Risk of venous thrombosis in patients with chronic kidney disease: identification of high-risk groups

Introduction: Chronic kidney disease (CKD) is a common disorder associated with increased cardiovascular mortality. The Intermountain Risk Score (IMRS) is an electronic risk calculator that utilizes the complete blood count (CBC), basic metabolic panel (BMP), age and sex to predict all-cause mortality. We tested whether IMRS predicts mortality in CKD patients (pts) and is additive to CKD staging. We also tested whether serum phosphate (PO4) or urinary albumin (U-alb)/creatinine (Cr) ratio adds predictive value. Methods: From October 2005 to May 2013, pts with CKD classes IIIa-V seen in the Intermountain Healthcare system with concurrent BMP and CBC tests were followed for survival at 1y (N=3,872) and 5y (N=3,727). Survival analyses were performed for pre-defined IMRS low-, medium- and high-risk groups for combined and separate CKD stages, and for PO4 and U-alb/Cr. Receiver operator characteristic curves were used to generate c-statistics. Results: For pts across the spectrum of CKD, mortality was significantly increased with medium- and high-risk compared to low-risk IMRS categories (1y medium-risk hazard ratio [HR]=4.60 [95% CI: 2.97, 7.12], 1y high-risk: HR=17.6, [11.46, 27.14]; and 5y medium-risk HR=2.5 [1.9, 3.2], 5y high-risk: HR=6.87 [5.44, 8.68], P < 0.001 for all). When adjusted for CKD stage, IMRS remained predictive (1y: HR=3.85 [2.47, 5.99] for medium-risk, HR=12.66 [8.11, 19.76] for high-risk; and 5y: HR=2.30 [1.80, 2.95] for medium-risk, HR=5.55 [4.36, 7.06] for high-risk, P < 0.001 for all). IMRS predicted 1y mortality more efficiently (c=0.735 [se 0.013]) than CKD stage (c=0.660 [se 0.013]); while combining IMRS and CKD stage increased the c-statistic to c=0.759 (se 0.014). PO4 predicted mortality (HR=1.23 [1.15-1.31]) but added only slightly to the IMRS 1y predictive ability (c=0.741 [se 0.016]). U-alb/Cr was not independently associated with mortality (HR=1.01 [0.99-1.01]). Conclusion: IMRS is a strong predictor of mortality in patients with CKD and is robustly complementary to CKD stage in refining risk stratification. Given the universal electronic availability and low cost of CBC and BMP, IMRS may represent a major advance in CKD risk assessment and management.

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Cost of Type 2 Diabetes Patients with Chronic Kidney Disease Based on Real-World Data: An Observational Population-Based Study in Spain

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18189853 ◽

2021 ◽

Vol 18 (18) ◽

pp. 9853

Author(s):

Ruth Usó-Talamantes ◽

Silvia González-de-Julián ◽

Javier Díaz-Carnicero ◽

Inmaculada Saurí-Ferrer ◽

José Luis Trillo-Mata ◽

...

Keyword(s):

Chronic Kidney Disease ◽

High Risk ◽

Kidney Disease ◽

Economic Impact ◽

Real World ◽

Healthcare Costs ◽

Risk Groups ◽

Health District ◽

Real World Data ◽

World Data

This study analyzed the prevalence, costs and economic impact of chronic kidney disease CKD in patients with T2D in a Spanish Health District using real-world data. Observational cross-sectional study in adult patients with T2D was through data extracted from the information systems of the Valencia Clínico–La Malvarrosa Health District in the year 2015. Patients were stratified with the KDIGO classification for CKD. Additionally, patients were assigned to Clinical Risk Groups (CRGs) according to multimorbidity. Direct costs of primary and specialized care, and medication were estimated. The prevalence of T2D in the database population (n = 28,345) was 10.8% (mean age (SD) = 67.8 years (13.9); 51.5% male). Up to 14.935 patients (52.6%) had data on kidney function. According to the KDIGO classification, 66.2% of the patients were at low risk of CKD, 20.6% at moderately increased risk, 7.9% at high risk, and 5.2% at very high risk. The average healthcare costs associated with these four risk groups were EUR 3437, EUR 4936, EUR 5899 and EUR 7389, respectively. The large number of T2D patients with CKD in the early stages of the disease generated a significant increase in direct healthcare costs. The economic impact could be mitigated by early and comprehensive therapeutic approaches.

