scholarly journals Epidemiology of Chronic Kidney Disease in Children: A Report from Lithuania

Medicina ◽  
2021 ◽  
Vol 57 (2) ◽  
pp. 112
Author(s):  
Jūratė Masalskienė ◽  
Šarūnas Rudaitis ◽  
Renata Vitkevič ◽  
Rimantė Čerkauskienė ◽  
Diana Dobilienė ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Pediatric Population ◽  
Clinical Signs ◽  
Epidemiological Data ◽  
Hereditary Diseases ◽  
Number Of Children ◽  
Age Related ◽  
Ckd Stage ◽  
Stage Renal Disease

Background and Objectives: The data on the prevalence of chronic kidney disease (CKD) in the pediatric population are limited. The prevalence of CKD ranges from 56 to 74.7 cases per million of the age-related population (pmarp). The most common cause of CKD among children is congenital anomalies of the kidney and urinary tract (CAKUT). With progressing CKD, various complications occur, and end-stage renal disease (ESRD) can develop. The aim of the study was to determine the causes, stage, prevalence, and clinical signs of CKD and demand for RRT (renal replacement therapy) among Lithuanian children in 2017 and to compare the epidemiological data of CKD with the data of 1997 and 2006. Materials and Methods: The data of 172 Lithuanian children who had a diagnosis of CKD (stage 2–5) in 1997 (n = 41), in 2006 (n = 65), and in 2017 (n = 66) were retrospectively analyzed. Physical development and clinical signs of children who had CKD (stage 2–5) in 2017 were assessed. Results: The prevalence of CKD stages 2–5 was 48.0 pmarp in 1997; 88.7 in 2006; and 132.1 in 2017 (p < 0.01). Congenital and hereditary diseases of the kidney in 1997 accounted for 66% of all CKD causes; in 2006, for 70%; and in 2017, for 79%. In 2017, children with CKD stages 4 or 5 (except transplanted children) had hypertension (87.5%) and anemia (50%) (p < 0.01). Children under ≤2 years with CKD were at a 3-fold greater risk of having elevated blood pressure (OR = 3.375, 95% CI: 1.186–9.904). Conclusions: There was no change in the number of children with CKD in Lithuania; however, the prevalence of CKD increased due to reduced pediatric population. CAKUT remains the main cause of CKD at all time periods. Among children with CKD stages 4 or 5, there were more children with hypertension and anemia. In children who were diagnosed with CKD at an early age hypertension developed at a younger age.

scholarly journals Contemporary National Outcomes of Acute Myocardial Infarction-Cardiogenic Shock in Patients with Prior Chronic Kidney Disease and End-Stage Renal Disease

2020 ◽  
Vol 9 (11) ◽  
pp. 3702
Author(s):  
Saraschandra Vallabhajosyula ◽  
Lina Ya’Qoub ◽  
Vinayak Kumar ◽  
Dhiran Verghese ◽  
Anna V. Subramaniam ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Coronary Angiography ◽  
Hospital Mortality ◽  
End Stage Renal Disease ◽  
Ckd Stage ◽  
Stage Renal Disease ◽  
End Stage

