Delay Early CKD with Lifestyle Intervention in African Americans with Diabetic Kidney Disease: A Pre-Post Pilot Study (Preprint)

2021 ◽  
Author(s):  
Mukoso Ozieh ◽  
Leonard E. Egede
Keyword(s):  
Chronic Kidney Disease ◽  
South Carolina ◽  
African Americans ◽  
Kidney Disease ◽  
Lifestyle Intervention ◽  
Self Care ◽  
Post Intervention ◽  
Culturally Tailored ◽  
Behavior Outcomes ◽  
Mean Differences

BACKGROUND Behavioral factors such as lifestyle have been shown to explain approximately 24% of the excess risk of chronic kidney disease among African Americans. OBJECTIVE The main objective of this study was to examine the feasibility and preliminary efficacy of a culturally tailored lifestyle intervention in African Americans with type 2 diabetes mellitus and chronic kidney disease (CKD). METHODS A pre-post design was used to test the feasibility of a lifestyle intervention in African American adults recruited from Medical University of South Carolina. Clinical outcomes (hemoglobin A1c, blood pressure and estimated glomerular filtration rate (eGFR)) were measured at baseline and post-intervention. Disease knowledge, self-care and behavior outcomes were also measured using validated structured questionnaires at baseline and post-intervention. Descriptive statistics and effect sizes were calculated to determine clinically important changes from baseline. RESULTS Significant pre-post mean differences and decreases were observed for HbA1c (mean 0.75, p=0.01), total cholesterol (mean 16.38, p<0.01), low density lipoprotein (mean 13.73, p<0.01) and eGFR (mean 6.73, p=0.02). Significant pre-post mean differences and increases were observed for CKD self-efficacy (mean -11.15, p=0.03), CKD knowledge (mean -2.62, p<0.01), exercise behavior (mean -1.21, p<0.01) and blood sugar testing (mean -2.15, p<0.01). CONCLUSIONS This study provides preliminary data for a large-scale appropriately powered, randomized control trial to examine a culturally tailored lifestyle intervention in African Americans to improve clinical, knowledge and self-care behavior outcomes in this population.

scholarly journals Sickle Cell Trait and Renal Function in Hispanics in the United States: the Northern Manhattan Study

2017 ◽  
Vol 27 (1) ◽  
pp. 11 ◽  
Author(s):  
Nicole D. Dueker ◽  
David Della-Morte ◽  
Tatjana Rundek ◽  
Ralph L. Sacco ◽  
Susan H. Blanton
Keyword(s):  
United States ◽  
Chronic Kidney Disease ◽  
African Americans ◽  
Kidney Disease ◽  
Sickle Cell ◽  
Sickle Cell Trait ◽  
The United States ◽  
Genetic Mutation ◽  
Single Mutation ◽  
Increased Risk

<p class="Pa7">Sickle cell anemia (SCA) is a common hematological disorder among individu­als of African descent in the United States; the disorder results in the production of abnormal hemoglobin. It is caused by homozygosity for a genetic mutation in HBB; rs334. While the presence of a single mutation (sickle cell trait, SCT) has long been considered a benign trait, recent research suggests that SCT is associated with renal dysfunction, including a decrease in estimated glomerular filtration rate (eGFR) and increased risk of chronic kidney disease (CKD) in African Americans. It is currently unknown whether similar associations are observed in Hispanics. Therefore, our study aimed to determine if SCT is associated with mean eGFR and CKD in a sample of 340 Dominican Hispanics from the Northern Manhattan Study. Using regression analyses, we tested rs334 for association with eGFR and CKD, adjusting for age and sex. eGFR was estimated using the Chronic Kidney Disease Epidemiology Collaboration equa­tion and CKD was defined as eGFR &lt; 60 mL/min/1.73 m2. Within our sample, there were 16 individuals with SCT (SCT carriers). We found that SCT carriers had a mean eGFR that was 12.12 mL/min/1.73m2 lower than non-carriers (P=.002). Additionally, SCT carriers had 2.72 times higher odds of CKD compared with non-carriers (P=.09). Taken together, these novel results show that Hispanics with SCT, as found among African Americans with SCT, may also be at increased risk for kidney disease.</p><p class="Pa7"><em>Ethn Dis. </em>2017; 27(1)<strong>:</strong>11-14; doi:10.18865/ed.27.1.11.</p><p class="Pa7"> </p>