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Risk for recurrent cardiovascular disease events among patients with diabetes and chronic kidney disease

Cardiovascular Diabetology ◽

10.1186/s12933-021-01247-0 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Demetria Hubbard ◽

Lisandro D. Colantonio ◽

Robert S. Rosenson ◽

Todd M. Brown ◽

Elizabeth A. Jackson ◽

...

Keyword(s):

Myocardial Infarction ◽

Cardiovascular Disease ◽

Chronic Kidney Disease ◽

Health Insurance ◽

High Risk ◽

Kidney Disease ◽

Peripheral Artery ◽

Increased Risk ◽

Patients With Diabetes ◽

Very High

Abstract Background Adults who have experienced multiple cardiovascular disease (CVD) events have a very high risk for additional events. Diabetes and chronic kidney disease (CKD) are each associated with an increased risk for recurrent CVD events following a myocardial infarction (MI). Methods We compared the risk for recurrent CVD events among US adults with health insurance who were hospitalized for an MI between 2014 and 2017 and had (1) CVD prior to their MI but were free from diabetes or CKD (prior CVD), and those without CVD prior to their MI who had (2) diabetes only, (3) CKD only and (4) both diabetes and CKD. We followed patients from hospital discharge through December 31, 2018 for recurrent CVD events including coronary, stroke, and peripheral artery events. Results Among 162,730 patients, 55.2% had prior CVD, and 28.3%, 8.3%, and 8.2% had diabetes only, CKD only, and both diabetes and CKD, respectively. The rate for recurrent CVD events per 1000 person-years was 135 among patients with prior CVD and 110, 124 and 171 among those with diabetes only, CKD only and both diabetes and CKD, respectively. Compared to patients with prior CVD, the multivariable-adjusted hazard ratio for recurrent CVD events was 0.92 (95%CI 0.90–0.95), 0.89 (95%CI: 0.85–0.93), and 1.18 (95%CI: 1.14–1.22) among those with diabetes only, CKD only, and both diabetes and CKD, respectively. Conclusion Following MI, adults with both diabetes and CKD had a higher risk for recurrent CVD events compared to those with prior CVD without diabetes or CKD.

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Optimal Protein Intake in Pre-Dialysis Chronic Kidney Disease Patients with Sarcopenia: An Overview

Nutrients ◽

10.3390/nu13041205 ◽

2021 ◽

Vol 13 (4) ◽

pp. 1205

Author(s):

Yoshitaka Isaka

Keyword(s):

Chronic Kidney Disease ◽

High Risk ◽

Kidney Disease ◽

Muscle Mass ◽

Exercise Therapy ◽

Protein Intake ◽

Renin Angiotensin System ◽

Protein Restriction ◽

Ckd Stage ◽

End Stage

Multi-factors, such as anorexia, activation of renin-angiotensin system, inflammation, and metabolic acidosis, contribute to malnutrition in chronic kidney disease (CKD) patients. Most of these factors, contributing to the progression of malnutrition, worsen as CKD progresses. Protein restriction, used as a treatment for CKD, can reduce the risk of CKD progression, but may worsen the sarcopenia, a syndrome characterized by a progressive and systemic loss of muscle mass and strength. The concomitant rate of sarcopenia is higher in CKD patients than in the general population. Sarcopenia is also associated with mortality risk in CKD patients. Thus, it is important to determine whether protein restriction should be continued or loosened in CKD patients with sarcopenia. We may prioritize protein restriction in CKD patients with a high risk of end-stage kidney disease (ESKD), classified to stage G4 to G5, but may loosen protein restriction in ESKD-low risk CKD stage G3 patients with proteinuria <0.5 g/day, and rate of eGFR decline <3.0 mL/min/1.73 m2/year. However, the effect of increasing protein intake alone without exercise therapy may be limited in CKD patients with sarcopenia. The combination of exercise therapy and increased protein intake is effective in improving muscle mass and strength in CKD patients with sarcopenia. In the case of loosening protein restriction, it is safe to avoid protein intake of more than 1.5 g/kgBW/day. In CKD patients with high risk in ESKD, 0.8 g/kgBW/day may be a critical point of protein intake.

