to women with no risk exposure, women with a history of at least one preterm delivery (HR = 1.789) and women with a history of at least one preeclampsia (HR = 1.784) had an increased risk for any subsequent CKD. The highest risk for CKD was found for women with a joint exposure of preterm delivery and preeclampsia (HR = 5.227). These effects were the same in magnitude only for the outcome of mild to moderate CKD, but strongly increased for the outcome of severe CKD (HR = 11.90). Preterm delivery and preeclampsia were identified as independent risk factors for all CKD stages. A joint exposure or preterm birth and preeclampsia was associated with an excessive maternal risk burden for CKD in the first decade after pregnancy. Since consequent follow-up policies have not been defined yet, these results will help guide long-term surveillance for early detection and prevention of kidney disease, especially for women affected by both conditions.

Download Full-text

Abstract 15407: Comorbidities and the Associated Long-term Utilization of Transthoracic Echocardiography Among Medicare Beneficiaries at a Large Academic Center

Circulation ◽

10.1161/circ.142.suppl_3.15407 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Patrick M Hyland ◽

Jiaman Xu ◽

Changyu Shen ◽

Lawrence Markson ◽

Warren J Manning ◽

...

Keyword(s):

Myocardial Infarction ◽

Heart Failure ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Transthoracic Echocardiography ◽

Medicare Beneficiaries ◽

Female Sex ◽

History Of

Introduction: The association between baseline patient characteristics and the long-term utilization of transthoracic echocardiography (TTE) is unknown and may help focus value-based care initiatives. Methods: TTE reports from patients with ≥ 2 TTEs at our institution were linked to 100% Medicare Fee-for-service inpatient claims, 1/1/2000 – 12/31/2017. To avoid inclusion of individuals with short-interval follow-up, TTEs with < 1 year between studies were excluded. Validated claims algorithms were used to create 12 baseline cardiovascular comorbidities. Multivariable Poisson regression was used to estimate adjusted rates of TTE intensity according to baseline comorbidities. Results: Over a median (IQR) follow-up of 5.8 (3.1 – 9.5) years, 18,579 individuals (69.3 ± 12.8 years; 50.5% female) underwent a total of 59,759 TTEs (range 2 – 59). The median TTE intensity was 0.64 TTEs/patient/year (IQR 0.35 – 1.24; range 0.11 – 22.02). The top five contributors to TTE intensity were heart failure, chronic kidney disease, history of myocardial infarction, smoking, and hyperlipidemia ( Figure ). Female sex was associated with decreased TTE utilization (adjusted RR 0.95, 95% CI 0.94-0.96, p < 0.0001). Atrial fibrillation, hypertension, and history of ischemic stroke or transient ischemic attack were not significantly related to TTE intensity after multivariable adjustment (all p > 0.05). Conclusions: Among Medicare beneficiaries with ≥ 2 TTEs at our institution, the median TTE intensity was 0.64 TTEs/patient/year but varied widely. Heart failure, chronic kidney disease, and history of myocardial infarction were the strongest predictors of increased utilization. Female sex was associated with decreased utilization, reflecting broader disparities in utilization of cardiovascular procedures. Further research is needed to clarify reasons for this sex disparity and associations with cardiovascular outcomes.

Download Full-text

Natural History of Chronic Kidney Disease Stages 2-4

Arab Journal of Nephrology and Transplantation ◽

10.4314/ajnt.v3i3.63142 ◽

2011 ◽

Vol 3 (3) ◽

Author(s):

MEA Yousi ◽

M El Nahas

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Natural History ◽

History Of ◽

Disease Stages

Download Full-text

Natural History of Progression of Chronic Kidney Disease in Stages 4 and 5

Arab Journal of Nephrology and Transplantation ◽

10.4314/ajnt.v3i2.58885 ◽

2010 ◽

Vol 3 (2) ◽

Author(s):

H Abdelwahab ◽

D Ansel ◽

T Feest ◽

M Abdelraheeem ◽

M El-Nahas

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Natural History ◽

History Of

Download Full-text

Long-Term Blood Pressure Variability, New-Onset Diabetes Mellitus, and New-Onset Chronic Kidney Disease in the Japanese General Population

Hypertension ◽

10.1161/hypertensionaha.115.05472 ◽

2015 ◽

Vol 66 (1) ◽

pp. 30-36 ◽

Cited By ~ 34

Author(s):

Yuichiro Yano ◽

Shouichi Fujimoto ◽

Holly Kramer ◽

Yuji Sato ◽

Tsuneo Konta ◽

...

