Predictive factors of rapid linear renal progression and mortality in patients with chronic kidney disease

Abstract Background Risk factors predictive of rapid linear chronic kidney disease (CKD) progression and its associations with end-stage renal disease (ESRD) and mortality requires further exploration, particularly as patients with linear eGFR trajectory represent a clear paradigm for understanding true CKD progression. Methods A linear regression slope was applied to all outpatient estimated glomerular filtration rate (eGFR) values for patients in the Salford Kidney Study who had ≥2years follow-up, ≥4 eGFR values and baseline CKD stages 3a-4. An eGFR slope (ΔeGFR) of ≤-4ml/min/1.73m2/yr defined rapid progressors, whereas -0.5 to +0.5ml/min/1.73m2/yr defined stable patients. Binary logistic regression was utilised to explore variables associated with rapid progression and Cox proportional hazards model to determine predictors for mortality prior to ESRD. Results There were 157 rapid progressors (median ΔeGFR -5.93ml/min/1.73m2/yr) and 179 stable patients (median ΔeGFR -0.03ml/min/1.73m2/yr). Over 5 years, rapid progressors had an annual rate of mortality or ESRD of 47 per 100 patients compared with 6 per 100 stable patients. Factors associated with rapid progression included younger age, female gender, higher diastolic pressure, higher total cholesterol:high density lipoprotein ratio, lower albumin, lower haemoglobin and a urine protein:creatinine ratio of >50g/mol. The latter three factors were also predictive of mortality prior to ESRD, along with older age, smoking, peripheral vascular disease and heart failure. Conclusions There is a heterogenous interplay of risk factors associated with rapid linear CKD progression and mortality in patients with CKD. Furthermore, rapid progressors have high rates of adverse outcomes and require close specialist monitoring.

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Predictive Factors of Rapid Linear Renal Progression and Mortality in Patients with Chronic Kidney Disease

10.21203/rs.3.rs-25163/v1 ◽

2020 ◽

Author(s):

Ibrahim Ali ◽

Rajkumar Chinnadurai ◽

Sara T. Ibrahim ◽

Darren Green ◽

Philip Kalra

Keyword(s):

Risk Factors ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Diastolic Pressure ◽

Adverse Outcomes ◽

Cox Proportional Hazards Model ◽

Rapid Progression ◽

Ckd Progression ◽

Factors Associated ◽

Rapid Progressors

Abstract Background: Risk factors predictive of rapid linear chronic kidney disease (CKD) progression and its associations with end-stage renal disease (ESRD) and mortality requires further exploration, particularly as patients with linear eGFR trajectory represent a clear paradigm for understanding true CKD progression.Methods: A linear regression slope was applied to all outpatient estimated glomerular filtration rate (eGFR) values for patients in the Salford Kidney Study who had ≥ 2 years follow-up, ≥ 4 eGFR values and baseline CKD stages 3a-4. An eGFR slope (ΔeGFR) of ≤-4 ml/min/1.73 m2/yr defined rapid progressors, whereas − 0.5 to + 0.5 ml/min/1.73 m2/yr defined stable patients. Binary logistic regression was utilised to explore variables associated with rapid progression and Cox proportional hazards model to determine predictors for mortality prior to ESRD.Results: There were 157 rapid progressors (median ΔeGFR − 5.93 ml/min/1.73 m2/yr) and 179 stable patients (median ΔeGFR − 0.03 ml/min/1.73 m2/yr). Over 5 years, rapid progressors had an annual rate of mortality or ESRD of 47 per 100 patients compared with 6 per 100 stable patients. Factors associated with rapid progression included younger age, female gender, higher diastolic pressure, higher total cholesterol:high density lipoprotein ratio, lower albumin, lower haemoglobin and a urine protein:creatinine ratio of > 50 g/mol. The latter three factors were also predictive of mortality prior to ESRD, along with older age, smoking, peripheral vascular disease and heart failure.Conclusions: There is a heterogenous interplay of risk factors associated with rapid linear CKD progression and mortality in patients with CKD. Furthermore, rapid progressors have high rates of adverse outcomes and require close specialist monitoring.

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Clustering Heatmap for Visualizing and Exploring Complex and High-dimensional Data Related to Chronic Kidney Disease

Journal of Clinical Medicine ◽

10.3390/jcm9020403 ◽

2020 ◽

Vol 9 (2) ◽

pp. 403 ◽

Cited By ~ 5

Author(s):

Cheng-Sheng Yu ◽

Chang-Hsien Lin ◽

Yu-Jiun Lin ◽

Shiyng-Yu Lin ◽

Sen-Te Wang ◽

...

