998-P: REVEAL-CKD: Prevalence of and Patient Characteristics Associated with Undiagnosed Stage 3 Chronic Kidney Disease

Diabetes ◽  
2021 ◽  
Vol 70 (Supplement 1) ◽  
pp. 998-P
Author(s):  
ALYSHAH ABDUL SULTAN ◽  
SALVATORE BARONE ◽  
SUPRIYA KUMAR ◽  
HUNGTA CHEN ◽  
KRISTER JÄRBRINK ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Patient Characteristics

scholarly journals Patient Characteristics and Outcomes of 11 721 Patients With Coronavirus Disease 2019 (COVID-19) Hospitalized Across the United States

2020 ◽  
Author(s):  
Michael W Fried ◽  
Julie M Crawford ◽  
Andrea R Mospan ◽  
Stephanie E Watkins ◽  
Breda Munoz ◽  
...  
Keyword(s):  
United States ◽  
Cardiovascular Disease ◽  
Chronic Kidney Disease ◽  
Mechanical Ventilation ◽  
Kidney Disease ◽  
Clinical Course ◽  
Patient Characteristics ◽  
The United States ◽  
Geographic Region ◽  
Hospitalized Patients

Abstract Background As coronavirus disease 2019 (COVID-19) disseminates throughout the United States, a better understanding of the patient characteristics associated with hospitalization, morbidity, and mortality in diverse geographic regions is essential. Methods Hospital chargemaster data on adult patients with COVID-19 admitted to 245 hospitals across 38 states between 15 February and 20 April 2020 were assessed. The clinical course from admission, through hospitalization, and to discharge or death was analyzed. Results A total of 11 721 patients were included (majority were >60 years of age [59.9%] and male [53.4%]). Comorbidities included hypertension (46.7%), diabetes (27.8%), cardiovascular disease (18.6%), obesity (16.1%), and chronic kidney disease (12.2%). Mechanical ventilation was required by 1967 patients (16.8%). Mortality among hospitalized patients was 21.4% and increased to 70.5% among those on mechanical ventilation. Male sex, older age, obesity, geographic region, and the presence of chronic kidney disease or a preexisting cardiovascular disease were associated with increased odds of mechanical ventilation. All aforementioned risk factors, with the exception of obesity, were associated with increased odds of death (all P values < .001). Many patients received investigational medications for treatment of COVID-19, including 48 patients on remdesivir and 4232 on hydroxychloroquine. Conclusions This large observational cohort describes the clinical course and identifies factors associated with the outcomes of hospitalized patients with COVID-19 across the United States. These data can inform strategies to prioritize prevention and treatment for this disease.

scholarly journals Prospects for improved glomerular filtration rate estimation based on creatinine—results from a transnational multicentre study

2020 ◽  
Vol 13 (4) ◽  
pp. 674-683 ◽  
Author(s):  
Jonas Björk ◽  
Ulf Nyman ◽  
Marie Courbebaisse ◽  
Lionel Couzi ◽  
R Neil Dalton ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Glomerular Filtration Rate ◽  
Kidney Disease ◽  
Glomerular Filtration ◽  
Filtration Rate ◽  
Patient Characteristics ◽  
Cross Sectional ◽  
Disease Epidemiology ◽  
Gfr Estimation ◽  
Glomerular Filtration Rate Estimation

Abstract Background The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) creatinine equation is routinely used to assess renal function but exhibits varying accuracy depending on patient characteristics and clinical presentation. The overall aim of the present study was to assess if and to what extent glomerular filtration rate (GFR) estimation based on creatinine can be improved. Methods In a cross-sectional analysis covering the years 2003–17, CKD-EPI was validated against measured GFR (mGFR; using various tracer methods) in patients with high likelihood of chronic kidney disease (CKD; five CKD cohorts, n = 8365) and in patients with low likelihood of CKD (six community cohorts, n = 6759). Comparisons were made with the Lund–Malmö revised equation (LMR) and the Full Age Spectrum equation. Results 7In patients aged 18–39 years old, CKD-EPI overestimated GFR with 5.0–16 mL/min/1.73 m2 in median in both cohort types at mGFR levels <120 mL/min/1.73 m2. LMR had greater accuracy than CKD-EPI in the CKD cohorts (P30, the percentage of estimated GFR within 30% of mGFR, 83.5% versus 76.6%). CKD-EPI was generally the most accurate equation in the community cohorts, but all three equations reached P30 above the Kidney Disease Outcomes Quality Initiative benchmark of 90%. Conclusions None of the evaluated equations made optimal use of available data. Prospects for improved GFR estimation procedures based on creatinine exist, particularly in young adults and in settings where patients with suspected or manifest CKD are investigated.

scholarly journals Sodium-glucose cotransporter 2 inhibition: which patient with chronic kidney disease should be treated in the future?