Keyword(s):

Diabetes Mellitus ◽

Blood Pressure ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

General Population ◽

Blood Pressure Variability ◽

Japanese General Population ◽

New Onset Diabetes Mellitus ◽

New Onset

Download Full-text

Defining the Natural History of Uremic Cardiomyopathy in Chronic Kidney Disease

JACC Cardiovascular Imaging ◽

10.1016/j.jcmg.2013.09.025 ◽

2014 ◽

Vol 7 (7) ◽

pp. 703-714 ◽

Cited By ~ 45

Author(s):

Nicola C. Edwards ◽

William E. Moody ◽

Colin D. Chue ◽

Charles J. Ferro ◽

Jonathan N. Townend ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Natural History ◽

Uremic Cardiomyopathy ◽

History Of

Download Full-text

Preeclampsia and the risk of chronic kidney disease: a national registry-based cohort study

European Journal of Public Health ◽

10.1093/eurpub/ckaa165.1174 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

P M Barrett ◽

F P McCarthy ◽

M Evans ◽

M Kublickas ◽

I J Perry ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Absolute Risk ◽

Population Based ◽

National Registry ◽

Medical Birth Register ◽

Increased Risk ◽

History Of

Abstract Background Preeclampsia is associated with increased risk of future cardiovascular disease, but evidence for associations with chronic kidney disease (CKD) has been inconsistent to date. We aimed to measure associations between preeclampsia and long-term CKD in a population-based sample of parous women, and to identify whether the risk differs by CKD subtype. Methods Using data from the Swedish Medical Birth Register, singleton live births from 1973-2012 were identified and linked to data from the Swedish Renal Register and National Patient Register (up to 2013). Preeclampsia was the main exposure of interest and was treated as a time-dependent variable. The primary outcome was maternal CKD, and this was classified into 5 subtypes: hypertensive, diabetic, glomerular/proteinuric, tubulo-interstitial, other/non-specific CKD. Cox proportional hazard regression models were used for analysis. Women with pre-pregnancy comorbidities were excluded. Results The dataset included 1,924,591 unique women who had 3,726,819 singleton pregnancies. The median follow-up was 20.7 (interquartile range 9.9-30.0) years. Overall, 90,964 women (4.7%) experienced preeclampsia and 18,146 (0.9%) developed CKD. Women who had preeclampsia had higher risk of developing any CKD during follow-up (aHR 1.88, 95% CI 1.79-1.98). The risk differed by CKD subtype, and was higher for hypertensive CKD (aHR 3.76, aHR 3.09-4.57), diabetic CKD (aHR 3.45, 95% CI 2.83-4.21) and glomerular/proteinuric CKD (aHR 2.08, 95% CI 1.90-2.29). Women who had preterm preeclampsia, recurrent preeclampsia, or preeclampsia complicated by pre-pregnancy obesity were also at greater risk of any CKD. Conclusions Women with a history of preeclampsia are at increased risk of long-term CKD. The risk is most marked for hypertensive CKD, diabetic CKD, and glomerular/proteinuric CKD. The absolute risk of CKD related to preeclampsia is substantial, and these women may warrant systematic renal monitoring in the years following delivery. Key messages Preeclampsia is an independent predictor of long-term risk of chronic kidney disease in otherwise healthy parous women. Women with a history of preeclampsia may warrant systematic renal monitoring through additional blood pressure, blood glucose, and proteinuria checks.

Download Full-text