A Body Mass Index-Based Cross-Classification Approach for the Assessment of Prognostic Factors in Chronic Kidney Disease Progression

Background/Aims: Cross-classification analyses are rarely reported. We investigated the prognostic factors for chronic kidney disease (CKD) progression using a body mass index (BMI)-based cross-classification approach. Methods: Patients’ renal outcome (≥50% decline in the estimated glomerular filtration rate or end-stage renal disease) in each subcohort was examined. Results: The number of prognostic factors identified in the multivariate Cox analysis was smaller in the “BMI ≥25, female” and CKD stage 3 subcohorts than in other subcohorts. Prognostic factors identified in the “BMI ≥25, CKD stage 3” subcohort only comprised albuminuria and male sex, and those in the “BMI ≥25, female” subcohort only comprised albuminuria, hyperphosphatemia, and anemia. Albuminuria, kidney impairment, male sex, hyperphosphatemia, anemia, and increased pulse pressure × heart rate product (PP × HR; pulsatile stress) were stable renal prognostic factors in almost all subcohorts. On the other hand, the prognostic value of increased BMI, younger age, hypoalbuminemia, increased intact parathyroid hormone, and decreased estimated 24-h urinary potassium excretion (e24hUK) differed according to subcohort. BMI was positively associated with CKD progression in the “BMI ≥25, age ≥65 years” and “BMI ≥25, CKD stages 4–5” subcohorts, whereas it was negatively associated with CKD progression in the “BMI <25, diabetes mellitus” subcohort. PP × HR was independently associated with CKD progression in the “BMI <25, CKD stage 3” subcohort, which had relatively few identified renal prognostic factors. Decreased e24hUK was a renal prognostic factor for CKD progression in the “BMI <25, CKD stages 4–5” subcohort, while no significant factors were observed in the “BMI ≥25, CKD stages 4–5” subcohort. Conclusion: A BMI-based cross-classification approach, which provides more comprehensive findings than that in previous approaches, is expected to be an effective method for evaluating renal prognostic factors in patients with CKD who are affected by multiple risk factors.

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The Risk of Tuberculosis Infection in Non-dialysis Chronic Kidney Disease Patients

Frontiers in Medicine ◽

10.3389/fmed.2021.715010 ◽

2021 ◽

Vol 8 ◽

Author(s):

Chia-Hsiang Li ◽

Hung-Jen Chen ◽

Wei-Chun Chen ◽

Chih-Yen Tu ◽

Te-Chun Hsia ◽

...

Keyword(s):

Body Mass Index ◽

Chronic Kidney Disease ◽

Renal Function ◽

Kidney Disease ◽

Body Mass ◽

Lower Risk ◽

Tuberculosis Infection ◽

University Hospital ◽

Ckd Stage ◽

Time Varying Covariates

Background: Patients with chronic kidney disease (CKD) receiving maintenance renal replacement therapy are at higher risk of tuberculosis (TB) infection. The risk of TB infection in CKD patients not receiving dialysis is unknown.Aim: We conduct this study to test the hypothesis that TB infection is negatively correlated to renal function.Design: Non-dialysis CKD stage 1–5 patients, admitted in China Medical University Hospital from January of 2003 to May of 2014, were enrolled in this study and were prospectively followed up to the diagnosis of TB, death, loss to follow-up, or December 2014. The risk factors of TB infection were analyzed using competing-risks regression analysis with time-varying covariates. The initiation of dialysis and patients' death were considered as competing events. Patients' estimated glomerular filtration rate (eGFR) and body mass index (BMI) were recorded at enrollment.Results: They were followed-up for a median duration of 1.4 years. Of the 7221 patients, TB infection was identified in 114 patients. Higher eGFR was associated with lower risk of TB infection (P < 0.01). The adjusted subdistribution hazard ratio (aSHR) was 0.82 [95% confidence interval (CI), 0.72 to 0.94] for every 5 ml/min/1.73 m2 increase in eGFR. In addition, higher BMI (p = 0.01) was associated with a lower risk of TB infection and the aSHR was 0.91 (95% CI, 0.85 to 0.98) for every 1 kg/m2 increase in BMI.Conclusion: Renal function and body mass index are independently associated with the risk of tuberculosis infection in patients with chronic kidney disease not receiving dialysis.

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Abstract P148: Association between Chronic Kidney Disease, Blood Pressure, HbA1c, and Body Mass Index with Healthcare Resource Utilization and Costs in Type 2 Diabetes Mellitus Patients

Circulation ◽

10.1161/circ.129.suppl_1.p148 ◽

2014 ◽

Vol 129 (suppl_1) ◽

Author(s):

Chien-Chia Chuang ◽

Edward Lee ◽

Erru Yang ◽

Sabyasachi Ghosh ◽

Alie Tawah ◽

...