Keyword(s):

Risk Factors ◽

Health Care ◽

Chronic Kidney Disease ◽

High Risk ◽

Kidney Disease ◽

Complex Disease ◽

Early Recognition ◽

Adverse Outcomes ◽

Rapid Decline ◽

Rapid Progression

Background: Preventive medicine and primary health care are essential for patients with chronic kidney disease (CKD) because the symptoms of CKD may not appear until the renal function is severely compromised. Early identification of the risk factors of CKD is critical for preventing kidney damage and adverse outcomes. Early recognition of rapid progression to advanced CKD in certain high-risk populations is vital. Methods: This is a retrospective cohort study, the population screened and the site where the study has been performed. Multivariate statistical analysis was used to assess the prediction of CKD as many potential risk factors are involved. The clustering heatmap and random forest provides an interactive visualization for the classification of patients with different CKD stages. Results: uric acid, blood urea nitrogen, waist circumference, serum glutamic oxaloacetic transaminase, and hemoglobin A1c (HbA1c) were significantly associated with CKD. CKD was highly associated with obesity, hyperglycemia, and liver function. Hypertension and HbA1c were in the same cluster with a similar pattern, whereas high-density lipoprotein cholesterol had an opposite pattern, which was also verified using heatmap. Early staged CKD patients who are grouped into the same cluster as advanced staged CKD patients could be at high risk for rapid decline of kidney function and should be closely monitored. Conclusions: The clustering heatmap provided a new predictive model of health care management for patients at high risk of rapid CKD progression. This model could help physicians make an accurate diagnosis of this progressive and complex disease.

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MO478FACTORS ASSOCIATED IN RAPID PROGRESSION OF CHRONIC KIDNEY DISEASE: A MULTICENTRE, RETROSPECTIVE COHORT STUDY

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab090.0040 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Fei Yee Lee ◽

Farida Islahudin ◽

Hin-Seng Wong ◽

Sunita Bavanandan ◽

Nurul Ain Mohd Tahir ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Cohort Study ◽

Kidney Disease ◽

Roc Curve ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Rapid Progression ◽

Ckd Progression ◽

Goodness Of Fit Test ◽

Factors Associated

Abstract Background and Aims Identification of risk factors linked with rapid chronic kidney disease (CKD) progression is beneficial in shaping preventative and management strategies for maximal benefits out of the existing resources and capacity of care. To this end, the study aims to investigate the factors associated with rapid progression of CKD in the Asian population. Method This multi-centre, retrospective cohort study recruited adult CKD patients of ≥18 years in two tertiary hospitals with a history of at least two years of Nephrology CKD clinic follow-up and with index eGFR, defined by the first identified estimated glomerular filtration rate (eGFR) during the study period, of ≥30 ml/min/1.73 m2. eGFR was calculated via CKD-EPI equation. Patients with less than three nephrology CKD clinic visits and outpatient eGFR values during the study period were excluded. Demographic data, clinical information, laboratory data and medication history were collected from the electronic medical records from January 2018 to March 2020. Annual slopes of eGFR change were quantified using linear regression of outpatient, non-emergency eGFR values, with a decline of >5ml/min/1.73m2/year defined as rapid CKD progression. Multiple logistic regression was used to identify factors associated with rapid CKD progression, in which variables with p ≤ 0.05 were considered as factors associated with rapid progression of CKD, followed by the examination of multicollinearity and correlation between the factors, and the use of the Hosmer-Lemeshow goodness-of-fit test, classification tables and area under the receiving operator characteristic (ROC) curve. Statistical analysis was performed using SPSS Version 23. Results Among the 357 patients, 199 (55.7%) were men, median age was 61 years, while 105 (29.4%) patients had rapid CKD progression. The factors associated with rapid CKD progression after adjusting for possible confounding factors were Category A3 albuminuria (adjusted Odds Ratio [aOR] 2.217, 95% confidence interval [CI]: 1.241, 3.961), and adjustments to antihypertensives (aOR 1.158, 95% CI: 1.034, 1.296). Multicollinearity and interaction terms were not found, while the Hosmer-Lemeshow test (p=0.675), classification table (overall correctly classified percentage =69.8%) and area under the ROC curve (62.9%) were supportive of the model’s fitness. Conclusion Rapid CKD progression was observed among one-third of CKD patients in our practice setting. Category A3 albuminuria and adjustment to antihypertensives were factors of rapid CKD progression. Maladaptation from adjustments to antihypertensives might cause medication-related problems that might accelerate the progression of CKD. An alternative explanation is that adjustments were necessary because of poorly controlled hypertension which is a well-known risk factor for progressive CKD. Furthermore, with worsening kidney failure, hypertension becomes more difficult to control hence also necessitating medication adjustments. The findings could guide identification of CKD patients for enhanced pharmaceutical care and monitoring, especially when antihypertensives are adjusted, and during transition from hospitalisation to outpatient care.

