scholarly journals Kidney trajectory charts to assist general practitioners in the assessment of patients with reduced kidney function: a randomised vignette study

2021 ◽  
pp. bmjebm-2021-111767
Author(s):  
Michelle Guppy ◽  
Paul Glasziou ◽  
Elaine Beller ◽  
Richard Flavel ◽  
Jonathan E Shaw ◽  
...  
Keyword(s):  
Kidney Function ◽  
General Practitioners ◽  
Estimated Glomerular Filtration Rate ◽  
Clinical Problem ◽  
Older Woman ◽  
Normal Range ◽  
Vignette Study ◽  
Stable Renal Function ◽  
Reduced Kidney Function ◽  
Kidney Function Decline

ObjectiveTo investigate the decisional impact of an age-based chart of kidney function decline to support general practitioners (GPs) to appropriately interpret estimated glomerular filtration rate (eGFR) and identify patients with a clinically relevant kidney problem.Design and settingRandomised vignette studyParticipants372 Australian GPs from August 2018 to November 2018.InterventionGPs were given two patient case scenarios: (1) an older woman with reduced but stable renal function and (2) a younger Aboriginal man with declining kidney function still in the normal range. One group was given an age-based chart of kidney function to assist their assessment of the patient (initial chart group); the second group was asked to assess the patients without the chart, and then again using the chart (delayed chart group).Main outcome measuresGPs’ assessment of the likelihood—on a Likert scale—that the patients had chronic kidney disease (CKD) according to the usual definition or a clinical problem with their kidneys.ResultsPrior to viewing the age-based chart GPs were evenly distributed as to whether they thought case 1—the older woman—had CKD or a clinically relevant kidney problem. GPs who had initial access to the chart were less likely to think that the older woman had CKD, and less likely to think she had a clinically relevant problem with her kidneys than GPs who had not viewed the chart. After subsequently viewing the chart, 14% of GPs in the delayed chart group changed their opinion, to indicate she was unlikely to have a clinically relevant problem with her kidneys.Prior to viewing the chart, the majority of GPs (66%) thought case 2—the younger man—did not have CKD, and were evenly distributed as to whether they thought he had a clinically relevant kidney problem. In contrast, GPs who had initial access to the chart were more likely to think he had CKD and the majority (72%) thought he had a clinically relevant kidney problem. After subsequently viewing the chart, 37% of GPs in the delayed chart group changed their opinion to indicate he likely had a clinically relevant problem with his kidneys.ConclusionsUse of the chart changed GPs interpretation of eGFR, with increased recognition of the younger male patient’s clinically relevant kidney problem, and increased numbers classifying the older female patient’s kidney function as normal for her age. This study has shown the potential of an age-based kidney function chart to reduce both overdiagnosis and underdiagnosis.

scholarly journals Manifestations of Reduced Kidney Function Occur at a Higher Estimated Glomerular Filtration Rate in Sickle Cell Anemia

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 2268-2268
Author(s):  
Santosh L. Saraf ◽  
Vimal K. Derebail ◽  
Xu Zhang ◽  
Mark T Gladwin ◽  
Victor R Gordeuk ◽  
...  
Keyword(s):  
Alkaline Phosphatase ◽  
Kidney Disease ◽  
Kidney Function ◽  
Sickle Cell ◽  
Research Funding ◽  
Estimated Glomerular Filtration Rate ◽  
Linear Trend ◽  
Kidney Dysfunction ◽  
Lower Egfr ◽  
Reduced Kidney Function

