scholarly journals Comparison of Outcomes of Chronic Kidney Disease Based on Etiology: A Prospective Cohort Study

2021 ◽  
Author(s):  
Hyunjin Ryu ◽  
Yeji Hong ◽  
Eunjeong Kang ◽  
Minjung Kang ◽  
Jayoun Kim ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Cohort Study ◽  
Kidney Disease ◽  
Kidney Failure ◽  
Adverse Outcomes ◽  
Hypertensive Nephropathy ◽  
Relative Risks ◽  
Hazard Ratios ◽  
Renal Progression ◽  
Egfr Decline

Abstract Background and objectivesThe cause of chronic kidney disease (CKD) affects outcomes. However, relative risks for adverse outcomes according to specific causes of CKD are not well studied.Design, setting, participants and measurementsProspective cohort study from KNOW-CKD cohort were analyzed using overlap propensity score weighting methods. Patients were grouped into four categories according to the cause of CKD: glomerulonephritis (GN), diabetic nephropathy (DN), hypertensive nephropathy (HTN), or polycystic kidney disease (PKD). From a total of 2,070 patients, the relative risk of kidney failure, composite of cardiovascular disease (CVD) and mortality, and the slope of the estimated glomerular filtration rate (eGFR) decline according to the cause of CKD were compared between causative groups pairwisely.ResultsThere were 565 cases of kidney failure and 259 cases of composite CVD and death over 6.0 years of follow-up. Hazard ratios of the PKD group for kidney failure were significantly increased at 1.82, 2.23, and 1.73 compared to GN, HTN, and DN, respectively. Hazard ratios of the DN group for the composite of CVD and death were also significantly increased at 2.07, and 1.73 compared to GN, and HTN, respectively. The adjusted eGFR decline slope for DN and PKD groups was -3.07, and -3.37 mL/min/1.73m2 per year, respectively, and all of these values were significantly different than those of the GN and HTN groups (-2.16, and -1.42 mL/min/1.73m2 per year, respectively).ConclusionsRisks for renal progression were relatively higher in patients with PKD compared to other causes of CKD. However, the composite of CVD and death were relatively higher in patients with DN-related CKD than those with GN- and HTN-related CKD.

scholarly journals P0795OUTCOME COMPARISON STUDY ACCORDING TO THE CAUSE OF CHRONIC KIDNEY DISEASE: RESULTS FROM KNOW-CKD STUDY

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Hyunjin Ryu ◽  
Yeji Hong ◽  
Jayoun Kim ◽  
Curie Ahn ◽  
Yun Kyu Oh ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Mixed Model ◽  
Linear Mixed Model ◽  
Adverse Outcomes ◽  
Hypertensive Nephropathy ◽  
Linear Pattern ◽  
Hazard Ratios ◽  
Egfr Slope

Abstract Background and Aims The cause of chronic kidney disease (CKD) is one of important factors for predicting the outcome. However, relative risks for the adverse outcomes according to the specific causes of CKD is unknown. Method Using the longitudinal data of prospective cohort of Korean predialysis CKD, KNOW-CKD cohort, the relative risk of end-stage renal disease (ESRD), composite of ESRD development or creatinine doubling, and composite of cardiovascular disease (CVD) and all-cause mortality according to the cause of CKD were compared. The patients were subgrouped in to four categories at the study entry according to the cause of CKD: glomerulonephritis (GN), diabetic nephropathy (DN), hypertensive nephropathy (HTN), and polycystic kidney disease (PKD). Since the baseline characteristics differed according to the causes of CKD, the inverse probability of treatment weighting (IPTW) methods was used to exclude the effects of other variables on the outcomes. The estimated glomerular filtration rate (eGFR) slope during follow-up was calculated for each cause of CKD using linear mixed model Results During the median follow-up of 4.1 years (interquartile range 1.12-7.12 years) total 441 (21.5%) of ESRD, 556 (27.1%) of composite of ESRD or creatinine doubling and 190 (9.3%) composite of CVD and all cause death occurred. In the IPTW adjusted cohorts, DN and PKD showed significantly increased hazard ratios of 1.85 and 5.57 for ESRD development and 1.74 and 4.57 for composite of ESRD developement or creatinine doubling, respectively, compared to GN in the fully adjusted model. Regarding compsite of CVD and all-cause death, also DN and PKD showed significantly increased hazard ratios of 1.93 and 2.16 compared to GN. The adjusted eGFR slope for DN, HTN and PKD was -2.32, -0.90, and -2.41 mL/min/1.73m2 per year, respectively, and all differ statistically significantly compared to GN (eGFR slope of -1.49 mL/min/1.73m2 per year). During the follow-up, GN and DN showed linear declining pattern however, HTN and PKD showed convex linear pattern. Conclusion The DN and PKD showed relatively higher risks for renal progression and composite of CVD and death compared to GN.

