MO183TELEMEDICINE AS A MODALITY OF HEALTH CARE DELIVERY FOR PATIENTS WITH SEVERE CHRONIC KIDNEY DISEASE DURING COVID-19 PANDEMIC

Abstract Background and Aims Telemedicine is a new modality of care delivery. Over the last months, it has been used to deliver health care to outpatients with chronic kidney disease (CKD) during COVID-19 pandemic. However, experience of telemedicine in patients with severe CKD is scarce and there are not reassuring data about its efficacy in improving patients’ outcome. To evaluate the efficacy and the outcome profile of telemedicine in people with severe CKD, we reviewed all data of outpatients with severe kidney impairment who underwent nephrological evaluation during the first wave of this pandemic. In particular, outcomes of the ambulatory activity (urgent-start dialysis, late referral and modalities of dialysis initiation) were compared to 2019 ambulatory activity. Method Outpatients with severe chronic kidney disease included in the ambulatory program called “Pre-Dialysis Program were enrolled in a retrospective study. We reviewed all electronic charts of patients who underwent nephrological follow-up from 9th March to June 21st, 2020 (15 weeks in total) at the University Hospital of Modena, Italy. Extension of the observation period to 30th September 2020 allowed us to determine the long-term effects of telemedicine on the rate of urgent-star dialysis, late referral, and modalities of dialysis initiation. Results During 15 weeks of follow-up, 186 nephrological visits were performed (Table) They were subdivided into telemedicine visits (56.5%) and in-person visits (43.5%). Overall, mean age of patients was 71.7±13.1 years with a prevalence of male (60.2%). Patients who received telemedicine visits had a statistically significant lower sCr (3.7±1.2 vs 4.5±1.5 mg/dl; P=0.0001) and higher eGFR level (14.7±6.02 vs 12.16±5.8 ml/min; P=0.002) than patients followed in the ambulatory setting. A high prevalence of patients with CKD stage 5 was monitored by in-person visits (P=0.0001). Patients followed by telemedicine had a clinical profile including a lower weight (P=0.007) and better control of metabolic acidosis (P=0.039) than the counterpart. Changes in domiciliary therapy occurred more frequently in patients monitored in the ambulatory setting (P=0.036). Statistically significant differences were encountered in the prescription of diuretics (P=0.002), sodium bicarbonate (P=0.043), antihypertensive drugs (P=0.001) and uric acid-lowering agents (P=0.046). During the 15-week period in 2019, 214 visits were performed (+13% compared to 2020). The vast majority of these visits were conducted in the hospital setting (210 out of 214; 98.2%). The severity of CKD was similar between patients, without statistically significant difference in the rate of patients in CKD stage III (P=0.7), stage IV (0.388) and stage V (P=0.593). Implementation of telemedicine to in-person visits during COVID-19 pandemic did not change the outcomes of patients. Short-term follow-up showed a similar rate in urgent-start dialysis (P=0.361), late referral (P=1), and HD (P=0.875) or PD initiation (P=0.661). Similar results were seen also at the end of the extended follow-up. Conclusion Implementation of telemedicine has been fundamental to maintain a high level of care in CKD patients during the COVID-19 pandemic. Telemedicine services in combination with in-person visits have contributed to the delivery of clinical monitoring in a group of patients with severe and progressive CKD. No differences have been identified in terms of rate of unplanned dialysis, late referral, and modality of dialysis initiation.

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Interatrial block, P terminal force or fragmented QRS do not predict new-onset atrial fibrillation in patients with severe chronic kidney disease

BMC Cardiovascular Disorders ◽

10.1186/s12872-020-01719-3 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Tapio Hellman ◽

Markus Hakamäki ◽

Roosa Lankinen ◽

Niina Koivuviita ◽

Jussi Pärkkä ◽

...