Kidney disease is a common complication in sickle cell anemia (SCA), which leads to increased morbidity and early mortality. The National Kidney Foundation guidelines use an estimated glomerular filtration rate (eGFR) cutoff of 60 mL/min/1.73m2 to define chronic kidney disease (CKD). However, many SCA patients have an elevated baseline eGFR due to low serum creatinine levels from reduced muscle mass, abnormal tubular secretion of serum creatinine into the urine, and/or high cardiac output from the hemolytic anemia (PMID: 23894560, 20185605). The standard definition of CKD may represent a greater decline from "normal" kidney function in SCA patients compared to the general population. In two independent SCA (Hb SS or Sβ0-thalassemia) cohorts, we investigated eGFR cutoffs for when kidney dysfunction, assessed by altered electrolyte (serum potassium) and acid-base (serum HCO3) balance, osteodystrophy (alkaline phosphatase), increased blood pressure and impaired erythropoiesis (hemoglobin < 9 g/dL and absolute reticulocyte count < 250 x 109/L), were observed. Laboratory and clinical variables were obtained at outpatient visits at the time of enrolment. The eGFR categories were grouped as follows: > 120, 90 - 120, 60 - 89, and < 60 mL/min/1.73m2. We compared linear and categorical variables by eGFR category using the test for linear trend and Cochran's test for linear trend, respectively. Mean values and standard error bars are provided in the figures. We first conducted our analysis in 270 SCA patients treated at the University of Illinois at Chicago (UIC). The median age of the cohort was 31 years (interquartile range (IQR), 23 - 42 years), 59% were female, and 52% were on hydroxyurea. The proportion of SCA patients by eGFR category was as follows: 69% with eGFR > 120 mL/min/1.73m2, 13% with eGFR 90 - 120 mL/min/1.73m2, 9% with eGFR 60 - 89 mL/min/1.73m2, and 9% with eGFR < 60 mL/min/1.73m2. With progressively lower eGFR category, we observed higher serum potassium, alkaline phosphatase, systolic blood pressure, and proportion of patients with ineffective erythropoiesis and lower serum HCO3 (Figure 1A) (P ≤ 0.0002). We repeated our analyses in 456 SCA patients from the multi-center Walk-Treatment of Pulmonary Hypertension and Sickle cell disease with Sildenafil Therapy (Walk-PHaSST) cohort. The median age of the cohort was 34 years (IQR, 24 - 45 years), 52% were female, and 43% were on hydroxyurea. The proportion of SCA patients by eGFR category was as follows: 68.5% with eGFR > 120 mL/min/1.73m2, 15% with eGFR 90 - 120 mL/min/1.73m2, 8.5% with eGFR 60 - 89 mL/min/1.73m2, and 8% with eGFR < 60 mL/min/1.73m2. Manifestations of reduced kidney function were progressively worse with lower eGFR category (Figure 1B) (P ≤ 0.02). We then assessed the association of eGFR with altered kidney function using the test for linear trend in a combined analysis of SCA patients from UIC and Walk-PHaSST as well as in non-SCA African Americans adults from the National Health and Nutrition Examination Survey (NHANES) cohort (n = 1331). The median age of the NHANES cohort was 48 years (IQR, 29 - 62) and 53% were female. The associations between eGFR and kidney dysfunction, based on the beta coefficients, were stronger for serum HCO3, potassium, and alkaline phosphatase in SCA versus non-SCA patients (Figure 1C). The most significant associations between eGFR and kidney dysfunction were observed at an eGFR cutoff of 80 mL/min/1.73m2 for SCA patients, which was higher than the cutoffs observed in non-SCA patients for HCO3 (40 mL/min/1.73m2), potassium (50 mL/min/1.73m2), and alkaline phosphatase (60 mL/min/1.73m2). In conclusion, we demonstrate that kidney dysfunction occurs in SCA patients at eGFR values that are above the standard thresholds currently used to define CKD. Manifestations of kidney dysfunction progressively worsen with lower eGFR category and the differences are most significant at an eGFR < 80 mL/min/1.73m2. Future studies to redefine kidney disease in SCA based on eGFR may help identify high-risk patients for earlier intervention strategies and for the avoidance of potential nephrotoxins, such as nonsteroidal anti-inflammatory drugs and intravenous contrast. Disclosures Saraf: Novartis: Consultancy, Membership on an entity's Board of Directors or advisory committees; Pfizer: Research Funding. Derebail:Retrophin: Consultancy; RTI: Honoraria; Novartis: Consultancy. Gladwin:Globin Solutions, Inc: Patents & Royalties: Provisional patents for the use of recombinant neuroglobin and heme-based molecules as antidotes for CO poisoning; United Therapeutics: Patents & Royalties: Co-inventor on an NIH government patent for the use of nitrite salts in cardiovascular diseases ; Bayer Pharmaceuticals: Other: Co-investigator. Gordeuk:Global Blood Therapeutics: Consultancy, Honoraria, Research Funding; Emmaus: Consultancy, Honoraria; CSL Behring: Consultancy, Honoraria, Research Funding; Inctye: Research Funding; Modus Therapeutics: Consultancy, Honoraria; Novartis: Consultancy, Honoraria, Research Funding; Pfizer: Research Funding; Ironwood: Research Funding; Imara: Research Funding. Little:Hemex Health, Inc.: Patents & Royalties; GBT: Research Funding.

