Screening strategies for chronic kidney disease in the general population: follow-up of cross sectional health survey

AbstractFew studies have investigated the incidence of cardiovascular disease (CVD) in the Asian chronic kidney disease (CKD) population. This study assessed the incidence of CVD, death, and a composite outcome of CVD and death in a prospective Korean predialysis CKD cohort. From a total of 2179 patients, incidence rates were analyzed, and competing risk analyses were conducted according to CKD stage. Additionally, incidence was compared to the general population. During a median 4.1 years of follow-up, the incidence of CVD, all-cause death, and the composite outcome was 17.2, 9.6, and 24.5 per 1000 person-years, respectively. These values were higher in diabetic vs. non-diabetic subjects (P < 0.001). For all outcomes, incidence rates increased with increasing CKD stage (CVD, P = 0.001; death, P < 0.001; and composite, P < 0.001). Additionally, CKD stage G4 [hazard ratio (HR) 2.8, P = 0.008] and G5 (HR 5.0, P < 0.001) were significant risk factors for the composite outcome compared to stage G1 after adjustment. Compared to the general population, the total cohort population (stages G1–G5) showed significantly higher risk of CVD (HR 2.4, P < 0.001) and the composite outcome (HR 1.7, P < 0.001). The results clearly demonstrate that CKD is a risk factor for CVD in an Asian population.

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Risk for chronic kidney disease increases with obesity: Health Survey for England 2010

Public Health Nutrition ◽

10.1017/s1368980015000488 ◽

2015 ◽

Vol 18 (18) ◽

pp. 3349-3354 ◽

Cited By ~ 13

Author(s):

Helen L MacLaughlin ◽

Wendy L Hall ◽

Thomas AB Sanders ◽

Iain C Macdougall

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Health Survey ◽

Normal Weight ◽

Overweight And Obesity ◽

Service Planning ◽

Cross Sectional ◽

Increased Risk ◽

Nationally Representative ◽

Health Survey For England

AbstractObjectiveStudies of the relationship between obesity and chronic kidney disease (CKD) in nationally representative population samples are limited. Our study aimed to determine if overweight and obesity were independently associated with the risk for CKD in the 2010 Health Survey for England (HSE).DesignThe HSE is an annually conducted cross-sectional study. In 2010 serum creatinine was included to determine the incidence of CKD in the population. CKD was defined as estimated glomerular filtration rate (eGFR) <60 ml/min per 1·73 m2 using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula. Multivariable logistic regression models were developed to calculate odds ratios and 95 % confidence intervals for CKD risk by BMI (reference category: BMI=18·5–24·9 kg/m2) and adjusted for age, gender, ethnicity, smoking, diabetes and hypertension.SettingA random sample of nationally representative households in England.SubjectsAdults (n 3463) with calculable eGFR and BMI were included.ResultsThe prevalence of CKD was 5·9 %. The risk of CKD was over 2·5 times higher in obese participants compared with normal-weight participants in the fully adjusted model (BMI=30·0–39·9 kg/m2: adjusted OR=2·78 (95 % CI 1·75, 4·43); BMI ≥ 40·0 kg/m2: adjusted OR=2·68 (95 % CI 1·05, 6·85)).ConclusionsObesity is associated with an increased risk of CKD in a national sample of the UK population, even after adjustment for known CKD risk factors, which may have implications for CKD screening and future national health service planning and delivery.

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Effects of Parathyroidectomy on Plasma iPTH and (1–84) PTH Levels in Patients with Stage 5 Chronic Kidney Disease

Hormone and Metabolic Research ◽

10.1055/a-0723-2807 ◽

2018 ◽

Vol 50 (10) ◽

pp. 761-767 ◽

Cited By ~ 1

Author(s):

Chen Huimin ◽

Cui Ying ◽

Xing Changying ◽

Zha Xiaoming ◽

Zhang Yan ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Cross Sectional Study ◽