Aplicabilidade da teoria do autocuidado na sistematização da assistência de enfermagem à pessoa com doença renal crônica / Applicability of self-care theory in the systematization of nursing care to people with chronic kidney disease

2021 ◽  
Vol 7 (6) ◽  
pp. 56446-56461
Author(s):  
Gleice Kely Santos Da Silva ◽  
Andressa Camille Sampaio Peixoto ◽  
Katarina Soares Morais ◽  
Lívia de Souza e Souza ◽  
Laís Lopes Gonçalves ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Nursing Care ◽  
Self Care ◽  
Care Theory

scholarly journals HUBUNGAN JENIS KANKER DENGAN FATIGUE PADA PASIEN KEMOTERAPI DI RSUD. ABDUL WAHAB SJAHRANIE SAMARINDA

2020 ◽  
Vol 2 (1) ◽  
pp. 1-8
Author(s):  
Bonifasius Hat ◽  
Rufina Hurai
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Self Care ◽  
P Value ◽  
Test Design ◽  
Purposive Sampling ◽  
Post Test

Chronic Kidney Disease merupakan  gangguan fungsi ginjal yang progresif dan ireversibel, salah satu penanganannya dengan hemodialisa, keluhan yang sering pada pasien hemodialisa adalah kelelahan. Tujuan penelitian ini melihat pengaruh edukasi berbasis self care terhadap perubahan tingkat kelelahan pada pasien hemodialisa, merupakan penelitian kuantitatif dengan metode kuasi eksperimen pre post test design di RSUD A. Wahab Sjahranie periode Mei-Juni 2017, pengambilan sampel dilakukan  dengan cara purposive sampling melibatkan 111 responden yang dibagi menjadi 2 kelompok intervensi edukasi berbasis self care 83 orang dan kelompok kontrol 28 orang. Hasil penelitian ini didapatkan setelah dilakukan intervensi selama 6 minggu, Uji Beda Berpasangan Non Parametrik Independent menunjukan bahwa nilai Asymp Sig (2 tailed) = 0,000 atau p-value <  0,05  ada pebedaan tingkat kelelahan antara kelompok intervensi terhadap kelompok kontrol, nilai OR menunjukkan kelompok intervensi edukasi berbasis self care memiliki kecenderungan mengalami perubahan tingkat kelelahan 1,22 kali lebih besar dibandingkan dengan kelompok kontrol. Pada analisis uji logistik ordinal hasil menunjukkan nilai p = 0,00 atau p-value <0,05  ada pengaruh yang signifikan intervensi edukasi berbasis self care yang diberikan terhadap perubahan tingkat kelelahan. Simpulan penelitian edukasi berbasis self care mempunyai pengaruh terhadap perubahan tingkat kelelahan dan direkomendasikan intervensi ini dapat diaplikasikan sebagai salah satu edukasi yang diberikan pada pasien menjalani hemodialisa

Systematic Review and Meta-analyses of Effects of Phosphate-lowering Agents in Non-dialysis Chronic Kidney Disease

2021 ◽  
pp. ASN.2021040554
Author(s):  
Nicole Lioufas ◽  
Elaine Pascoe ◽  
Carmel Hawley ◽  
Grahame Elder ◽  
Sunil Badve ◽  
...  
Keyword(s):  
Systematic Review ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Clinical Outcomes ◽  
Serum Phosphate ◽  
Risk Of Bias ◽  
Lowering Therapy ◽  
Mean Differences ◽  
Meta Analyses

