MO487DYSNATRAEMIA AND ASSOCIATED MORTALITY RISK THRESHOLDS ARE MODIFIED BY KIDNEY FUNCTION IN THE IRISH HEALTH SYSTEM: THE NATIONAL KIDNEY DISEASE SURVEILLANCE SYSTEM (NKDSS)

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Conor Walsh ◽  
Leonard Browne ◽  
Austin Stack
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Kidney Function ◽  
Mortality Risk ◽  
Surveillance System ◽  
Disease Surveillance ◽  
Optimal Range ◽  
Disease Surveillance System ◽  
All Cause Mortality ◽  
The Impact

Abstract Background and Aims Dysnatraemia is associated with increased mortality risk in the general population, but it is unclear to what extent kidney function influences this relationship. We investigated the impact of dysnatraemia on total and cardiovascular (CV) mortality while exploring the concurrent impact of chronic kidney disease. Method We utilised data from the Irish Kidney Disease Surveillance System (NKSS) to explore the association of serum sodium (Na+) (mmol/L) and mortality in a longitudinal cohort study. We identified all adult individuals (age > 18 years) who accessed health care from January 1st, 2007 and December 31st, 2013 in a regional health system with complete data on serum Na+, associated laboratory indicators and vital status up to 31st December 2013 (n = 32, 686). Patients receiving dialysis were excluded. The primary exposure was serum Na+ first recorded during the study period for each patient with a concurrent serum glucose measurement. Chronic kidney disease was defined as eGFR <60ml/min/1.73m² vs greater recorded at index date. The association of serum Na+ with all-cause (ACM) and CV mortality was explored in categories and as a continuous variable using polynomial splines. Multivariable Cox regression with competing risks determined hazard ratios (HR) and 95% confidence intervals with adjustment for baseline health indicators. Results There were 5,118 deaths (15.7%) over a median follow up of 5.5 years. In multivariable adjusted models, the association of serum Na+ with all-cause and CV mortality followed a non-linear, u-shaped pattern. For all-cause mortality, the optimal range for greatest survival was between 139-146 mmol/L [HR 1.02 (1.00-1.03) and HR 1.19 (1.02-1.38) respectively, while for CV mortality, the optimal range was much narrower at 134-143mmol/L [HR 1.16 (1.02-1.23) and HR 1.09 (1.01-1.89) respectively] (Figure 1). The impact of serum Na+ on mortality was modified by baseline kidney function (p value < 0.001 for interaction). In stratified analysis, the impact of serum Na+ on all-cause mortality was greatly attenuated among patients with GFR< 60 ml/min/m², than above. This pattern was replicated in analyses of CV mortality. Conclusion This study supports the view that hypernatraemia and hyponatraemia are better tolerated with poorer kidney function. The risk thresholds for mortality were much narrower for CV death than all-cause death suggesting that these thresholds be taken into account to inform decision making and therapeutic interventions. Funding source Health Research Board (HRB-SDAP-2019-036), Midwest Research and Education Foundation (MKid)

scholarly journals Establishing a National Chronic Kidney Disease Surveillance System for the United States

2009 ◽  
Vol 5 (1) ◽  
pp. 152-161 ◽  
Author(s):  
Rajiv Saran ◽  
Elizabeth Hedgeman ◽  
Laura Plantinga ◽  
Nilka Rios Burrows ◽  
Brenda W. Gillespie ◽  
...  
Keyword(s):  
United States ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Surveillance System ◽  
Disease Surveillance ◽  
The United States ◽  
Disease Surveillance System

scholarly journals P0818IMPROVING MORTALITY TRENDS FOR PATIENTS WITH CHRONIC KIDNEY DISEASE IN THE IRISH HEALTH SYSTEM: THE IRISH KIDNEY DISEASE SURVEILLANCE SYSTEM (IKDSS)

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Matthew Laird ◽  
Raihan Alheyali ◽  
Leonard Browne ◽  
Liam Plant ◽  
Cathal Walsh ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Health System ◽  
Surveillance System ◽  
Disease Surveillance ◽  
Age Distribution ◽  
Mortality Rates ◽  
Mortality Data ◽  
Irish Population ◽  
Disease Surveillance System