Background: There are limited data on acute myocardial infarction with cardiogenic shock (AMI-CS) stratified by chronic kidney disease (CKD) stages. Objective: To assess clinical outcomes in AMI-CS stratified by CKD stages. Methods: A retrospective cohort of AMI-CS during 2005–2016 from the National Inpatient Sample was categorized as no CKD, CKD stage-III (CKD-III), CKD stage-IV (CKD-IV) and end-stage renal disease (ESRD). CKD-I/II were excluded. Outcomes included in-hospital mortality, use of coronary angiography, percutaneous coronary intervention (PCI) and mechanical circulatory support (MCS). We also evaluated acute kidney injury (AKI) and acute hemodialysis in non-ESRD admissions. Results: Of 372,412 AMI-CS admissions, CKD-III, CKD-IV and ESRD comprised 20,380 (5.5%), 7367 (2.0%) and 18,109 (4.9%), respectively. Admissions with CKD were, on average, older, of the White race, bearing Medicare insurance, of a lower socioeconomic stratum, with higher comorbidities, and higher rates of acute organ failure. Compared to the cohort without CKD, CKD-III, CKD-IV and ESRD had lower use of coronary angiography (72.7%, 67.1%, 56.9%, 61.1%), PCI (53.7%, 43.8%, 38.4%, 37.6%) and MCS (47.9%, 38.3%, 33.3%, 34.2%), respectively (all p < 0.001). AKI and acute hemodialysis use increased with increase in CKD stage (no CKD–38.5%, 2.6%; CKD-III–79.1%, 6.5%; CKD-IV–84.3%, 12.3%; p < 0.001). ESRD (adjusted odds ratio [OR] 1.25 [95% confidence interval {CI} 1.21–1.31]; p < 0.001), but not CKD-III (OR 0.72 [95% CI 0.69–0.75); p < 0.001) or CKD-IV (OR 0.82 [95 CI 0.77–0.87] was predictive of in-hospital mortality. Conclusions: CKD/ESRD is associated with lower use of evidence-based therapies. ESRD was an independent predictor of higher in-hospital mortality in AMI-CS.

scholarly journals Prediction of non-responsiveness to pre-dialysis care program in patients with chronic kidney disease: a retrospective cohort analysis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Emily K. King ◽  
Ming-Han Hsieh ◽  
David R. Chang ◽  
Cheng-Ting Lu ◽  
I-Wen Ting ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Cohort Analysis ◽  
Care Program ◽  
Rapid Progression ◽  
Net Benefit ◽  
Risk Equation ◽  
Ckd Stage ◽  
All Cause Mortality ◽  
Stage Renal Disease

AbstractThe responsiveness of patients with chronic kidney disease (CKD) to nephrologists’ care is unpredictable. We defined the longitudinal stages (LSs) 1–5 of estimated glomerular filtration rate (eGFR) by group-based trajectory modeling for repeated eGFR measurements of 7135 patients with CKD aged 20–90 years from a 13-year pre-end-stage renal disease (ESRD) care registry. Patients were considered nonresponsive to the pre-dialysis care if they had a more advanced eGFR LS compared with the baseline. Conversely, those with improved or stable eGFR LS were considered responsive. The proportion of patients with CKD stage progression increased with the increase in the baseline CKD stage (stages 1–2: 29.2%; stage 4: 45.8%). The adjusted times to ESRD and all-cause mortality in patients with eGFR LS-5 were 92% (95% confidence interval [CI] 86–96%) and 57% (95% CI 48–65%) shorter, respectively, than in patients with eGFR LS-3A. Among patients with baseline CKD stages 3 and 4, the adjusted times to ESRD and all-cause death in the nonresponsive patients were 39% (95% CI 33–44%) and 20% (95% CI 14–26%) shorter, respectively, than in the responsive patients. Our proposed Renal Care Responsiveness Prediction (RCRP) model performed significantly better than the conventional Kidney Failure Risk Equation in discrimination, calibration, and net benefit according to decision curve analysis. Non-responsiveness to nephrologists’ care is associated with rapid progression to ESRD and all-cause mortality. The RCRP model improves early identification of responsiveness based on variables collected during enrollment in a pre-ESRD program. Urgent attention should be given to characterize the underlying heterogeneous responsiveness to pre-dialysis care.

A short guideline on chronic kidney disease for medical laboratory practice / Kronik böbrek hastalığında tıbbi laboratuvar uygulamaları için kısa kılavuz

2016 ◽  
Vol 41 (4) ◽  
Author(s):  
Sedat Abuşoğlu ◽  
İlknur Aydın ◽  
Funda Bakar ◽  
Tan Bekdemir ◽  
Özlem Gülbahar ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Cystatin C ◽  
Early Stage ◽  
Pediatric Population ◽  
Adult Population ◽  
Isotope Dilution Mass Spectrometry ◽  
Medical Laboratory ◽  
Stage Renal Disease ◽  
End Stage