Keyword(s):

Atrial Fibrillation ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

P Wave ◽

Stage 4 ◽

Ckd Stage ◽

Severe Chronic Kidney Disease ◽

Onset Atrial Fibrillation ◽

New Onset

Abstract Background The prevalence of left atrial enlargement (LAE) and fragmented QRS (fQRS) diagnosed using ECG criteria in patients with severe chronic kidney disease (CKD) is unknown. Furthermore, there is limited data on predicting new-onset atrial fibrillation (AF) with LAE or fQRS in this patient group. Methods We enrolled 165 consecutive non-dialysis patients with CKD stage 4–5 without prior AF diagnosis between 2013 and 2017 in a prospective follow-up cohort study. LAE was defined as total P-wave duration ≥120 ms in lead II ± > 1 biphasic P-waves in leads II, III or aVF; or duration of terminal negative portion of P-wave > 40 ms or depth of terminal negative portion of P-wave > 1 mm in lead V1 from a baseline ECG, respectively. fQRS was defined as the presence of a notched R or S wave or the presence of ≥1 additional R waves (R’) or; in the presence of a wide QRS complex (> 120 ms), > 2 notches in R or S waves in two contiguous leads corresponding to a myocardial region, respectively. Results Mean age of the patients was 59 (SD 14) years, 56/165 (33.9%) were female and the mean estimated glomerular filtration rate was 12.8 ml/min/1.73m2. Altogether 29/165 (17.6%) patients were observed with new-onset AF within median follow-up of 3 [IQR 3, range 2–6] years. At baseline, 137/165 (83.0%) and 144/165 (87.3%) patients were observed with LAE and fQRS, respectively. Furthermore, LAE and fQRS co-existed in 121/165 (73.3%) patients. Neither findings were associated with the risk of new-onset AF within follow-up. Conclusion The prevalence of LAE and fQRS at baseline in this study on CKD stage 4–5 patients not on dialysis was very high. However, LAE or fQRS failed to predict occurrence of new-onset AF in these patients.

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Recommendations for Systematizing Transplant Education Within a Care Delivery System for Patients With Chronic Kidney Disease Stages 3 to 5

Progress in Transplantation ◽

10.1177/1526924820913520 ◽

2020 ◽

Vol 30 (2) ◽

pp. 76-87 ◽

Cited By ~ 1

Author(s):

Amy D. Waterman ◽

Amanda Faye Lipsey ◽

Omesh N. Ranasinghe ◽

Emily H. Wood ◽

Crystal Anderson ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

General Education ◽

Culturally Responsive ◽

Care Delivery ◽

Disease Stage ◽

Medical Mistrust ◽

Spanish Speaking ◽

Ckd Stage

Context: Early tailored transplant education could help patients make informed transplant choices. Objective: We interviewed 40 patients with chronic kidney disease (CKD) stages 3 to 5, 13 support persons, and 10 providers at Kaiser Permanente Southern California to understand: (1) barriers to transplant education and (2) transplant educational preferences and recommendations based on CKD stage and primary language spoken. Design: A grounded theory analysis identified central themes related to transplant education barriers, preferences, and recommendations. Results: Barriers included confusion about diagnosis and when transplant may be necessary, concerns about transplant risks, families’ lack of transplant knowledge, financial burdens, transportation and scheduling, and the emotional overload of chronic illness. Hispanic and Spanish-speaking participants reported difficulty in understanding transplant education and medical mistrust. Recommendations included providing general education, earlier introduction to transplant, wait-listing information, transplant education for support persons, living donation education for patients and potential donors, opportunities to meet living donors and kidney recipients, information on the benefits of transplant, recovery, and available financial resources, flexible class scheduling, online and print resources, and more provider follow-up. Spanish-speaking and Hispanic participants recommended using bilingual educators, print, video, and online resources in Spanish, and culturally responsive education. Patients with CKD stages 3 to 4 wanted information on slowing disease progression and avoiding transplant. Conclusion: Increasing access to culturally responsive transplant education in multiple languages, pairing appropriate content to the disease stage, and increasing system-wide follow-up as the disease progresses might help patients make more informed choices about transplant.

