scholarly journals Trans-ethnic Mendelian randomization study reveals causal relationships between cardio-metabolic factors and chronic kidney disease

2020 ◽  
Author(s):  
Jie Zheng ◽  
Yuemiao Zhang ◽  
Humaira Rasheed ◽  
Venexia Walker ◽  
Yuka Sugawara ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Mendelian Randomization ◽  
East Asian ◽  
Causal Effects ◽  
European Ancestry ◽  
East Asians ◽  
East Asian Ancestry

BACKGROUND The chronic kidney disease (CKD) public health burden is substantial and has not declined as expected with current interventions on disease treatments. A large number of clinical, biological, and behavioural risk factors have been associated with CKD. However, it is unclear which of them are causal. OBJECTIVE To systematically test whether previously reported risk factors for CKD are causally related to the disease in European and East Asian ancestries. DESIGN Two-sample Mendelian randomization (MR) and non-linear MR analyses. PARTICIPANTS 53,703 CKD cases and 960,624 controls of European ancestry from CKDGen, UK Biobank and HUNT, and 13,480 CKD cases and 238,118 controls of East Asian ancestry from Biobank Japan, China Kadoorie Biobank and Japan-Kidney-Biobank/ToMMo. MEASURES Systematic literature mining of PubMed studies identified 45 clinical risk factors and biomarkers with robustly associated genetic variants, including phenotypes related to blood pressure, diabetes, glucose, insulin, lipids, obesity, smoking, sleep disorders, nephrolithiasis, uric acid, coronary artery disease, bone mineral density, homocysteine, C-reactive protein, micro-nutrients and thyroid function, which were selected as exposures. The outcome was CKD (defined by clinical diagnosis or by estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73m2). RESULTS Eight risk factors showed evidence of causal effects on CKD in European ancestry, including body mass index (BMI), hypertension, systolic blood pressure, high density lipoprotein cholesterol, apolipoprotein A-I, lipoprotein A, type 2 diabetes (T2D) and nephrolithiasis. In East Asian ancestry, BMI, T2D and nephrolithiasis showed evidence of causal effects on CKD. Hypertension showed reliable evidence of a strong causal effect on CKD in Europeans but in contrast appeared to show a null effect in East Asians, suggesting the possibility of different causal risk factors in Europeans and East Asians. Although liability to T2D showed consistent effects on CKD, the effect of glycemic traits on CKD was weak, suggesting T2D may have glucose-independent mechanisms to influence CKD. Non-linear MR indicated a threshold relationship between genetically predicted BMI and CKD, with increased risk at BMI above 25 kg/m2. LIMITATION Due to the unbalanced distribution of data between ancestries, we could only test 17 of the 45 risk factors in East Asian participants. CONCLUSIONS Eight CKD-associated risk factors showed evidence of causal effects on the disease in over 1.2 million European and East Asian ancestries. These risk factors were predominantly related to cardio-metabolic health, which supports the shared causal link between cardio-metabolic health and kidney function. This study provides evidence of potential intervention targets for primary prevention of CKD, which could help reduce the global burden of CKD and its cardio-metabolic co-morbidities.

scholarly journals Identifying High-Risk Individuals for Chronic Kidney Disease: Results of the CHERISH Community Demonstration Project

2018 ◽  
Vol 48 (6) ◽  
pp. 447-455 ◽  
Author(s):  
Nilka Ríos Burrows ◽  
Joseph A. Vassalotti ◽  
Sharon H. Saydah ◽  
Rebecca Stewart ◽  
Monica Gannon ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Chronic Kidney Disease ◽  
High Risk ◽  
Kidney Disease ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Demonstration Project ◽  
Screening Criteria ◽  
State And Local

Background: Most people with chronic kidney disease (CKD) are not aware of their condition. Objectives: To assess screening criteria in identifying a population with or at high risk for CKD and to determine their level of control of CKD risk factors. Method: CKD Health Evaluation Risk Information Sharing (CHERISH), a demonstration project of the Centers for Disease Control and Prevention, hosted screenings at 2 community locations in each of 4 states. People with diabetes, hypertension, or aged ≥50 years were eligible to participate. In addition to CKD, screening included testing and measures of hemoglobin A1C, blood pressure, and lipids. ­Results: In this targeted population, among 894 people screened, CKD prevalence was 34%. Of participants with diabetes, 61% had A1C < 7%; of those with hypertension, 23% had blood pressure < 130/80 mm Hg; and of those with high cholesterol, 22% had low-density lipoprotein < 100 mg/dL. Conclusions: Using targeted selection criteria and simple clinical measures, CHERISH successfully identified a population with a high CKD prevalence and with poor control of CKD risk factors. CHERISH may prove helpful to state and local programs in implementing CKD detection programs in their communities.