Abstract Background and Aims It is unclear whether targeted efforts for the treatment of chronic kidney disease (CKD) has led to a sustained reduction in mortality rates. We examined annual trends in mortality for patients with and without CKD in the Irish health system. Method We utilised data from the Irish Kidney Disease Surveillance System (IKDSS) to explore 1-year mortality rates among patients with and without CKD in the health system. The principal data sources included; regional laboratory information systems; dialysis registers; and mortality data files from the national Central Statistics Office (CSO). We created multi-annual cohorts of patients, age > 18 years with one or more serum creatinine values who received healthcare within the Irish health system from 2008 to 2012. Serum creatinine values (first test in fiscal year) were used to calculate glomerular filtration rate (eGFR) and CKD was defined as GFR < 60ml/min/1.73m. Mortality data were available from the national mortality files with vital status up to December 31st 2013. Age standardised death rates were determined for the Irish population (IRE) and the European Standard Population (ESP) (standardised to the age distribution of a standard European population in 2012. Comparisons were conducted using segmented linear regression. Results We included 351,223 adult individuals between 2008 and 2012. Age standardised mortality rates (EU) were more than 2-fold higher for patients with CKD than without, P<0.001. From 2008-2012, age-standardised mortality rates decreased significantly in patients with CKD from a peak of 47.7 to 31 per 1000 person-years, P for trend=p=0.012, and from a peak of 17.8 to 15.5 per 1000 person-years in patients without CKD, P=0.006. Mortality rates for men were significantly higher than for women in patients with and without CKD, but the pattern of improvement was similar for both sexes. These patterns were replicated when comparisons were made using Irish standard age distribution. Conclusion Mortality rates among CKD patients have declined in the Irish population from 2008 to 2012 in both men and women. The processes and interventions that have led to these reductions need further exploration. Figure 1. (a) Crude and age standardised mortality rates (b-c) of those with and without CKD in the Irish Health System between 2008-2012 .

scholarly journals Speckle Tracking Echocardiography and All-Cause and Cardiovascular Mortality Risk in Chronic Kidney Disease Patients

2019 ◽  
Vol 44 (4) ◽  
pp. 690-703 ◽  
Author(s):  
Laura Jahn ◽  
Rafael Kramann ◽  
Nikolaus Marx ◽  
Jürgen Floege ◽  
Michael Becker ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Mortality Risk ◽  
Speckle Tracking ◽  
Speckle Tracking Echocardiography ◽  
Myocardial Dysfunction ◽  
Left Ventricular ◽  
Control Group ◽  
Increased Risk ◽  
All Cause Mortality

Background and Objectives: Patients with chronic kidney disease (CKD) exhibit a highly increased risk of cardiovascular (CV) morbidity and mortality. Subtle changes in left ventricular function can be detected by two-dimensional (2D) speckle tracking echocardiography (STE). This study investigated whether myocardial dysfunction detected by 2D STE may aid in CV and all-cause mortality risk assessment in patients with CKD stages 3 and 4. Method: A study group of 285 patients (CKD 3: 193 patients; CKD 4: 92 patients) and a healthy control group (34 participants) were included in the retrospective study. 2D STE values as well as early and late diastolic strain rates were measured in ventricular longitudinal, circumferential and radial directions. Patients’ CV and all-cause outcome was determined. Results: In the CKD group all measured longitudinal STE values and radial strain were significantly reduced compared to the control group. Cox proportional hazards regression revealed global longitudinal strain to predict CV and all-cause mortality (hazard ratio [HR] 1.15, 95% CI 1.06–1.25; p = 0.0008 and HR 1.09, 95% CI 1.04–1.14; p = 0.0003). After adjustment for sex, age, diabetes, estimated glomerular filtration rate, and preexisting CV disease, this association was maintained for CV mortality and all-cause mortality (HR 1.16, 95% CI 1.06–1.27; p = 0.0019 and HR 1.08, 95% CI 1.03–1.14; p = 0.0026, respectively). Conclusions: The present study shows that 2D STE detects reduced left ventricular myocardial function and allows the prediction of CV and all-cause mortality in patients at CKD stages 3 and 4.

scholarly journals The impact of ramipril on kidney function parameters in the chronic kidney disease patient with hypertension