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The Importance Of Early Nephrology Referral Of Patients With Chronic Kidney Disease

International Archives of Medicine ◽

10.3823/2356 ◽

2017 ◽

Vol 10 ◽

Author(s):

Geraldo Bezerra Da Silva Júnior Introduc ◽

Amanda Maria Timbó Rocha ◽

Tuane Queiroz Frota ◽

Vanessa Ribeiro de Vasconcelos ◽

Sônia Maria Holanda Almeida Araújo

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Care Service ◽

Health Care Service ◽

Early Referral ◽

Ckd Stage ◽

Specialized Health Care ◽

The Impact ◽

Late Referral

Late referral of patients with chronic kidney disease (CKD) to the Nephrologist is associated with higher mortality. We have evaluated the impact of early referral to Nephrologist in a specialized health care service in Fortaleza, Ceará, Brazil. A total of 98 patients were analyzed. Mean age was 60.9±5 years, and the majority of them were female (56.1%). The majority of patients was in stage III of CKD (43.8%), followed by stage II (24.4%). In the re-evaluation, after 6 months of follow-up, 37.9% of patients had renal function improvement and were classified in a new CKD stage. Early Nephrologist referral seems to be adequate and can be associated with lower incidence of complications, need of dialysis and mortality.

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Design and methodology of the Aging Nephropathy Study (AGNES): a prospective cohort study of elderly patients with chronic kidney disease

BMC Nephrology ◽

10.1186/s12882-020-02116-w ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Venceslau A. Coelho ◽

Giovani GN. Santos ◽

Carla M. Avesani ◽

Cicero Italo L. Bezerra ◽

Luana Cristina A. Silva ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Elderly Patients ◽

Study Design ◽

Nutritional Assessment ◽

Dialysis Initiation ◽

Body Composition Assessment ◽

Link Type ◽

Ckd Stage

Abstract Background Renal replacement therapy (RRT) is usually indicated for patients with chronic kidney disease (CKD) with glomerular filtration rate below 10 ml/ml/min/1.73m2. However, the need for RRT and timing of dialysis initiation are debatable for patients aged 70 years or older. We here describe the study design and methodology of the Aging Nephropathy Study (AGNES) protocol that aims at evaluating to what extent geriatric-related conditions such as frailty, cognitive dysfunction, and presence of comorbidities have an impact on survival and RRT initiation in this group of patients. In this manuscript we provide detailed information about the AGNES study design and methodology. Methods AGNES is a prospective observational cohort that aim to investigate clinical, biochemical and demographic factors associated with RRT initiation and mortality of patients with CKD stage 4 or 5 who are aged 70 years and older. We plan to include 200 patients over 5 years. Clinically stable outpatients on conservative management for at least 6 months will be recruited from the Nephrogeriatric Clinic at the Hospital das Clinicas da Universidade de Sao Paulo, Brazil. Eligible patients are submitted to a full clinical examination, geriatric assessment, and blood test at baseline. Following the baseline visit the patients are being monitored during an observational follow up period of at least 12 months during which patients will be contacted in the clinic at their regular follow up or by phone until either RRT initiation or death occurs. This cohort includes evaluation of cognition by the education-adjusted 10-point Cognitive Screener (10-CS), frailty by Fried index score, a complete nutritional assessment (by body composition assessment, global subjective assessment and dietary intake), comorbidities by Charlson comorbidity index and biochemical markers including FGF-23 and Klotho. Discussion The AGNES cohort, a real-world study of current clinical practice in elderly patients with advanced CKD prior to dialysis initiation, will shed light into progression of CKD and its complications, indications of RRT and factors determining survival. This investigation will elucidate to what extent geriatric conditions, nutritional status and clinical factors are associated with survival, quality of life and RRT initiation in elderly CKD patients not yet on dialysis. Trial registration Registered on ClinicalTrials.gov on 18 October 2019 (NCT04132492).

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Chronic kidney disease progression among patients with type 2 diabetes identified in US administrative claims: a population cohort study

Clinical Kidney Journal ◽

10.1093/ckj/sfaa200 ◽

2020 ◽

Author(s):

Csaba P Kovesdy ◽

Danielle Isaman ◽

Natalia Petruski-Ivleva ◽

Linda Fried ◽

Michael Blankenburg ◽

...