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Effects of CYP3A5 Polymorphism on Rapid Progression of Chronic Kidney Disease: A Prospective, Multicentre Study

Journal of Personalized Medicine ◽

10.3390/jpm11040252 ◽

2021 ◽

Vol 11 (4) ◽

pp. 252

Author(s):

Fei Yee Lee ◽

Farida Islahudin ◽

Aina Yazrin Ali Nasiruddin ◽

Abdul Halim Abdul Gafor ◽

Hin-Seng Wong ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Logistic Regression ◽

Kidney Disease ◽

Personalised Medicine ◽

Rapid Progression ◽

Multiple Logistic Regression ◽

Ckd Progression ◽

Factors Associated ◽

Prospective Multicentre Study ◽

Cyp3a5 Polymorphism

Personalised medicine is potentially useful to delay the progression of chronic kidney disease (CKD). The aim of this study was to determine the effects of CYP3A5 polymorphism in rapid CKD progression. This multicentre, observational, prospective cohort study was performed among adult CKD patients (≥18 years) with estimated glomerular filtration rate (eGFR) ≥30 mL/min/1.73 m2, who had ≥4 outpatient, non-emergency eGFR values during the three-year study period. The blood samples collected were analysed for CYP3A5*3 polymorphism. Rapid CKD progression was defined as eGFR decline of >5 mL/min/1.73 m2/year. Multiple logistic regression was then performed to identify the factors associated with rapid CKD progression. A total of 124 subjects consented to participate. The distribution of the genotypes adhered to the Hardy–Weinberg equilibrium (X2 = 0.237, p = 0.626). After adjusting for potential confounding factors via multiple logistic regression, the factors associated with rapid CKD progression were CYP3A5*3/*3 polymorphism (adjusted Odds Ratio [aOR] 4.190, 95% confidence interval [CI]: 1.268, 13.852), adjustments to antihypertensives, young age, dyslipidaemia, smoking and use of traditional/complementary medicine. CKD patients should be monitored closely for possible factors associated with rapid CKD progression to optimise clinical outcomes. The CYP3A5*3/*3 genotype could potentially be screened among CKD patients to offer more individualised management among these patients.

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POS-495 RISK FACTORS ASSOCIATED WITH MORTALITY AMONG CHRONIC KIDNEY DISEASE PATIENTS ON REGULAR HEMODIALYSIS PRESENTING IN EMERGENCY SERVICES

Kidney International Reports ◽

10.1016/j.ekir.2021.03.522 ◽

2021 ◽

Vol 6 (4) ◽

pp. S214

Author(s):

T.M. SHRESTHA ◽

P.N. Prasad ◽

L. Bhusal ◽

R.P. Neupane ◽

R. Ghimire

Keyword(s):

Risk Factors ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Emergency Services ◽

Factors Associated ◽

Regular Hemodialysis

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Risk factors associated with valvular calcification in patients with chronic kidney disease. Analysis of NEFRONA study

Nefrología (English Edition) ◽

10.1016/j.nefroe.2021.08.002 ◽

2021 ◽

Vol 41 (3) ◽

pp. 337-346

Author(s):

Lidia Martínez Fernández ◽

J. Emilio Sánchez-Alvarez ◽

César Morís de la Tassa ◽

José Joaquín Bande Fernández ◽

Virtudes María ◽

...

Keyword(s):

Risk Factors ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Factors Associated ◽

Valvular Calcification ◽

Disease Analysis

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MO535PREVALENCE OF CHRONIC KIDNEY DISEASE AND ASSOCIATED RISK FACTORS ON THE ISLAND OF MONTSERRAT

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab087.0055 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Keniel Chrysostom ◽

Lori-Ann Fisher ◽

Everard Barton ◽

Adedamola Soyibo ◽

Grethlyn West ◽

...