2020 ◽  
Vol 11 (4) ◽  
pp. 6932-6937
Author(s):  
Mohammed Salim KT ◽  
Saravanakumar RT ◽  
Dilip C ◽  
Amrutha KP
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Kidney Function ◽  
Enzyme Inhibitors ◽  
Disease Patient ◽  
Cost Effective ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Converting Enzyme Inhibitors ◽  
Cost Effective Technique ◽  
The Impact

The administration of angiotensin converting enzyme inhibitors had gain popularity owing to their efficacy and safety in chronic kidney disease (CKD) patients. However, it is certainly necessary to look into the impact of the ramipril in kidney impaired individuals. We had enrolled 190 CKD with hypertensive patients based on the exclusion and inclusion criteria. The elder patients constituted to have a major share in the CKD population on ramipril therapy. From the study, it was found that the high costly brand was chosen the most and least cost was preferred only for 2 patients. The glomerular filtration rate (GFR) and serum creatinine, the major determinants of kidney function, had a small relationship with the dose of ramipril. However, the antihypertensive drug showed to have a favorable impact on patients overall treatment outcome. It is vital to evaluate the amount of protein in urine in case of a CKD patient. The easiest and cost effective technique, the dipstick urine protein test was done. The test value was found to be 1+ (30mg/dl) for majority of the patients and only 2 patients were observed with more than 1000 mg/dl. The ability of ramipril to reduce the progression of CKD can be attributed to the pooling of the data in +1 (30mg/dl) range.

scholarly journals Disease Surveillance by Private Health Providers in Nigeria: A Research Proposal

2016 ◽  
Vol 8 (1) ◽  
Author(s):  
Olusesan A. Makinde ◽  
Clifford O. Odimegwu
Keyword(s):  
Surveillance System ◽  
Disease Surveillance ◽  
International Health ◽  
Healthcare Services ◽  
Health Providers ◽  
Factors Affecting ◽  
Disease Surveillance System ◽  
Surveillance And Response ◽  
The Impact ◽  
Suspicious Case

A large proportion of Nigerians access healthcare services in private health facilities (PHFs) but the compliance of these PHFs to the mandatory disease surveillance and reporting - a means of implementing the international health regulation of 1969 - has not been established. The recent Ebola outbreak spread to Nigeria and revealed challenges in the efficiency of the surveillance system after a suspicious case presented at a PHF. The impact of an inefficient disease surveillance system can be far reaching. Thus, we propose a study to investigate and understand factors affecting compliance of these PHFs to the country disease surveillance and response system.

MO517EFFECT MODIFIERS OF SERUM POTASSIUM AND MORTALITY IN THE IRISH HEALTH SYSTEM: THE NATIONAL KIDNEY DISEASE SURVEILLANCE SYSTEM (NKDSS)

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Leonard Browne ◽  
Austin Stack
Keyword(s):  
Kidney Disease ◽  
Health System ◽  
Surveillance System ◽  
Disease Surveillance ◽  
Index Date ◽  
Continuous Variable ◽  
P Value ◽  
Medical Supervision ◽  
Disease Surveillance System ◽  
Baseline Health

Abstract Background and Aims Serum potassium (K+) exhibits a u-shaped association with mortality but uncertainty exists regarding optimal thresholds for survival and influencing factors. We examined the impact of serum K* on mortality in the Irish Health System with particular focus on kidney function and location of medical supervision. Method We utilised data from the Irish Kidney Disease Surveillance System (NKSS) to explore the association of serum K+ and mortality in a longitudinal cohort study. We identified all adult individuals (age > 18 years) who accessed health care from 2007 and 2012 in a regional health system with complete data on serum K+, associated laboratory indicators and vital status up to 31st December 2013 (n = 32,643). We randomly selected a single K+ measurement per patient with date of measurement as index date. Chronic kidney disease was defined as eGFR <60ml/min/1.73m² vs greater recorded at index date. Location of medical supervision was recorded as emergency room, inpatient location; outpatient clinic, and general practice location. The association of serum K+ was explored in categories and as a continuous variable in restricted cubic splines with mortality. Multivariable Cox regression determined hazard ratios and 95% confidence intervals with adjustment for baseline health indicators. Results Mean age was 57.1 years, 5,056 died (15.4%) with a median follow-up of 5.1 years. With adjustment, for age, sex, baseline health status, and location of medical supervision, the pattern of mortality was non-linear and u-shaped with greatest risks for patients with extreme values. Modelled as a continuous variable, the serum K +thresholds for optimal survival were from 4.1 to 5.2 mmol/L. Compared to patients without baseline CKD, the risks were attenuated for patients with CKD (p-value interaction 0.012). The associated risk thresholds were wider for CKD patients with significant increased risk above 5.8 mmol/L whereas, for those without CKD, serum K +thresholds for optimal survival were between 4.2-5.4 mmol/L. Similarly, mortality patterns were greatly attenuated for patients who were managed in the outpatient and general practice locations (p-value interaction <0.001) than the emergency room or inpatient settings (Figure 1). Conclusion Risk thresholds for optimal survival for serum K+ vary according to CKD and location of medical supervision in real-world clinical cohorts. Better understanding of these thresholds and effect modifiers are essential for inform decision making and therapeutic interventions. Funding Source Health Research Board (HRB-SDAP-2019-036), Midwest Research and Education Foundation (MKid), Vifor Pharma.