P0750ASSOCIATION OF SERUM POTASSIUM LEVELS WITH RAPID KIDNEY FUNCTION DECLINE IN PATIENTS WITH CONGENITAL SINGLE KIDNEY

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
FLORICA GADALEAN ◽  
Florina Parv ◽  
Ligia Petrica ◽  
SILVIA VELCIOV ◽  
Cristina Anca Gluhovschi ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Glomerular Filtration Rate ◽  
Kidney Function ◽  
Serum Potassium ◽  
Filtration Rate ◽  
Estimated Glomerular Filtration Rate ◽  
Plasma Potassium ◽  
Lower Serum ◽  
Kidney Function Decline ◽  
Single Kidney

Abstract Background and Aims Hypokalemia is associated with progression of chronic kidney disease (CKD), although the possible underlying mechanisms are not well established. Several observational studies showed that low or even low to normal serum potassium levels predict the decline of kidney function in the general population. However, this hypothesis has not been yet investigated in patients with reduced nephron number as are congenital single kidney (cSK) patients. Our aim was to prospectively examine the association of plasma potassium with risk of rapid kidney function decline in a cSK patients’ cohort. Method A cohort of 67 consecutive patients with cSK (mean age = 44.4+/-15.7 years; males 29p (43.28%)), with a mean estimated glomerular filtration rate (eGFR) = 65.2+/-28 ml/min/1.73m2, were enrolled in this longitudinal observational study. We evaluated the associations of plasma potassium levels with longitudinal kidney function decline by estimated glomerular filtration rate (eGFR). The eGFR was assessed with CKD-EPI formula. The rapid kidney function decline was defined as a fall in eGFR of more than 5 ml/min/1.73 m2/year, according to the KDIGO guidelines. Results During a mean follow-up time of 20.16+/-9.3 months, 31.34% (21p) of patients presented decline of eGFR, with a fall of mean – 11.6+/-5.43 ml/min/1.73m2/year. In univariable regression analysis, the decline of eGFR was associated with baseline eGFR (R2=0.09, p=0.013), age (R2=0.31, p&lt;0.001), male gender (R2=0.14, p=0.001), arterial hypertension (R2=0.17, p=0.001), diabetes mellitus (R2=0.13, p=0.003), coronary artery disease (R2=0.12, p=0.005), uric acid (R2=0.23, p&lt;0.001), C-reactive protein (R2=0.09, p=0.011), proteinuria/24h (R2=0.14, p=0.002) and serum potassium (R2=0.29, p&lt;0.001). The serum potassium levels were significantly lower in the group with rapid decline of eGFR, with a mean of 3.62+/-0.41 mmol/L vs. 4.51+/-0.74 mmol/L, p&lt;0.001. In multivariable regression analysis, the association between lower serum potassium levels and risk of rapid eGFR decline remained significant (HR=1.65; 95%CI, 1.105-2.49; p=0.015). Conclusion These results suggest that lower serum potassium levels may play a role in rapid kidney function decline in the cSK population. Further research is required to assess whether the higher risk of kidney function decline in cSK individuals could be diminished when optimised serum potassium levels strictly.

scholarly journals Dietary Patterns Based on Estimated Glomerular Filtration Rate and Kidney Function Decline in the General Population: The Lifelines Cohort Study

Nutrients ◽  
2020 ◽  
Vol 12 (4) ◽  
pp. 1099 ◽  
Author(s):  
Qingqing Cai ◽  
Louise H. Dekker ◽  
Stephan J. L. Bakker ◽  
Martin H. de Borst ◽  
Gerjan J. Navis
Keyword(s):  
Glomerular Filtration Rate ◽  
General Population ◽  
Glomerular Filtration ◽  
Kidney Function ◽  
Dietary Patterns ◽  
Filtration Rate ◽  
Estimated Glomerular Filtration Rate ◽  
High Consumption ◽  
Kidney Function Decline ◽  
Egfr Decline