Keyword(s):

Blood Pressure ◽

Body Mass Index ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Body Mass ◽

Resource Utilization ◽

Healthcare Resource ◽

Healthcare Resource Utilization ◽

Ckd Stage ◽

Stage 1

Background: Newer classes of oral anti-diabetic medications affect not only HbA1c but also weight and blood pressure (BP); however, the use and effects may be limited in patients with chronic kidney disease (CKD). To better understand the potential value of newer anti-diabetic medications, we assessed the individual and collective contribution of these co-existing conditions on healthcare resource utilization (HRU) and costs within a large US T2DM patient population. Methods: This study analyzed electronic health records from integrated delivery networks across the US between 2008 and 2012. Beginning at first evidence of T2DM diagnosis, adults with T2DM and medical and laboratory data observed were categorized by CKD, BP, HbA1c, and obesity status as observed in the 12-month post-index period.CKD stage 5 patients were excluded. HRU was assessed during the 12-month post-index period (i.e., physician office, outpatient, and emergency room [ER) visits and hospitalizations). Unit costs were assigned to HRU to estimate total medical costs. Regression models were performed to assess the association between clinical variables and HRU/costs. Results: The final study sample included 23,492 T2DM patients (mean age: 60.7 years; female: 52.2%). More advanced CKD and a higher systolic BP were associated with a higher risk of hospitalization/ER visits and more outpatient/physician visits. Higher HbA1c levels were associated with a higher risk of hospitalization/ER visits. The relationship between body mass index (BMI) and HRU varied. Compared to overweight patients, normal/underweight patients had significantly greater risk of being hospitalized and ER visits, while patients with obesity classes 1-3 had similar risk. CKD stage 1, 2, 3A, 3B, and 4 had total costs of 1.18, 1.17, 1.44, 1.54, and 1.80 times those of patients without CKD (all p<0.01). Compared to patients with HbA1c <7%, those with an HbA1c 7.5%-<8%, 8%-<9%, and ≥9% had 1.07, 1.17, and 1.24 times of total costs, respectively (all p<0.05). Patients with systolic BP 130-<140 and ≥140 mmHg had total costs 1.12 and 2.30 times those of patients with systolic BP<130mmHg (both p<0.01). Normal/underweight and obesity stage 1, 2, 3 patients showed a non-linear trend of having total costs of 1.13, 0.91, 0.92 and 1.07 times those of overweight patients, respectively (all p<0.01). Conclusions: Among T2DM patients, t here is a positive relationship between CKD, BP, and HbA1c on HRU/costs. These findings highlight the importance of managing comorbid conditions in T2DM patients. Future studies should investigate reasons for the relationships we observed between BMI and HRU/costs.

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P6199Lipoprotein(a) and risk of chronic kidney disease among 4,235 Japanese hospitalized patients

European Heart Journal ◽

10.1093/eurheartj/ehz746.0804 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

H Tada ◽

K Yamagami ◽

T Nishikawa ◽

A Nohara ◽

M Kawashiri ◽

...

Keyword(s):

Risk Factors ◽

Body Mass Index ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Body Mass ◽

Japanese Population ◽

Ldl Cholesterol ◽

Hdl Cholesterol ◽

University Hospital ◽

Ckd Stage

Abstract Background Lipoprotein (a) [Lp(a)] has been shown to be associated with the development of chronic kidney disease (CKD) among various ethnicities. In addition, recent Mendelian randomization studies have suggested that Lp(a) seems to be causally associated with CKD. However, few data exist regarding this issue among Japanese population. Purpose We aimed to investigate the association between serum Lp(a) and the CKD among Japanese population. Methods We retrospectively investigated 6,130 subjects whose serum Lp(a) had been measured for any reason (e.g. any operations which needs bed rest for a long duration, risk factors for atherosclerosis such as hypertension or diabetes) at our University Hospital from April 2004 to March 2014. We excluded 1,895 subjects due to the lack clinical data. We assessed their Lp(a), LDL cholesterol, HDL cholesterol, triglycerides, presence of hypertension, diabetes, chronic kidney disease, smoking, body mass index, presence of coronary artery disease (CAD), and presence of CKD (stage 3 or greater). Results When the study subjects were divided into 5 groups based on their CKD stage, there was a significant trend among their serum Lp(a) levels (P-trend = 2.7×10–13). Under these conditions, multiple regression analysis showed that Lp(a) was significantly associated with CKD [odds ratio (OR): 1.12, 95% confidence interval (CI): 1.08–1.17; p=1.3×10–7: per 10mg/dL)., independent of other classical risk factors, including age, gender, body mass index, hypertension, diabetes, smoking, LDL cholesterol and triglycerides. Under these conditions, Lp(a) was significantly associated with CAD [OR: 1.11, 95% CI: 1.06–1.16; p=1.7×10–6: per 10mg/dL), independent of the presence of CKD. Conclusion Serum Lp(a) was associated with the development of CKD independent of other classical risk factors among Japanese population as well.

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