Mendelian Randomization Analysis as a Tool to Gain Insights into Causes of Diseases: A Primer

2021 ◽  
pp. ASN.2020121760
Author(s):  
Adrienne Tin ◽  
Anna Köttgen
Keyword(s):  
Risk Factors ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Mendelian Randomization ◽  
Mr Studies ◽  
Causal Relationships ◽  
Omics Technologies ◽  
Basic Concepts ◽  
Traditional Risk Factors ◽  
Randomization Analysis

Many Mendelian randomization (MR) studies have recently been published, with inferences on the causal relationships between risk factors and diseases that have potential implications for clinical research. In nephrology, MR methods have been applied to investigate potential causal relationships of traditional risk factors, lifestyle factors, and biomarkers from omics technologies with kidney function or chronic kidney disease. This primer summarizes the basic concepts of MR studies, highlighting methods employed in recent applications, and emphasizes key elements in conducting and reporting of MR studies that are important for interpreting the results.

scholarly journals The Metabolic Syndrome and Risk of Chronic Kidney Disease: Pathophysiology and Intervention Strategies

2012 ◽  
Vol 2012 ◽  
pp. 1-9 ◽  
Author(s):  
Heather A. LaGuardia ◽  
L. Lee Hamm ◽  
Jing Chen
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Metabolic Syndrome ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Intervention Strategies ◽  
Elevated Blood ◽  
The Metabolic Syndrome ◽  
Prevalence Of Obesity ◽  
Complications And Mortality

Metabolic syndrome is characterized by a clustering of cardiovascular risk factors, including abdominal obesity, elevated blood pressure and glucose concentrations, and dyslipidemia. The presence of this clinical entity is becoming more pervasive throughout the globe as the prevalence of obesity increases worldwide. Moreover, there is increased recognition of the complications and mortality related to this syndrome. This paper looks to examine the link between metabolic syndrome and the development of chronic kidney disease.

scholarly journals Chronic Kidney Disease and Associated Risk Factors Assessment among Diabetes Mellitus Patients at A Tertiary Hospital, Northwest Ethiopia

1970 ◽  
Vol 28 (6) ◽  
Author(s):  
Shewaneh Damtie ◽  
Belete Biadgo ◽  
Habtamu Wondifraw Baynes ◽  
Sintayehu Ambachew ◽  
Tadele Melak ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Blood Pressure ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Systolic Blood Pressure ◽  
Older Age ◽  
Diabetic Patients ◽  
Study Participants

BACKGROUND: The prevalence of chronic kidney disease, particularly in diabetic patients, is increasing rapidly throughout the world. Nowadays, many individuals in developing nations are suffering from diabetes which is one of the primary risk factors of chronic kidney disease.METHODS: Institution based cross-sectional study was conducted at the University of Gondar Hospital from February to April 2016. A total of 229 study participants were selected using systematic random sampling technique. Urine sample was collected for albumin determination by dipstick. The Simplified Modification of Diet in Renal Disease study equation was used to estimate glomerular filtration rate. Binary logistic regression model was used to identify risk factors.RESULTS: Of the total 229 study participants, 50.2% were females and the mean age was 47±15.7 years. Among study participants, the prevalence of chronic kidney disease (CKD) was found to be 21.8% (95% CI: 16% - 27%). Of all study participants, 9(3.9%) had renal impairment (eGFR < 60 ml/min/ 1.73 m2) and 46 (20.1%) had albuminuria. Older age (AOR: 5.239, 95% CI: 2.255-12.175), systolic blood pressure ≥140mmHg (AOR: 3.633, 95% CI: 1.597-8.265), type 2 diabetes mellitus (AOR: 3.751, 95% CI: 1.507-9.336) and longer duration of diabetes (AOR: 3.380, 95% CI: 1.393-8.197) were independent risk factors of CKD.CONCLUSIONS: The study identified high prevalence (21.8%) of CKD among diabetic adults. CKD was significantly associated with older age, systolic blood pressure, type 2 DM and longer duration of DM. Thus, DM patients should be diagnosed for chronic kidney disease and then managed accordingly. 