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MO817ALDOSTERONE ANTAGONISTS FOR PATIENTS WITH CHRONIC KIDNEY DISEASE REQUIRING DIALYSIS

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab098.009 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Takeshi Hasegawa ◽

Hiroki Nihiwaki ◽

Erika Ota ◽

William Levack ◽

Hisashi Noma

Keyword(s):

Chronic Kidney Disease ◽

High Risk ◽

Kidney Disease ◽

Standard Care ◽

Meta Analysis ◽

Cardiovascular Death ◽

Aldosterone Antagonists ◽

Mortality And Morbidity ◽

Risk Of Death ◽

Increased Risk

Abstract Background and Aims Patients with chronic kidney disease (CKD) undergoing dialysis are at a particularly high risk of cardiovascular mortality and morbidity. This systematic review and meta-analysis aimed to evaluate the benefits and harms of aldosterone antagonists, both non-selective (spironolactone) and selective (eplerenone), in comparison to control (placebo or standard care) in patients with CKD requiring haemodialysis or peritoneal dialysis. Method We searched the Cochrane Kidney and Transplant Register of Studies up to 29 July 2019 using search terms relevant to this review. Studies in the Register are identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Register Search Portal and ClinicalTrials.gov. We included individual and cluster randomised controlled trials (RCTs), cross-over trials, and quasi-RCTs that compared aldosterone antagonists with placebo or standard care in patients with CKD requiring dialysis. We used a random-effects model meta-analysis to perform a quantitative synthesis of the data. We used the I2 statistic to measure heterogeneity among the trials in each analysis. We indicated summary estimates as a risk ratio (RR) for dichotomous outcomes with their 95% confidence interval (CI). We assessed the certainty of the evidence for each of the main outcomes using the GRADE (Grades of Recommendation, Assessment, Development, and Evaluation) approach. Results We included 16 trials (14 parallel RCTs and two cross-over trials) involving a total of 1,446 patients. Among included studies, 13 trials compared spironolactone to placebo or standard care and one trial compared eplerenone to a placebo. Most studies had an unclear or high risk of bias. Compared to control, aldosterone antagonists reduced the risk of all-cause death for patients with CKD requiring dialysis (9 trials, 1,119 patients: RR 0.45, 95% CI 0.30 to 0.67; moderate certainty of evidence). Aldosterone antagonist also decreased the risk of death due to cardiovascular disease (6 trials, 908 patients: RR 0.37, 95% CI 0.22 to 0.64; moderate certainty of evidence) and cardiovascular and cerebrovascular morbidity (3 trials, 328 patients: RR 0.38, 95% CI 0.18 to 0.76; moderate certainty of evidence). While aldosterone antagonists had an apparent increased risk of gynaecomastia compared with control (4 trials, 768 patients: RR 5.95, 95% CI 1.93 to 18.3; moderate certainty of evidence), the elevated risk of hyperkalaemia due to aldosterone antagonists was uncertain (9 trials, 981 patients: RR 1.41, 95% CI 0.72 to 2.78; low certainty of evidence). Conclusion Based on moderate certainty of the evidence, aldosterone antagonists could reduce the risk of all-cause and cardiovascular death and morbidity due to cardiovascular and cerebrovascular disease but increase the risk of gynaecomastia in patients with CKD requiring dialysis.

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

American Journal of Nephrology ◽

10.1159/000495082 ◽

2018 ◽

Vol 48 (6) ◽

pp. 447-455 ◽

Cited By ~ 2

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.

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