Keyword(s):

Type 2 Diabetes ◽

Chronic Kidney Disease ◽

Cohort Study ◽

Kidney Disease ◽

Disease Progression ◽

Administrative Claims ◽

Short Period ◽

Ckd Stage

Abstract Background Chronic kidney disease (CKD), one of the most common complications of type 2 diabetes (T2D), is associated with poor health outcomes and high healthcare expenditures. As the CKD population increases, a better understanding of the prevalence and progression of CKD is critical. However, few contemporary studies have explored the progression of CKD relative to its onset in T2D patients using established markers derived from real-world care settings. Methods This retrospective, population-based cohort study assessed CKD progression among adults with T2D and with newly recognized CKD identified from US administrative claims data between 1 January 2008 and 30 September 2018. Included were patients with T2D and laboratory evidence of CKD as indicated by the established estimated glomerular filtration rate (eGFR) and urine albumin:creatinine ratio (UACR) criteria. Disease progression was described as transitions across the eGFR- and UACR-based stages. Results A total of 65 731 and 23 035 patients with T2D contributed to the analysis of eGFR- and UACR-based CKD stage progression, respectively. CKD worsening was observed in approximately 10–17% of patients over a median follow-up of 2 years. Approximately one-third of patients experienced an increase in eGFR values or a decrease in UACR values during follow-up. Conclusions A relatively high proportion of patients were observed with disease progression over a short period of time, highlighting the need for better identification of patients at risk of rapidly progressive CKD. Future studies are needed to determine the clinical characteristics of these patients to inform earlier diagnostic and therapeutic interventions aimed at slowing disease progression.

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Dietary Micronutrients and Risk of Chronic Kidney Disease: A Cohort Study with 12 Year Follow-Up

Nutrients ◽

10.3390/nu13051517 ◽

2021 ◽

Vol 13 (5) ◽

pp. 1517

Author(s):

Juyeon Lee ◽

Kook-Hwan Oh ◽

Sue-Kyung Park

Keyword(s):

Chronic Kidney Disease ◽

Cohort Study ◽

Kidney Disease ◽

Epidemiologic Study ◽

Population Based ◽

Dietary Guidelines ◽

Dietary Intakes ◽

Increased Risk ◽

Ckd Stage

We investigated the association between dietary micronutrient intakes and the risk of chronic kidney disease (CKD) in the Ansan-Ansung study of the Korean Genome and Epidemiologic Study (KoGES), a population-based prospective cohort study. Of 9079 cohort participants with a baseline estimate glomerular filtration rate (eGFR) ≥60 mL/min/1.73 m2 and a urine albumin to creatinine ratio (UACR) <300 mg/g and who were not diagnosed with CKD, we ascertained 1392 new CKD cases over 12 year follow-up periods. The risk of CKD according to dietary micronutrient intakes was presented using hazard ratios (HRs) and 95% confidence intervals (95% CIs) in a full multivariable Cox proportional hazard models, adjusted for multiple micronutrients and important clinico-epidemiological risk factors. Low dietary intakes of phosphorus (<400 mg/day), vitamin B2 (<0.7 mg/day) and high dietary intake of vitamin B6 (≥1.6 mg/day) and C (≥100 mg/day) were associated with an increased risk of CKD stage 3B and over, compared with the intake at recommended levels (HR = 6.78 [95%CI = 2.18–21.11]; HR = 2.90 [95%CI = 1.01–8.33]; HR = 2.71 [95%CI = 1.26–5.81]; HR = 1.83 [95%CI = 1.00–3.33], respectively). In the restricted population, excluding new CKD cases defined within 2 years, an additional association with low folate levels (<100 µg/day) in higher risk of CKD stage 3B and over was observed (HR = 6.72 [95%CI = 1.40–32.16]). None of the micronutrients showed a significant association with the risk of developing CKD stage 3A. Adequate intake of micronutrients may lower the risk of CKD stage 3B and over, suggesting that dietary guidelines are needed in the general population to prevent CKD.