P1857SALT CONSUMPTION, LIFESTYLE AND PROTEINURIA IN A HETEROGENEOUS YOUNG POPULATION

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Claudia Zullo ◽  
Lorenzo Dallari ◽  
Alfredo Bagalà ◽  
Chiara Somma ◽  
Giuseppe Ferro ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Dietary Habits ◽  
Salt Intake ◽  
World Health ◽  
Dietary Salt ◽  
Dietary Salt Intake ◽  
Italian Regions

Abstract Background and Aims Obesity, hypertension, smoke, high dietary salt intake and physical inactivity are the main modifiable risk factors for chronic kidney disease, that affects about 9-10% of Italian people. About daily salt intake, the World Health Organization recommends a maximum consumption of 5 grams of salt per day. In Italy, most people consume too much salt – on average 8-10 grams per day or around twice the recommended maximum level of intake. Aim of this study was to investigate dietary habits and lifestyle of the heterogeneous students population of “Scuola Carabinieri di Firenze” (attended by people coming from all Italian regions) and their relations with urinary abnormalities. Method from November 2018 to March 2019 we collected anamnestic and anthropometric data, blood pressure measurements and body cellular mass (BCM) of 257 young subjects (152 males, 105 females; mean age 32 + 11 yy). We determinated sodium, chlorine and protein excretion on a spot urine sample in addition to plasma creatinine levels. Statistical analyses were performed using SPSS. Results We analyzed preliminary data of urinary sodium excretion (UNa), proteinuria (Up) and hematuria (Urbc) of all the subjects. Fifty-five percent of them had a UNa higher than 100 mmol/L (approximately equivalent to a dietary salt intake of 6 grams/day). In these subjects with higher salt consumption, Up and Urbc, measured by urine dipstick, were detectable in 32% and 21% respectively. In subjects with lower salt intake (less than 6 grams/day), Up and Urbc were 0% and 5% respectively. To determine if there was an association between our variables, we used Pearson correlation coefficient. We found that UNa was directly related to Up (r 0.26, p 0.002), age (r 0.22 p 0.011) and diastolic blood pressure (DBP, r 0.22, p 0.012). We also found that poor exercise (r -0.15, p 0.7) and low lean body mass percentage (r -0.15, p 0.7) were inversely related to UNa. Conclusion high dietary salt intake is associated with elevated blood pressure and proteinuria in a young and “healthy” population. Hypertension and proteinuria are both known risk factors for the development of chronic kidney disease. Wrong dietary habits and lifestyles must be detected and corrected in order to prevent nephropathy onset.

Nocturnal Dipping and Left Ventricular Mass Index in the Chronic Kidney Disease in Children Cohort

2021 ◽  
pp. CJN.09810721
Author(s):  
Christine Bakhoum ◽  
Ronit Katz ◽  
Joshua Samuels ◽  
Tala Al-Rousan ◽  
Susan Furth ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Chronic Kidney Disease ◽  
African American ◽  
Kidney Disease ◽  
Left Ventricular Mass Index ◽  
Sodium Intake ◽  
Left Ventricular ◽  
Spline Regression ◽  
African American Race

Background and objectives: The physiological nocturnal blood pressure decline is often blunted in patients with chronic kidney disease (CKD); however, the consequences of blood pressure non-dipping in children are largely unknown. Our objective was to determine risk factors for non-dipping and to investigate if non-dipping is associated with higher left ventricular mass index (LVMI) in children with CKD. Design, setting, participants, and measurements: We conducted a cross-sectional analysis of ambulatory blood pressure monitoring and echocardiographic data in participants of the Chronic Kidney Disease in Children study. Multivariable linear and spline regression analyses were used to evaluate the relationship of risk factors with dipping, and of dipping with LVMI. Results: Within 552 participants, mean age was 11 (± 4) years, mean eGFR was 53 (± 20) ml/min/1.73m2, and 41% were classified as non-dippers. In subjects with non-glomerular CKD, female sex and higher sodium intake were significantly associated with less systolic and diastolic dipping (p≤ 0.05). In those with glomerular CKD, African American race and greater proteinuria were significantly associated with less systolic and diastolic dipping (p≤ 0.05). Systolic and diastolic dipping were not significantly associated with LVMI; however, in spline regression plots, diastolic dipping appeared to have a non-linear relationship with LVMI. As compared to diastolic dipping of 20-25%, dipping of < 20% was associated with 1.41 g/m2.7 higher LVMI (95% CI -0.47, 3.29), and dipping of > 25% was associated with 1.98 g/m2.7 higher LVMI (95% CI -0.77, 4.73), though these relationships did not achieve statistical significance. Conclusion: African American race, female sex, and greater proteinuria and sodium intake were significantly associated with blunted dipping in children with CKD. We did not find a statistically significant association between dipping and LVMI.