Third Generation ◽

Intact Parathyroid Hormone ◽

Sectional Study ◽

Cross Sectional ◽

The Third ◽

Follow Up Study

AbstractCurrently, the second-generation intact parathyroid hormone (iPTH) assay is commonly used for measuring PTH levels. The iPTH assay detects both full-length (1–84)PTH and (7–84)PTH fragments, which have antagonistic effects on (1–84)PTH in bones and kidneys. The third-generation PTH assay is specific for (1–84)PTH. This study examined the features of different PTH fragments in stage 5 chronic kidney disease (CKD) and the effects of parathyroidectomy (PTX) on the above markers in severe secondary hyperparathyroidism (SHPT) patients. The cross-sectional study included 262 stage 5 CKD patients and 90 controls. A prospective follow-up study was then conducted in 34 PTX patients. Second- and third-generation assays were used to measure plasma iPTH and (1–84)PTH levels, respectively. Circulating (7–84)PTH levels were calculated by subtracting the (1–84)PTH value from the iPTH value. Different plasma PTH fragments were higher, and (1–84)PTH/iPTH was lower in CKD patients than in controls. Plasma (1–84)PTH and (7–84)PTH concentrations increased as iPTH levels increased, and (7–84)PTH increased more evidently. Plasma iPTH, (1–84)PTH and (7–84)PTH levels were 1530.5 (885.0–2111.5) pg/ml, 683.1 (431.4–1018.0) pg/ml, and 739.3 (452.6–1261.0) pg/ml, respectively, in PTX patients. Plasma iPTH, (1–84)PTH and (7–84)PTH concentrations decreased considerably, and the (1–84)PTH/iPTH ratio increased after PTX (median follow-up interval: 10.9 months). Stage 5 CKD patients had higher plasma levels of different PTH fragments, and lower (1–84)PTH/iPTH ratio. PTX could significantly reverse these abnormalities in severe SHPT patients. The iPTH assay overestimated the function of the parathyroid glands; thus, the third-generation PTH assay is likely better for the management of CKD patients.

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The role of circulating galectin-1 in type 2 diabetes and chronic kidney disease: evidence from cross-sectional, longitudinal and Mendelian randomisation analyses

Diabetologia ◽

10.1007/s00125-021-05594-1 ◽

2021 ◽

Author(s):

Isabel Drake ◽

Emanuel Fryk ◽

Lena Strindberg ◽

Annika Lundqvist ◽

Anders H. Rosengren ◽

...

Keyword(s):

Type 2 Diabetes ◽

Chronic Kidney Disease ◽

Diabetic Nephropathy ◽

Kidney Disease ◽

Kidney Function ◽

Mendelian Randomisation ◽

Cross Sectional ◽

Genome Wide

Abstract Aims/hypothesis Galectin-1 modulates inflammation and angiogenesis, and cross-sectional studies indicate that galectin-1 may be a uniting factor between obesity, type 2 diabetes and kidney function. We examined whether circulating galectin-1 can predict incidence of chronic kidney disease (CKD) and type 2 diabetes in a middle-aged population, and if Mendelian randomisation (MR) can provide evidence for causal direction of effects. Methods Participants (n = 4022; 58.6% women) in the Malmö Diet and Cancer Study–Cardiovascular Cohort enrolled between 1991 and 1994 (mean age 57.6 years) were examined. eGFR was calculated at baseline and after a mean follow-up of 16.6 ± 1.5 years. Diabetes status was ascertained through registry linkage (mean follow-up of 18.4 ± 6.1 years). The associations of baseline galectin-1 with incident CKD and type 2 diabetes were assessed with Cox regression, adjusting for established risk factors. In addition, a genome-wide association study on galectin-1 was performed to identify genetic instruments for two-sample MR analyses utilising the genetic associations obtained from the Chronic Kidney Disease Genetics (CKDGen) Consortium (41,395 cases and 439,303 controls) and the DIAbetes Genetics Replication And Meta-analysis (DIAGRAM) consortium (74,124 cases and 824,006 controls). One genome-wide significant locus in the galectin-1 gene region was identified (sentinel SNP rs7285699; p = 2.4 × 10−11). The association between galectin-1 and eGFR was also examined in individuals with newly diagnosed diabetes from the All New Diabetics In Scania (ANDIS) cohort. Results Galectin-1 was strongly associated with lower eGFR at baseline (p = 2.3 × 10−89) but not with incident CKD. However, galectin-1 was associated with increased risk of type 2 diabetes (per SD increase, HR 1.12; 95% CI 1.02, 1.24). Two-sample MR analyses could not ascertain a causal effect of galectin-1 on CKD (OR 0.92; 95% CI 0.82, 1.02) or type 2 diabetes (OR 1.05; 95% CI 0.98, 1.14) in a general population. However, in individuals with type 2 diabetes from ANDIS who belonged to the severe insulin-resistant diabetes subgroup and were at high risk of diabetic nephropathy, genetically elevated galectin-1 was significantly associated with higher eGFR (p = 5.7 × 10−3). Conclusions/interpretation Galectin-1 is strongly associated with lower kidney function in cross-sectional analyses, and two-sample MR analyses suggest a causal protective effect on kidney function among individuals with type 2 diabetes at high risk of diabetic nephropathy. Future studies are needed to explore the mechanisms by which galectin-1 affects kidney function and whether it could be a useful target among individuals with type 2 diabetes for renal improvement. Graphical abstract