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The low-protein diet for chronic kidney disease: 8 years of clinical experience in a nephrology ward

Clinical Kidney Journal ◽

10.1093/ckj/sfz141 ◽

2019 ◽

Vol 13 (2) ◽

pp. 253-260 ◽

Cited By ~ 1

Author(s):

Ivano Baragetti ◽

Ilaria De Simone ◽

Cecilia Biazzi ◽

Laura Buzzi ◽

Francesca Ferrario ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Estimated Glomerular Filtration Rate ◽

Independent Predictor ◽

Protein Diet ◽

Low Protein Diet ◽

Low Protein ◽

Stage 4 ◽

Ckd Stage ◽

Severe Chronic Kidney Disease

Abstract Background Guidelines indicate that a low-protein diet (LPD) delays dialysis in severe chronic kidney disease (CKD). We assessed the value of these guidelines by performing a retrospective analysis in our renal clinical practice. Methods The analysis was performed from 1 January 2010 to 31 March 2018 in 299 CKD Stage 4 patients followed for 70 months in collaboration with a skilled nutritionist. The patients included 43 patients on a controlled protein diet (CPD) of 0.8 g/kg/day [estimated glomerular filtration rate (eGFR) 20–30 mL/min/1.73 m2 body surface (b.s.)], 171 patients on an LPD of 0.6 g/kg/day and 85 patients on an unrestricted protein diet (UPD) who were not followed by our nutritionist (LPD and UPD, eGFR <20 mL/min/1.73 m2 b.s.). Results eGFR was higher in CPD patients than in UPD and LPD patients (21.9 ± 7.4 mL/min/1.73 m2 versus 17.6 ± 8.00 mL/min/1.73 m2 and 17.1 ± 7.5 mL/min/1.73 m2; P = 0.008). The real daily protein intake was higher in UPD patients than in LPD and CDP patients (0.80 ± 0.1 g/kg/day versus 0.6 ± 0.2 and 0.63 ± 0.2 g/kg/day; P = 0.01). Body mass index (BMI) was stable in the LPD and CPD groups but decreased from 28.5 ± 4.52 to 25.4 ± 3.94 kg/m2 in the UPD group (P < 0.001). The renal survival of UPD, LPD and CPD patients was 47.1, 84.3 and 90.7%, respectively, at 30 months (P < 0.001), 42.4, 72.0 and 79.1%, respectively, at 50 months (P < 0.001) and 42.4, 64.1 and 74.4%, respectively, at 70 months (P < 0.001). The LPD patients started dialysis nearly 24 months later than the UPD patients. Diet was an independent predictor of dialysis [−67% of RR reduction (hazard ratio = 0.33; confidence interval 0.22–0.48)] together with a reduction in BMI. Conclusions An LPD recommended by nephrologists in conjunction with skilled dietitians delays dialysis and preserves nutritional status in severe CKD.

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Chronic Kidney Disease, Hypertension and Cardiovascular Sequelae during Long Term Follow up of Adults with Atypical Hemolytic Uremic Syndrome

Blood ◽

10.1182/blood-2018-99-119999 ◽

2018 ◽

Vol 132 (Supplement 1) ◽

pp. 3754-3754 ◽

Cited By ~ 1

Author(s):

Shruti Chaturvedi ◽

Alison R. Moliterno ◽

Samuel A. Merrill ◽

Evan M Braunstein ◽

Xuan Yuan ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Atypical Hemolytic Uremic Syndrome ◽