No specific dietary patterns have been established that are linked with loss of kidney function. We aimed to identify an estimated glomerular filtration rate-based dietary pattern (eGFR-DP) and to evaluate its association with eGFR decline and chronic kidney disease (CKD) incidence in the general population. We included 78,335 participants from the Lifelines cohort in the Northern Netherlands. All participants had an eGFR >60 mL/min/1.73 m2 at baseline and completed a second visit five years later. The eGFR-DP was constructed at baseline using a 110-item food frequency questionnaire by reduced rank regression, stratified by sex. Logistic regression was performed to evaluated the association between the eGFR-DP score and either a ≥20% eGFR decline or incident CKD. Among women, eGFR-DP were characterized by high consumption of egg, cheese, and legumes and low consumption of sweets, white meat, and commercially prepared dishes. In men, eGFR-DP were characterized by high consumption of cheese, bread, milk, fruits, vegetables, and beer and low consumption of white and red meat. A higher eGFR-DP score was associated with a lower risk of a ≥20% eGFR decline (OR 4th vs. 1st quartile, women: 0.79 [95% CI: 0.73–0.87]; men: 0.67 [0.59–0.76]). The association between the eGFR-DP score and CKD incidence was lost upon adjustment for baseline eGFR. Our results provide support for dietary interventions to prevent kidney function decline in the general population.

Rate of Decline in Kidney Function and Age-of-Onset or Duration of Type 2 Diabetes

2021 ◽  
Author(s):  
Oyunchimeg Buyadaa ◽  
Agus Salim ◽  
Jedidiah I Morton ◽  
Dianna J Magliano ◽  
Jonathan E Shaw
Keyword(s):  
Type 2 Diabetes ◽  
Kidney Function ◽  
Estimated Glomerular Filtration Rate ◽  
Middle Age ◽  
Age Of Onset ◽  
Duration Of Diabetes ◽  
Rate Of Decline ◽  
Kidney Function Decline ◽  
Egfr Decline

Abstract The association between rate of kidney function decline and age-of-onset or duration of type 2 diabetes has not been well investigated. We aimed to examine whether rates of estimated glomerular filtration rate (eGFR) decline differ by age-of-onset or duration in people with type 2 diabetes. Using the Action to Control Cardiovascular Risk in Diabetes study dataset rates of eGFR decline were calculated using a joint-longitudinal-survival model and were compared among groups defined by the age-of-onset (0–39, 40–49, 50–59, 60–69 and > 70 years) and 5-year diabetes duration intervals. Changes in renal function were evaluated using median of 6 (interquartile range: 3–10) eGFR measurements per person. eGFR decline was the slowest in those with an age-at-diagnosis of 50 − 59 years or those with duration of diabetes < 5 years. The rates of eGFR decline were significantly greater in those with an age-of-onset < 40 years or those with duration of diabetes > 20 years compared to those diagnosed at 50 − 59 or those with duration of diabetes < 5 years (-1.98 vs -1.61 ml/min/year; -1.82 vs -1.52 ml/min/year; respectively (p < 0.001). Those with youngest age-of-onset or longest duration of type 2 diabetes had more rapid declines in eGFR compared to those diagnosed at middle age or those with shorter duration of diabetes.

scholarly journals Prevalence and health correlates of reduced kidney function among community-dwelling Chinese older adults: the China Health and Retirement Longitudinal Study

BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e042396
Author(s):  
Haiyu Jin ◽  
Jingyi Zhou ◽  
Chenkai Wu
Keyword(s):  
Older Adults ◽  
Glomerular Filtration Rate ◽  
Longitudinal Study ◽  
Kidney Disease ◽  
Kidney Function ◽  
Cardiac Disease ◽  
Filtration Rate ◽  
Estimated Glomerular Filtration Rate ◽  
South Central ◽  
Reduced Kidney Function

ObjectivesWe aimed to understand the prevalence of reduced kidney function in China by sociodemographics and geographical region, and to examine health correlates of reduced kidney function.DesignCross-sectional study.Setting and participantsParticipants were 6706 adults ≥60 years from the 2015–2016 wave of the China Health and Retirement Longitudinal Study.Outcome measuresReduced kidney function was defined as an estimated glomerular filtration rate of less than 60 mL/min per 1.73 m². The estimated glomerular filtration rate was calculated with the creatinine–cystatin C equation developed by the Chronic Kidney Disease Epidemiology Collaboration in 2012. The associations between reduced kidney function and potential risk factors were analysed using multivariable regression models.ResultsThe prevalence of reduced kidney function was 10.3% (95% CI: 9.3% to 11.2%), corresponding to approximately 20 million older adults. Multivariable analysis showed that older adults with hypertension (β=−3.61, 95% CI: −4.42 to 2.79), cardiac disease (β=−1.90, 95% CI: −2.93 to 0.86), who had a stroke (β=−3.75, 95% CI: −6.35 to 1.15), kidney disease (β=−3.88, 95% CI: −5.62 to 2.13), slow gait speed (β=−2.23, 95% CI: −3.27 to 1.20), and living in the South (β=−4.38, 95% CI: −5.95 to 2.80) and South Central (β=−1.85, 95% CI: −3.15 to 0.56) were more significantly likely to have reduced kidney function.ConclusionsKidney function screening should be performed, especially in patients with hypertension, cardiac disease and who had a stroke. More efforts should be paid to improve the kidney function of older adults living in the South and South Central parts of China.