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Screening for Chronic Kidney Disease in Adult Males in Vojvodina: A Cross-Sectional Study

Journal of Medical Biochemistry ◽

10.1515/jomb-2017-0006 ◽

2017 ◽

Vol 36 (2) ◽

pp. 153-162 ◽

Cited By ~ 3

Author(s):

Velibor Čabarkapa ◽

Branislava Ilinčić ◽

Mirjana Đerić ◽

Isidora Radosavkić ◽

Mirko Špovac ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

General Population ◽

Cross Sectional Study ◽

Urine Specimen ◽

Adult Males ◽

Sectional Study ◽

Cross Sectional ◽

Early Stage Disease ◽

Arterial Blood

Summary Background: Chronic kidney disease (CKD) is one of the most significant global health problems accompanied by numerous complicatons, with constant increase in the number of affected people. This number is much higher in early phases of disease and patients are mostly asymptomatic, so early detection of CKD is crucial. The aim was examination of the prevalence of CKD in the general population of males in Vojvodina, based on estimated glomerular filtration rate (eGFR) and urine albumin/creatinine ratio (ACR), and exploring the determinants and awareness of CKD. Methods: This cross-sectional study included 3060 male examinees from the general population, over 18 years of age, whose eGFR and ACR were calculated, first morning urine specimen examined, arterial blood pressure measured and body mass index calculated. Standard biochemistry methods determined creatinine, urea, uric acid and glucose serum concentrations as well as albumin and creatinine urine levels. Results: Prevalence of CKD in the adult male population is 7.9%, highest in men over 65 years of age (46.7%), while in the other age groups it is 3.6-12.6%. The largest number of examinees with a positive CKD marker suffer from arterial hypertension (HTA) and diabetes mellitus (DM). Only 1.3% of examinees with eGFR<60 ml/min/1.73 m2 and/or ACR≥ 3 mg/mmol had been aware of positive CKD biomarkers. Conclusions: Obtained results show the prevalence of CKD in adult males is 7.9%, HTA and DM are the most important CKD risk factors and the level of CKD awareness is extremely low (1.3%) indicating the necessity for introduction of early stage disease recognition measures, including raising CKD awareness.