Left Ventricular ◽

Myocardial Infarctions ◽

Ckd Stage ◽

Uremic Syndrome ◽

St Elevation

Abstract INTRODUCTION: Atypical hemolytic uremic syndrome (aHUS) is a complement mediated thrombotic microangiopathy that predominantly affects the kidneys although extra-renal manifestations are common. In the pre-eculizumab era, 40-65% of patients either died or had end stage renal disease (ESRD) at 1 year. Long-term renal and cardiovascular outcomes are less well described in the eculizumab era. We conducted this cohort study to describe the renal and cardiovascular outcomes of adult survivors of aHUS, both on and off continued eculizumab therapy. METHODS: Patients with aHUS were identified from the prospective Complement Associated Disease Registry and through the Center for Clinical Data Analysis at Johns Hopkins University. Demographic and clinical data were abstracted, including details of aHUS diagnosis, laboratory studies, treatment, and outcomes including renal function, hypertension and echocardiographic studies. The prevalence of hypertension was compared between patients with and without chronic kidney disease (CKD) using the chi squared test. RESULTS: 45 individuals with aHUS were followed at Johns Hopkins Hospital with a median [interquartile range (IQR)] time since diagnosis of 37.4 [IQR 20.7, 62.6] months. Median age at diagnosis was 32.5 [IQR 23.2, 49.2] years and 71.1% were female. Acute kidney injury was present in 98% (44/45); however, neurologic (64.4%), gastrointestinal (68.8%), and cardiovascular (55.5%) involvement was also common (Table 1). Hypertensive urgency or emergency was present in 40% (18/45), while 13.3% (6/45) had an acute coronary syndrome during the acute episode (2 ST elevation myocardial infarctions and 4 non-ST elevation myocardial infarctions). Complement gene sequencing was completed for 34 patients, of which 8 had variants in CFH, one in CFH and CD46, 5 in other genes (MCP1, CFHR1 homozygous deletion, DGKE, THBD, and THBD with del(CFH-SCR20-CFHR1-int5)]and 20 patients had no pathogenic variants. Thirty-two (71.1%) patients were treated initially with plasma exchange (median 6 [3, 12] exchanges). Thirty-nine (86.7%) received eculizumab (5 started at the time of renal transplant after developing ESRD), and 20 of these (51%) have since discontinued therapy. Median duration of eculizumab therapy was 2.7 [0.9-11.3] months for those who stopped therapy and 29.5 [8.8-55] months for those who continued. One patient died due to a myocardial infarction during the aHUS episode. Of the 44 survivors, 15 (34.1%) had complete renal recovery, 9 (20.5%) had chronic kidney disease (CKD) stage 1-4, and 20 (45.5%) developed CKD stage 5 requiring dialysis at 3 months after the acute episode. Fifteen patients underwent subsequent renal transplantation. At the end of follow up, 23 (52.2%) had CKD [2.2% stage 2, 15.6% stage 3, 4.4% stage 4 and 28.9% stage 5) (Figure 1A). Although not statistically significant, there was a higher rate of CKD (63.1% versus 52.6%, P=0.511) among those not on eculizumab; however, this primarily reflects eculizumab being stopped after ESRD. Hypertension was present in 35 (79.5%) survivors (Figure 1B), of which 14 (40%) had incident hypertension. The prevalence of hypertension was not significantly different between patients with CKD and normal renal function (87% versus 71.4%, P=0.202). Thirty-one (70.4%) were on antihypertensive therapy, and 67% (21 of 31) of these were not controlled to <140/90 mmHg despite the use of multiple agents (Figure 1C). Echocardiograms were performed in 29 (64.4%) individuals (12 within 3 months of diagnosis, and 17 after 3 months). Of these 17, 29.4% were normal studies, 23.5% had reduced left ventricular ejection fraction, 29.4% demonstrated left ventricular hypertrophy or diastolic dysfunction, and 11.7% had pulmonary hypertension. CONCLUSION: Malignant hypertension and cardiac involvement are common during acute aHUS. aHUS survivors also have a high prevalence of hypertension, including a notable incidence of new onset as well as uncontrolled hypertension following aHUS diagnosis. CKD is present in the majority of survivors, and structural cardiopulmonary disease is common. Complement activation has been implicated in the pathogenesis of cardiovascular disease. Further investigation is needed to evaluate the epidemiology of cardiovascular sequelae in aHUS, their associations with specific complement mutations, and optimal management. Disclosures No relevant conflicts of interest to declare.

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Dental health assessed using panoramic radiograph and adverse events in chronic kidney disease stage 4–5 patients transitioning to dialysis and transplantation–A prospective cohort study

PLoS ONE ◽

10.1371/journal.pone.0258055 ◽

2021 ◽

Vol 16 (9) ◽

pp. e0258055

Author(s):