scholarly journals Rate of decline in kidney function and known age-of-onset or duration of type 2 diabetes

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Oyunchimeg Buyadaa ◽  
Agus Salim ◽  
Jedidiah I. Morton ◽  
Dianna J. Magliano ◽  
Jonathan E. Shaw
Keyword(s):  
Type 2 Diabetes ◽  
Kidney Function ◽  
Estimated Glomerular Filtration Rate ◽  
Middle Age ◽  
Age Of Onset ◽  
Duration Of Diabetes ◽  
Rate Of Decline ◽  
Kidney Function Decline ◽  
Egfr Decline

AbstractThe association between rate of kidney function decline and age-of-onset or duration of diabetes has not been well investigated. We aimed to examine whether rates of estimated glomerular filtration rate (eGFR) decline differ by age-of-onset or duration in people with type 2 diabetes. Using the Action to Control Cardiovascular Risk in Diabetes study which included those with HbA1c ≥ 7.5% and who were at high risk of cardiovascular events,, rates of eGFR decline were calculated and were compared among groups defined by the known age-of-onset (0–39, 40–49, 50–59, 60–69 and > 70 years) and 5-year diabetes duration intervals. Changes in renal function were evaluated using median of 6 (interquartile range 3–10) eGFR measurements per person. eGFR decline was the slowest in those with known age-at-diagnosis of 50–59 years or those with duration of diabetes < 5 years. The rates of eGFR decline were significantly greater in those with known age-of-onset < 40 years or those with duration of diabetes > 20 years compared to those diagnosed at 50–59 or those with duration of diabetes < 5 years (− 1.98 vs − 1.61 mL/min/year; − 1.82 vs − 1.52 mL/min/year; respectively (p < 0.001). Those with youngest age-of-onset or longer duration of diabetes had more rapid declines in eGFR compared to those diagnosed at middle age or those with shorter duration of diabetes.

scholarly journals Housing Insecurity and Risk of Adverse Kidney Outcomes

Kidney360 ◽  
2020 ◽  
Vol 1 (4) ◽  
pp. 241-247 ◽  
Author(s):  
Tessa K. Novick ◽  
Chiazam Omenyi ◽  
Dingfen Han ◽  
Alan B. Zonderman ◽  
Michele K. Evans ◽  
...  
Keyword(s):  
Kidney Disease ◽  
Kidney Function ◽  
Healthy Aging ◽  
Social Determinant ◽  
Urine Albumin ◽  
Increased Risk ◽  
Multivariable Regression ◽  
Reduced Kidney Function ◽  
Relationship Of ◽  
Kidney Function Decline

BackgroundHousing insecurity is characterized by high housing costs or unsafe living conditions that prevent self-care and threaten independence. We examined the relationship of housing insecurity and risk of kidney disease.MethodsWe used longitudinal data from the Healthy Aging in Neighborhoods of Diversity across the Life Span study (Baltimore, MD). We used multivariable regression to quantify associations between housing insecurity and rapid kidney function decline (loss of >5 ml/min per 1.73 m2 of eGFR per year) and, among those without kidney disease at baseline, incident reduced kidney function (eGFR <60 ml/min per 1.73 m2) and incident albuminuria (urine albumin-creatinine ratio [ACR] ≥30 mg/g).ResultsAmong 1262 participants, mean age was 52 years, 40% were male and 57% were black. A total of 405 (32%) reported housing insecurity. After a median of 3.5 years of follow-up, rapid kidney function decline, incident reduced kidney function, and incident albuminuria occurred in 199 (16%), 64 (5%), and 74 (7%) participants, respectively. Housing insecurity was associated with increased odds of incident albuminuria (unadjusted OR, 2.04; 95% CI, 1.29 to 3.29; adjusted OR, 3.23; 95% CI, 1.90 to 5.50) but not rapid kidney function decline or incident reduced kidney function.ConclusionsIn this urban population, housing insecurity was associated with increased risk of subsequent albuminuria. Increased recognition of housing insecurity as a social determinant of kidney disease is needed, and risk-reduction efforts that specifically target populations experiencing housing insecurity should be considered.

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