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Plasma potassium ranges associated with mortality across stages of chronic kidney disease: the Stockholm CREAtinine Measurements (SCREAM) project

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfy249 ◽

2018 ◽

Vol 34 (9) ◽

pp. 1534-1541 ◽

Cited By ~ 11

Author(s):

Alessandro Gasparini ◽

Marie Evans ◽

Peter Barany ◽

Hairong Xu ◽

Tomas Jernberg ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Estimated Glomerular Filtration Rate ◽

Plasma Potassium ◽

Small Scale ◽

Cross Sectional ◽

Ckd Stage ◽

Lower Egfr ◽

Threatening Condition

Abstract Background Small-scale studies suggest that hyperkalaemia is a less threatening condition in chronic kidney disease (CKD), arguing adaptation/tolerance to potassium (K+) retention. This study formally evaluates this hypothesis by estimating the distribution of plasma K+ and its association with mortality across CKD stages. Methods This observational study included all patients undergoing plasma K+ testing in Stockholm during 2006–11. We randomly selected one K+ measurement per patient and constructed a cross-sectional cohort with mortality follow-up. Covariates included demographics, comorbidities, medications and estimated glomerular filtration rate (eGFR). We estimated K+ distribution and defined K+ ranges associated with 90-, 180- and 365-day mortality. Results Included were 831 760 participants, of which 70 403 (8.5%) had CKD G3 (eGFR <60–30 mL/min) and 8594 (1.1%) had CKD G4–G5 (eGFR <30 mL/min). About 66 317 deaths occurred within a year. Adjusted plasma K+ increased across worse CKD stages: from median 3.98 (95% confidence interval 3.49–4.59) for eGFR >90 to 4.43 (3.22–5.65) mmol/L for eGFR ≤15 mL/min/1.73 m2. The association between K+ and mortality was U-shaped, but it flattened at lower eGFR strata and shifted upwards. For instance, the range where the 90-day mortality risk increased by no more than 100% was 3.45–4.94 mmol/L in eGFR >60 mL/min, but was 3.36–5.18 in G3 and 3.26–5.53 mmol/L in G4–G5. In conclusion, CKD stage modifies K+ distribution and the ranges that predict mortality in the community. Conclusion Although this study supports the view that hyperkalaemia is better tolerated with worse CKD, it challenges the current use of a single optimal K+ range for all patients.

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Abstract 3149: Is Plasma B-type Natriuretic Peptide Measurement Valid for Prediction of Cardiovascular Events in Chronic Kidney Disease? A Community-Based Longitudinal Study

Circulation ◽

10.1161/circ.118.suppl_18.s_1103-b ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Masafumi Sakuma ◽

Motoyuki Nakamura ◽

Fumitaka Tanaka ◽

Toshiyuki Onoda ◽

Shinji Makita ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

General Population ◽

Natriuretic Peptide ◽

Cardiovascular Events ◽

Composite Endpoint ◽

Community Based ◽

Mdrd Equation ◽

Artery Disease

Elevated plasma B-type natriuretic peptide (BNP) levels have been reported to be a marker for risk of cardiovascular events (CVE) including heart failure, coronary artery disease and stroke in the general population. However, plasma BNP is increased by renal dysfunction, and it is therefore not known whether plasma BNP might be a reliable biomarker for predicting onset of CVE in the cohort with impaired renal function as represented by chronic kidney disease (CKD). Baseline data including plasma BNP, serum creatinine, and urine protein were determined in 14265 participants from a community-based population. Estimated glomerular filtration rate (eGFR) was calculated using a modified MDRD equation, and CKD was defined by the following two methods (Def 1 = eGFR<60 ml/min/1.73m 2 and/or proteinuria; Def 2 = eGFR<60 ml/min/1.73m 2 ). Numbers of CKD subjects were 1927 according to Def 1 and 1604 according to Def 2. CVE endpoint was surveyed prospectively. The mean follow-up duration was 2.9 years. After adjustment for traditional cardiovascular risk factors and atrial fibrillation, relative risk (RR) for CVE was significantly higher in the highest BNP quartile compared to the lowest BNP quartile according to both definitions (Def 1, RR=3.51, p<0.01: Def 2, RR=4.67, p<0.01) (Figure ). Furthermore, the RR for a composite endpoint of CVE and death was also significantly higher in the highest BNP quartile, again by both definitions (Def1, RR=2.71, p<0.01: Def 2, RR=3.09, p<0.02). Measurement of plasma BNP levels provides strong predictive information about future onset of CVE and death, even in CKD subjects selected from the general population.

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