Keyword(s):

Risk Factors ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Female Gender ◽

Health Care Facilities ◽

Cluster Sampling ◽

Long Term Effects ◽

Ckd Progression ◽

Cross Sectional ◽

The Caribbean

Abstract Background and Aims Chronic Kidney Disease (CKD) is a global health problem with disproportionate burden in low- and middle-income countries in Latin America and the Caribbean. Despite these disparities, little is known of the prevalence and risk factors of CKD in the Caribbean. We sought to determine prevalence of CKD among patients attending ambulatory centres in Montserrat, an island that to date, has no facilities for renal replacement therapy. Method A cross-sectional observational study of Participants were individuals aged ≥18 years was performed. Random cluster sampling of at least 500 participants who attended clinic from January 1 to July 1, 2020 across all primary health care facilities on island was performed. Patients without lab values for creatinine were excluded. The main outcome measures was estimated CKD prevalence (as defined based on KDIGO 2012 guidelines of eGFR < 60mL/min/1.73m2 using creatinine based CKD-EPI for blacks; and estimated prevalence of CKD risk factors (Self-reported diabetes or hypertension and obesity, BMI> 30kg/m2). Multivariate Logistic regression was used to determine independent predictors of CKD. Results Three hundred and fifty-five participants (n = 355) were selected for participation. Participants’ mean age was 63 ± 17 years, with 60% (n=213) being female. 38% (n=135) had self-reported diabetes and 58% (n=201) had hypertension; and 44% were obese. Mean± SD estimated GFR was 81 ± 30 ml/min/1.73 m2 . One quarter of the participants (25%) had an eGFR <60 ml/min/1.73 m2, indicating CKD. Age [95% CI, OR 1.03 (1.01–1.07)], Self-reported hypertension [95% CI, OR 2.09, (1.13–3.90)] and female gender [95% CI ,OR 0.20 (0.10, 0.39)] were independent predictors of reduced eGFR. Conclusion CKD and its risk factors were prevalent among adults in Montserrat. Consideration must be made for infrastructural and/or policy changes to be mandated, to slow the progression of CKD. Primary prevention initiatives can be implemented to reduce the associated morbidity, mortality and cost associated with CKD. There is room for further longitudinal studies to identify etiology, as well as factors affecting CKD progression. This study will also propel creation of the Montserrat arm of the Caribbean Renal Registry, to allow for future follow up of long-term effects, as well as ascertain risk factors for CKD progression.

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Abstract MP07: Soluble Urokinase-type Plasminogen Activator Receptor is associated with progression of hypertension-attributed chronic kidney disease in African Americans

Circulation ◽

10.1161/circ.137.suppl_1.mp07 ◽

2018 ◽

Vol 137 (suppl_1) ◽

Author(s):

Shengyuan Luo ◽

Josef Coresh ◽

Adrienne Tin ◽

Casey M Rebholz ◽

Teresa K Chen ◽

...

Keyword(s):

Chronic Kidney Disease ◽

African Americans ◽

Kidney Disease ◽

Plasminogen Activator ◽

Cox Proportional Hazards ◽

Adverse Outcomes ◽

Ckd Progression ◽

Type Plasminogen Activator ◽

Urokinase Type Plasminogen Activator ◽

Plasminogen Activator Receptor

Introduction: Soluble urokinase-type plasminogen activator receptor (suPAR), a circulating signaling protein and marker of immune activation, has been linked to incident and progressive chronic kidney disease (CKD) in select patient populations, often with few African Americans. Hypothesis: We assessed the hypothesis that higher circulating levels of suPAR are associated with risk for progression of hypertension-attributed CKD in African Americans. Methods: We quantified baseline plasma levels of suPAR in participants of the African-American Study of Kidney Disease and Hypertension (AASK), a clinical trial of African Americans with hypertension-attributed CKD, and regular assessment of measured glomerular filtration rate (mGFR), and proteinuria. We used Cox proportional hazards regression to assess the associations of suPAR with CKD progression (defined as doubling of serum creatinine or end-stage renal disease [ESRD]), ESRD, worsening proteinuria (pre-ESRD doubling of 24-hour urine protein to creatinine ratio [UPCR] to ≥220 mg/g), and all-cause death. Results: Among 955 AASK participants, the median baseline suPAR was 4462 pg/mL (25 th to 75 th percentile: 3425-5923 pg/mL), mean mGFR was 46 mL/min per 1.73 m 2 , and median 24-hour UPCR was 79.6 mg/g. After controlling for baseline demographics, AASK trial arm, mGFR, proteinuria, APOL1 risk status, and clinical risk factors, there was a 1.42-times higher risk for CKD progression per two-fold higher baseline suPAR (HR 1.42, 95% CI: 1.17-1.71, p <0.001). Higher suPAR was also independently associated with ESRD (HR 1.59, 95% CI: 1.26-2.00, p <0.001) and death (HR 1.40, 95% CI: 1.12-1.75, p =0.003). Only in patients with two APOL1 risk alleles was suPAR associated with worsening proteinuria (HR 1.77, 95% CI 1.11-2.82, p =0.016; p interaction =0.008). Conclusion: Our study provides evidence of associations between higher suPAR levels and risk for various adverse outcomes in African Americans with hypertension-attributed CKD, independent of proteinuria and GFR.

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