2020 ◽  
Vol 35 (Supplement_1) ◽  
pp. i48-i55 ◽  
Author(s):  
Brendon L Neuen ◽  
Meg J Jardine ◽  
Vlado Perkovic
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Large Scale ◽  
Patient Characteristics ◽  
Major Advance ◽  
Current Guideline ◽  
Current Standard ◽  
Sodium Glucose Cotransporter ◽  
The Future ◽  
Sglt2 Inhibition

Abstract The advent of sodium-glucose cotransporter 2 (SGLT2) inhibitors represents a major advance for people with type 2 diabetes (T2DM) and chronic kidney disease (CKD). The results of the Canagliflozin and Renal Events in Diabetes with Established Nephropathy Clinical Evaluation (CREDENCE) trial have clearly demonstrated that canagliflozin prevents kidney failure and cardiovascular events. The results from three other large-scale randomized trials, collectively enrolling >30 000 participants, have provided further evidence that the effects of SGLT2 inhibition on major kidney outcomes in people with T2DM may be present across the class, although this will only be known for certain when Dapagliflozin and Renal Outcomes and Cardiovascular Mortality in Patients with CKD (DAPA-CKD) (NCT03036150) and The Study of Heart and Kidney Protection with Empagliflozin (EMPA-KIDNEY) (NCT03594110) are reported over coming years. Importantly, the benefits of SGLT2 inhibition have been achieved in addition to the current standard of care. This review summarizes evidence for SGLT2 inhibition in people with T2DM and CKD, evaluates key patient characteristics and concomitant drug use that may influence the use of these drugs in people with CKD, discusses current guideline recommendations and explores how these drugs may be used in people with CKD in the future, including in combination with other treatments.

Chronic kidney disease unawareness and determinants using 1999–2014 National Health and Nutrition Examination Survey Data

2021 ◽  
Author(s):  
Ana Florea ◽  
Elizabeth T Jacobs ◽  
Robin B Harris ◽  
Yann C Klimentidis ◽  
Bijin Thajudeen ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
National Health ◽  
Disease Status ◽  
Patient Characteristics ◽  
The United States ◽  
Self Report ◽  
Nutrition Examination Survey ◽  
Older Individuals ◽  
Health And Nutrition

Abstract Background Although chronic kidney disease (CKD) affects 15% of the United States (US) population, <10% of the US CKD population is aware of their disease. This is significant as untreated CKD can progress to end-stage renal disease which would require dialysis or transplantation. This study aimed to provide updated information regarding US CKD unawareness. Methods Data from the 1999–2014 National Health and Nutrition Examination Survey (NHANES) were used (n = 38 474); response rate > 70%. CKD self-report and lab-confirmed CKD were used to assess CKD unawareness. Adjusted logistic regression models examined association between unawareness and patient characteristics. Results In individuals with lab-confirmed CKD (n = 7137, 14.3%), 91.5% answered ‘no’ to self-report question; in those without CKD, 1.1% answered ‘yes’ to self-report question. In those with lab-confirmed CKD, in the adjusted models, increased age [odds ratio (ORs), 1.03 (95%CI, 1.02–1.04)] and female sex [OR, 1.37 (95%CI, 1.08–1.72)] were statistically significantly associated with greater odds of being unaware of CKD. Conclusion These findings demonstrated high unawareness of disease status as there was a discrepancy between respondents’ self-reported CKD diagnosis and lab-confirmed CKD. Older individuals and women may be more unaware of their CKD; these groups should be queried about reasons for increased unawareness.

Performance of creatinine-based equations for estimating glomerular filtration rate changes over time

2018 ◽  
Vol 35 (5) ◽  
pp. 819-827 ◽  
Author(s):  
Marieke H C van Rijn ◽  
Marie Metzger ◽  
Martin Flamant ◽  
Pascal Houillier ◽  
Jean-Philippe Haymann ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Glomerular Filtration Rate ◽  
Kidney Disease ◽  
Glomerular Filtration ◽  
Filtration Rate ◽  
Patient Characteristics ◽  
Estimated Gfr ◽  
Changes Over Time ◽  
Over Time ◽  
Measured Gfr

Abstract Background Glomerular filtration rate (GFR) is commonly used to monitor chronic kidney disease (CKD) progression, but its validity for evaluating kidney function changes over time has not been comprehensively evaluated. We assessed the performance of creatinine-based equations for estimating GFR slope according to patient characteristics and specific CKD diagnosis. Methods In the NephroTest cohort study, we measured GFR 5324 times by chromium 51–labeled ethylenediamine tetraacetic acid renal clearance in 1955 adult patients with CKD Stages 1–4 referred to nephrologists (Stages 1–2, 19%) and simultaneously estimated GFR with both the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) and Modification of Diet in Renal Disease (MDRD) equations for isotope dilution mass spectrometry traceable creatinine; absolute and relative GFR slopes were calculated using a linear mixed model. Results Over a median follow-up of 3.4 [interquartile range (IQR) 2.0–5.6] years, the decline in mean absolute and relative measured GFR (mGFR) and CKD-EPI and MDRD estimated GFR (eGFR) was 1.6 ± 1.2, 1.5 ± 1.4 and 1.3 ± 1.3 mL/min/1.73 m2/year and 5.9 ± 5.3, 5.3 ± 5.3 and 4.8 ± 5.2%/year, respectively; 52% and 55% of the patients had MDRD and CKD-EPI eGFR slopes within 30% of mGFR slopes. Both equations tended to overestimate the GFR slope in the youngest patients and underestimate it in the oldest, thus producing inverse associations between age and mGFR versus eGFR slope. Other patient characteristics and specific CKD diagnoses had little effect on the performance of the equations in estimating associations. Conclusions This study shows little bias, but poor precision in GFR slope estimation for both MDRD and CKD-EPI equations. Importantly, bias strongly varied with age, possibly due to variations in muscle mass over time, with implications for clinical care and research.

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