Mikko J. Järvisalo ◽

Viljami Jokihaka ◽

Markus Hakamäki ◽

Roosa Lankinen ◽

Heidi Helin ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Oral Health ◽

Kidney Disease ◽

Dental Health ◽

C Reactive Protein ◽

Reactive Protein ◽

Stage 4 ◽

Ckd Stage ◽

Maintenance Dialysis

Background and aims Oral health could potentially be a modifiable risk factor for adverse outcomes in chronic kidney disease (CKD) patients transitioning from predialysis treatment to maintenance dialysis and transplantation. We aimed to study the association between an index of radiographically assessed oral health, Panoramic Tomographic Index (PTI), and cardiovascular and all-cause mortality, major adverse cardiovascular events (MACEs) and episodes of bacteremia and laboratory measurements during a three-year prospective follow-up in CKD stage 4–5 patients not on maintenance dialysis at baseline. Methods Altogether 190 CKD stage 4–5 patients without maintenance dialysis attended panoramic dental radiographs in the beginning of the study. The patients were followed up for three years or until death. MACEs and episodes of bacteremia were recorded during follow-up. Laboratory sampling for C-reactive protein and leukocytes was repeated tri-monthly. Results PTI was not associated with baseline laboratory parameters or C-reactive protein or leukocytes examined as repeated measures through the 3-year follow-up. During follow-up, 22 patients had at least one episode of bacteremia, but only 2 of the bacteremias were considered to be of oral origin. PTI was not associated with incident bacteremia during follow-up. Thirty-six patients died during follow-up including 17 patients due to cardiovascular causes. During follow-up 42 patients were observed with a MACE. PTI was independently associated with all-cause (HR 1.074 95% CI 1.029–1.122, p = 0.001) and cardiovascular (HR 1.105, 95% CI 1.057–1.157, p<0.0001) mortality, as well as, incident MACEs (HR 1.071 95% CI 1.031–1.113, p = 0.0004) in the multivariable Cox models adjusted for age and kidney transplantation or CKD treatment modality during follow-up. Conclusions Radiographically assessed dental health is independently associated with all-cause and cardiovascular mortality and MACEs but not with the incidence of bacteremia in CKD stage 4–5 patients transitioning to maintenance dialysis and renal transplantation during follow-up.

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Incidence of fractures in middle-aged individuals with early chronic kidney disease: a population-based analysis of CARTaGENE

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfz259 ◽

2020 ◽

Vol 35 (10) ◽

pp. 1712-1721 ◽

Cited By ~ 1

Author(s):

Louis-Charles Desbiens ◽

Rémi Goupil ◽

François Madore ◽

Fabrice Mac-Way

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Population Based ◽

Fracture Incidence ◽

Administrative Databases ◽

Middle Aged ◽

Cox Models ◽

Ckd Stage ◽

Age And Sex

Abstract Background Previous studies evaluating fractures in chronic kidney disease (CKD) have mostly focused on hip or major fractures in aged populations with moderate to advanced CKD. We aimed at evaluating the association between early CKD and fracture incidence at all sites across age and sex in middle-aged individuals. Methods We analyzed CARTaGENE, a prospective population-based survey of 40- to 69-year-old individuals from Quebec (Canada). Estimated glomerular filtration rate (eGFR) at baseline was evaluated categorically or continuously using restricted cubic splines. Fractures at any site (except toes, hand and craniofacial) for up to 7 years of follow-up were identified through administrative databases using a validated algorithm. Adjusted Cox models were used to evaluate the association of CKD with fracture. Interaction terms for age and sex were also added. Results A total of 19 391 individuals (756 CKD Stage 3; 9114 Stage 2; 9521 non-CKD) were included and 829 fractures occurred during a median follow-up of 70 months. Compared with the median eGFR of 90 mL/min/1.73 m2, eGFRs of ≤60 mL/min/1.73 m2 were associated with increased fracture incidence in unadjusted and adjusted models [adjusted hazard ratio (HR) = 1.25 (95% confidence interval 1.05–1.49) for 60 mL/min/1.73 m2; 1.65 (1.14–2.37) for 45 mL/min/1.73 m2]. The eGFR was linearly associated with fracture incidence <75 mL/min/1.73 m2 [HR = 1.18 (1.04–1.34) per 10 mL/min/1.73 m2 decrease] but not above [HR = 0.98 (0.91–1.06) per 10 mL/min/1.73 m2 decrease). The effect of decreased eGFR on fracture incidence was more pronounced in younger individuals [HR = 2.45 (1.28–4.67) at 45 years; 1.11 (0.73–1.67) at 65 years] and in men. Conclusions Even early CKD increases fracture incidence, especially in younger individuals and in men.

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