Background: Benefits of phosphate-lowering interventions on clinical outcomes in patients with chronic kidney disease (CKD) are unclear; systematic reviews have predominantly involved dialysis patients. This study aimed to summarize evidence from randomized controlled trials (RCTs) concerning benefits and risks of non-calcium-based phosphate-lowering treatment in non-dialysis CKD. Methods: We conducted a systematic review and meta-analyses of RCTs involving noncalcium-based phosphate-lowering therapy compared to placebo, calcium-based binders, or no study medication, in adults with CKD not on dialysis or post-transplant. RCTs had ≥3 months follow up and outcomes included biomarkers of mineral metabolism, cardiovascular parameters, and adverse events. Outcomes were meta-analyzed using the Sidik-Jonkman method for random effects. Unstandardized mean differences were used as effect sizes for continuous outcomes, with common measurement units and Hedge's g standardized mean differences (SMD) otherwise. Odds ratios were used for binary outcomes. Cochrane risk of bias and GRADE assessment determined the certainty of evidence. Results: Twenty trials involving 2,498 participants (median sample size 120, median follow up 9 months) were eligible for inclusion. Overall, risk of bias was low. Compared with placebo, non calcium-based phosphate binders reduced serum phosphate (12 trials, weighted mean difference -0.37, 95% CI -0.58,-0.15 mg/dL, low certainty evidence) and urinary phosphate excretion (8 trials, SMD -0.61, 95% CI -0.90,-0.31, low certainty evidence), but resulted in increased constipation (9 trials, log odds ratio [OR] 0.93, 95% CI 0.02, 1.83, low certainty evidence) and greater vascular calcification score (3 trials, SMD 0.47, 95% CI 0.17, 0.77, very low certainty evidence). Data for effects of phosphate-lowering therapy on cardiovascular events (log OR 0.51 [95% CI -0.51, 1.17]) and death were scant. Conclusions: Non-calcium-based phosphate-lowering therapy reduced serum phosphate and urinary phosphate excretion, but there was an unclear effect on clinical outcomes and intermediate cardiovascular end-points. Adequately powered RCTs are required to evaluate benefits and risks of phosphate-lowering therapy on patient-centered outcomes.

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

Circulation ◽  
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.

Abstract P099: The Relation of Kidney Disease to Measures of Digital Arterial Tonometry in the Jackson Heart Study

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Eric McClendon ◽  
Solomon Musani ◽  
Sushante Khaire ◽  
Herman Taylor ◽  
Ervin Fox
Keyword(s):  
Chronic Kidney Disease ◽  
African Americans ◽  
Endothelial Dysfunction ◽  
Kidney Disease ◽  
Least Square ◽  
Jackson Heart Study ◽  
Pulse Wave Amplitude ◽  
Arterial Tonometry ◽  
Heart Study ◽  
Age And Sex

Background: The presence of chronic kidney disease is greater in African Americans than in non-Hispanic whites. Though there is data to show a relation between endothelial dysfunction and end-stage kidney disease, the relation to mild and moderate chronic kidney disease (particularly in African Americans) is unclear. Methods and Results: Digital arterial tonometry was performed during Exam 2 and 3 of the Jackson Heart Study using the endoPAT2000. Data from digital arterial tonometry included baseline pulse wave amplitude (BPA) as a measure of endothelial tone and reactive hyperemic index (F-RHI) as a measure of endothelial function. For this study, the estimated glomerular filtration rate (eGFR) was calculated using the MDRD equation. Those participants with eGFR < 60 ml/min/1.73m2 were defined as having CKD. Participants with eGFR < 15 ml/min/1.73m2 were excluded from the analysis. Microalbuminuria in this study was defined as a urinary albumin:creatinine ratio ≥ 17mg/g in men and ≥ 25 mg/g in women. We compared the differences in least square means adjusted for age and sex, and adjusted for multiple traditional clinical covariates using a generalized linear model. Results: There were 834 participants in the study population (mean age 58.5 years, 61% women); 87 (10.4%) participants with CKD and 108 (13.0%) with microalbuminuria. In age and sex adjusted samples, we found that both BPA and F-RHI were significantly associated with CKD in the pooled samples. However in multivariable adjusted analysis the relation was no longer significant in either the pooled or sex-specific samples. In the multivariable adusted analysis,BPA was significantly (P=0.036) associated with microalbuminuria in men and F-RHI was weakly significantly (P=0.08) associated with microalbuminuria in women. Conclusion: We found that endothelial dysfunction as measured by digital arterial tonometry is not significantly associated with chronic kidney disease. There is an association of endothelial tone in men and endothelial dysfunction in women with microalbuminuria.

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