scholarly journals Anemia as a Risk Factor for Cardiovascular Disease and All-Cause Mortality in Diabetes: The Impact of Chronic Kidney Disease

2005 ◽  
Vol 16 (11) ◽  
pp. 3403-3410 ◽  
Author(s):  
Panagiotis T. Vlagopoulos ◽  
Hocine Tighiouart ◽  
Daniel E. Weiner ◽  
John Griffith ◽  
Dan Pettitt ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Chronic Kidney Disease ◽  
Risk Factor ◽  
Kidney Disease ◽  
All Cause Mortality ◽  
The Impact

scholarly journals Thyroid function, renal events and mortality in chronic kidney disease patients: the German Chronic Kidney Disease study

2020 ◽  
Author(s):  
Ulla T Schultheiss ◽  
Inga Steinbrenner ◽  
Matthias Nauck ◽  
Markus P Schneider ◽  
Fruzsina Kotsis ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Kidney Function ◽  
Thyroid Function ◽  
Positive Association ◽  
Inverse Association ◽  
All Cause Mortality ◽  
Disease Study ◽  
Reduced Kidney Function

Abstract Background Hypothyroidism and low free triiodothyronine (FT3) syndrome [low FT3 levels with normal thyroid-stimulating hormone (TSH)] have been associated with reduced kidney function cross-sectionally in chronic kidney disease (CKD) patients with severely reduced estimated glomerular filtration rate (eGFR) or end-stage kidney disease (ESKD). Results on the prospective effects of impaired thyroid function on renal events and mortality for patients with severely reduced eGFR or from population-based cohorts are conflicting. Here we evaluated the association between thyroid and kidney function with eGFR (cross-sectionally) as well as renal events and mortality (prospectively) in a large, prospective cohort of CKD patients with mild to moderately reduced kidney function. Methods Thyroid markers were measured among CKD patients from the German Chronic Kidney Disease study. Incident renal endpoints (combined ESKD, acute kidney injury and renal death) and all-cause mortality were abstracted from hospital records and death certificates. Time to first event analysis of complete data from baseline to the 4-year follow-up (median follow-up time 4.04 years) of 4600 patients was conducted. Multivariable linear regression and Cox proportional hazards models were fitted for single and combined continuous thyroid markers [TSH, free thyroxine (FT4), FT3] and thyroid status. Results Cross-sectionally, the presence of low-FT3 syndrome showed a significant inverse association with eGFR and continuous FT3 levels alone showed a significant positive association with eGFR; in combination with FT4 and TSH, FT3 levels also showed a positive association and FT4 levels showed a negative association with eGFR. Prospectively, higher FT4 and lower FT3 levels were significantly associated with a higher risk of all-cause mortality (Nevents = 297). Per picomole per litre higher FT3 levels the risk of reaching the composite renal endpoint was 0.73-fold lower (95% confidence interval 0.65–0.82; Nevents = 615). Compared with euthyroid patients, patients with low-FT3 syndrome had a 2.2-fold higher risk and patients with hypothyroidism had a 1.6-fold higher risk of experiencing the composite renal endpoint. Conclusions Patients with mild to moderate CKD suffering from thyroid function abnormalities are at an increased risk of adverse renal events and all-cause mortality over time.

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