scholarly journals Pre-eclampsia and risk of later kidney disease: nationwide cohort study

BMJ ◽  
2019 ◽  
pp. l1516 ◽  
Author(s):  
Jonas H Kristensen ◽  
Saima Basit ◽  
Jan Wohlfahrt ◽  
Mette Brimnes Damholt ◽  
Heather A Boyd
Keyword(s):  
Chronic Kidney Disease ◽  
Cohort Study ◽  
Kidney Disease ◽  
Outcome Measure ◽  
Cox Regression ◽  
Hazard Ratio ◽  
Hazard Ratios ◽  
Gestational Age At Delivery ◽  
History Of

ABSTRACTObjectiveTo investigate associations between pre-eclampsia and later risk of kidney disease.DesignNationwide register based cohort study.SettingDenmark.PopulationAll women with at least one pregnancy lasting at least 20 weeks between 1978 and 2015.Main outcome measureHazard ratios comparing rates of kidney disease between women with and without a history of pre-eclampsia, stratified by gestational age at delivery and estimated using Cox regression.ResultsThe cohort consisted of 1 072 330 women followed for 19 994 470 person years (average 18.6 years/woman). Compared with women with no previous pre-eclampsia, those with a history of pre-eclampsia were more likely to develop chronic renal conditions: hazard ratio 3.93 (95% confidence interval 2.90 to 5.33, for early preterm pre-eclampsia (delivery <34 weeks); 2.81 (2.13 to 3.71) for late preterm pre-eclampsia (delivery 34-36 weeks); 2.27 (2.02 to 2.55) for term pre-eclampsia (delivery ≥37 weeks). In particular, strong associations were observed for chronic kidney disease, hypertensive kidney disease, and glomerular/proteinuric disease. Adjustment for cardiovascular disease and hypertension only partially attenuated the observed associations. Stratifying the analyses on time since pregnancy showed that associations between pre-eclampsia and chronic kidney disease and glomerular/proteinuric disease were much stronger within five years of the latest pregnancy (hazard ratio 6.11 (3.84 to 9.72) and 4.77 (3.88 to 5.86), respectively) than five years or longer after the latest pregnancy (2.06 (1.69 to 2.50) and 1.50 (1.19 to 1.88). By contrast, associations between pre-eclampsia and acute renal conditions were modest.Conclusions Pre-eclampsia, particularly early preterm pre-eclampsia, was strongly associated with several chronic renal disorders later in life. More research is needed to determine which women are most likely to develop kidney disease after pre-eclampsia, what mechanisms underlie the association, and what clinical follow-up and interventions (and in what timeframe post-pregnancy) would be most appropriate and effective.

scholarly journals The dapagliflozin and prevention of adverse outcomes in chronic kidney disease (DAPA-CKD) trial: baseline characteristics

2020 ◽  
Vol 35 (10) ◽  
pp. 1700-1711 ◽  
Author(s):  
David C Wheeler ◽  
Bergur V Stefansson ◽  
Mikhail Batiushin ◽  
Oleksandr Bilchenko ◽  
David Z I Cherney ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Enzyme Inhibitor ◽  
Kidney Diseases ◽  
Sglt2 Inhibitor ◽  
Adverse Outcomes ◽  
Chronic Glomerulonephritis ◽  
Hypertensive Nephropathy ◽  
Wide Range ◽  
Baseline Characteristics