scholarly journals Risk factors mediating the effect of body mass index and waist-to-hip ratio on cardiovascular outcomes: Mendelian randomization analysis

2021 ◽  
Author(s):  
Dipender Gill ◽  
Verena Zuber ◽  
Jesse Dawson ◽  
Jonathan Pearson-Stuttard ◽  
Alice R. Carter ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Body Mass Index ◽  
Body Mass ◽  
Mendelian Randomization ◽  
European Ancestry ◽  
Standard Deviation Increase ◽  
Waist To Hip Ratio ◽  
Artery Disease

Abstract Background Higher body mass index (BMI) and waist-to-hip ratio (WHR) increase the risk of cardiovascular disease, but the extent to which this is mediated by blood pressure, diabetes, lipid traits, and smoking is not fully understood. Methods Using consortia and UK Biobank genetic association summary data from 140,595 to 898,130 participants predominantly of European ancestry, Mendelian randomization mediation analysis was performed to investigate the degree to which systolic blood pressure (SBP), diabetes, lipid traits, and smoking mediated an effect of BMI and WHR on the risk of coronary artery disease (CAD), peripheral artery disease (PAD) and stroke. Results The odds ratio of CAD per 1-standard deviation increase in genetically predicted BMI was 1.49 (95% CI 1.39 to 1.60). This attenuated to 1.34 (95% CI 1.24 to 1.45) after adjusting for genetically predicted SBP (proportion mediated 27%, 95% CI 3% to 50%), to 1.27 (95% CI 1.17 to 1.37) after adjusting for genetically predicted diabetes (41% mediated, 95% CI 18% to 63%), to 1.47 (95% CI 1.36 to 1.59) after adjusting for genetically predicted lipids (3% mediated, 95% −23% to 29%), and to 1.46 (95% CI 1.34 to 1.58) after adjusting for genetically predicted smoking (6% mediated, 95% CI −20% to 32%). Adjusting for all the mediators together, the estimate attenuated to 1.14 (95% CI 1.04 to 1.26; 66% mediated, 95% CI 42% to 91%). A similar pattern was observed when considering genetically predicted WHR as the exposure, and PAD or stroke as the outcome. Conclusions Measures to reduce obesity will lower the risk of cardiovascular disease primarily by impacting downstream metabolic risk factors, particularly diabetes and hypertension. Reduction of obesity prevalence alongside control and management of its mediators is likely to be most effective for minimizing the burden of obesity.

scholarly journals Community-Based Screening for Chronic Kidney Disease, Hypertension and Diabetes in Dharan

2013 ◽  
Vol 52 (189) ◽  
pp. 205-212 ◽  
Author(s):  
Sanjib Kumar Sharma ◽  
Subodh Dhakal ◽  
Lekhjung Thapa ◽  
Anup Ghimire ◽  
Rikesh Tamrakar ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Intervention Program ◽  
Lifestyle Modification ◽  
Fasting Blood Glucose ◽  
Management Program ◽  
Community Based ◽  
Spot Urine

Introduction: Nepal cannot afford renal replacement therapy for End Stage Renal Disease due to lack of resources. Early diagnosis of Chronic Kidney Disease and its risk factors may reduce the need of renal replacement therapy.Methods:A community-based screening on, 3218 people ≥20 years were assessed by door-to-door survey in Dharan, Nepal. Health status, lifestyle habit, physical examination and blood pressure were evaluated. Spot urine was examined for proteins and glucose by dipstick. Fasting blood glucose and serum creatinine were measured in a subset of 1000 people and the prevalence of Chronic Kidney Disease was evaluated.Results: Overweight, obesity, hypertension, diabetes and proteinuria were found in 20%, 5.0%, 38.6%, 7.5%, and 5.1% respectively. In the subset group, Chronic Kidney Disease was detected in 10.6%. Multivariate analysis indicated age (P <0.0001) and diabetes (P = 0.027) as statistically significant predictors for Chronic Kidney Disease. Total of 848 patients entered the management program of lifestyle modification and pharmacologic intervention. Glycemic and blood pressure control was achieved in 60% and 72%, respectively. Regression or stabilization of proteinuria was reported in 52% of patients. Conclusions: Burden of Chronic Kidney Disease and cardiovascular risk factors are high in Dharan. Reasonable control of blood sugar, hypertension and proteinuria was achieved in this program. Findings indicate that activation a large prevention and intervention program to tackle Chronic Kidney Disease and Cardiovascular Disease in Nepal is needed.Keywords: chronic kidney disease; community-screening; diabetes; hypertension; intervention; Nepal.

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