Abstract Background The Dapagliflozin and Prevention of Adverse outcomes in Chronic Kidney Disease (DAPA-CKD; NCT03036150) trial was designed to assess the effect of the sodium–glucose co-transporter 2 (SGLT2) inhibitor dapagliflozin on kidney and cardiovascular events in participants with CKD with and without type 2 diabetes (T2D). This analysis reports the baseline characteristics of those recruited, comparing them with those enrolled in other trials. Methods In DAPA-CKD, 4304 participants with a urinary albumin:creatinine ratio (UACR) ≥200 mg/g and estimated glomerular filtration rate (eGFR) between 25 and 75 mL/min/1.73 m2 were randomized to dapagliflozin 10 mg once daily or placebo. Mean eGFR was 43.1 mL/min/1.73 m2 and median UACR was 949 mg/g (108 mg/mmol). Results Overall, 2906 participants (68%) had a diagnosis of T2D and of these, 396 had CKD ascribed to a cause other than diabetes. The most common causes of CKD after diabetes (n = 2510) were ischaemic/hypertensive nephropathy (n = 687) and chronic glomerulonephritis (n = 695), of which immunoglobulin A nephropathy (n = 270) was the most common. A total of 4174 participants (97%) were receiving an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker, 1882 (43.7%) diuretics, 229 (5.3%) mineralocorticoid receptor antagonists and 122 (2.8%) glucagon-like peptide 1 receptor agonists. In contrast to the Canagliflozin and Renal Events in Diabetes with Established Nephropathy Clinical Evaluation (CREDENCE), the DAPA-CKD trial enrolled participants with CKD due to diabetes and to causes other than diabetes. The mean eGFR of participants in the DAPA-CKD trial was 13.1 mL/min/1.73 m2 lower than in CREDENCE, similar to that in the Finerenone in Reducing Kidney Failure and Disease Progression in DKD (FIDELIO-DKD) trial and the Study Of diabetic Nephropathy with AtRasentan (SONAR). Conclusions Participants with a wide range of underlying kidney diseases receiving renin–angiotensin system blocking therapy have been enrolled in the DAPA-CKD trial. The trial will examine the efficacy and safety of dapagliflozin in participants with CKD Stages 2–4 and increased albuminuria, with and without T2D.

Nephrology consultation and kidney failure in people with stage 4 chronic kidney disease: a population-based cohort study

2020 ◽  
Author(s):  
Ping Liu ◽  
Robert R. Quinn ◽  
Giuliana Cortese ◽  
Mohamed Mahsin ◽  
Matthew T. James ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Cohort Study ◽  
Kidney Disease ◽  
Kidney Failure ◽  
Population Based ◽  
Stage 4

scholarly journals A Paradigm to Discover Biomarkers Associated With Chronic Kidney Disease Progression

2020 ◽  
Vol 15 ◽  
pp. 117727192097614
Author(s):  
Ibrahim Ali ◽  
Sara T Ibrahim ◽  
Rajkumar Chinnadurai ◽  
Darren Green ◽  
Maarten Taal ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Biomarker Discovery ◽  
Personalised Medicine ◽  
Adverse Outcomes ◽  
Chronic Kidney Disease Progression ◽  
Ckd Progression ◽  
New Era ◽  
Kidney Disease Progression ◽  
Renal Progression

Biomarker discovery in the field of risk prediction in chronic kidney disease (CKD) embraces the prospect of improving our ability to risk stratify future adverse outcomes and thereby guide patient care in a new era of personalised medicine. However, many studies that report biomarkers predictive of CKD progression share a key methodological limitation: failure to characterise patients’ renal progression precisely. This weakens any observable association between a biomarker and an outcome poorly defined by a patient’s change in renal function over time. In this commentary, we discuss the need for a better approach in this research arena and describe a compelling strategy that has the advantage of offering robust and meaningful biomarker exploration relevant to CKD progression.

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