AbstractChronic kidney disease (CKD) is asymptomatic in the early stage. Kidney function might be lost 90% when the symptoms are overt. However, in case of early detection, progression of the disease can be prevented or delayed. If not detected it results in end stage renal disease. Therefore, the level of awareness about CKD should be increased. The role of medical laboratory is utmost important for the diagnosis and staging of CKD. In this paper, the main tasks of the laboratory specialists are described and the outlines are as follows.• Creatinine assays should be traceable to internationally recognised reference materials and methods, specifically isotope dilution mass spectrometry.• When reporting the creatinine result, eGFR should also be reported in adult (>18 years) population. A warning expression should be included in the report form if eGFR result is <60 mL/min/1.73 m• eGFR values should be expressed quantitatively up to 90 mL/min/1.73 m• eGFR equations of the adult population should not be used for pediatric population. Different equations utilizing also patient height should be used. The enzymatic creatinine assay should be preferred. eGFR based on cystatin C can be used for confirmation in the pediatric population.• Cystatin C measurements, at least when eGFR based on creatinine is not reliable and for confirmation should be encouraged.• Proteinuria or albuminuria values should be measured in spot samples and reported in proportion to creatinine.

scholarly journals Chronic Kidney Disease: Highlights for the General Pediatrician

2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
Raymond Quigley
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Pediatric Population ◽  
Critical Role ◽  
Vitamin D Metabolism ◽  
General Pediatrician ◽  
Organ Systems ◽  
Progression Of Kidney Disease ◽  
Stage Renal Disease ◽  
End Stage

Chronic kidney disease in the pediatric population has been increasing. Early detection and treatment can slow down the progression of kidney disease and help prevent the development of end stage renal disease. In addition, as the kidney function declines, there are many pathophysiologic interactions with other organ systems that need to be monitored and treated. In particular, because of impaired vitamin D metabolism, calcium and phosphorus homeostasis is dysregulated and results in secondary bone disease. Anemia is common due to a number of factors including impaired erythropoietin production. Growth is often impacted by chronic kidney disease but can be improved by proper treatment. Complications of chronic kidney disease can be minimized by proper monitoring and treatment of these parameters. The general pediatrician plays a critical role in this process.

scholarly journals High Unawareness of Chronic Kidney Disease in Germany

2021 ◽  
Vol 18 (22) ◽  
pp. 11752
Author(s):  
Susanne Stolpe ◽  
Bernd Kowall ◽  
Christian Scholz ◽  
Andreas Stang ◽  
Cornelia Blume
Keyword(s):  
Risk Factors ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Cardiovascular Comorbidities ◽  
Increased Risk ◽  
Binomial Regression ◽  
Ckd Stage ◽  
Stage Renal Disease ◽  
End Stage ◽  
Prevalence Ratios

Chronic kidney disease (CKD) is associated with an increased risk for cardiovascular events, hospitalizations, end stage renal disease and mortality. Main risk factors for CKD are diabetes, hypertension, and older age. Although CKD prevalence is about 10%, awareness for CKD is generally low in patients and physicians, hindering early diagnosis and treatment. We analyzed baseline data of 3305 participants with CKD Stages 1–4 from German cohorts and registries collected in 2010. Prevalence of CKD unawareness and prevalence ratios (PR) (each with 95%-confidence intervals) were estimated in categories of age, sex, CKD stages, BMI, hypertension, diabetes and other relevant comorbidities. We used a log-binomial regression model to estimate the PR for CKD unawareness for females compared to males adjusting for CKD stage and CKD risk factors. CKD unawareness was high, reaching 71% (68–73%) in CKD 3a, 49% (45–54%) in CKD 3b and still 30% (24–36%) in CKD4. Prevalence of hypertension, diabetes or cardiovascular comorbidities was not associated with lower CKD unawareness. Independent of CKD stage and other risk factors unawareness was higher in female patients (PR = 1.06 (1.01; 1.10)). Even in patients with CKD related comorbidities, CKD unawareness was high. Female sex was strongly associated with CKD unawareness. Guideline oriented treatment of patients at higher risk for CKD could increase CKD awareness. Patient–physician communication about CKD might be amendable.

Abstract 49: The Effect of Gender, Obesity, and Chronic Kidney Disease on Cardiovascular Events

2012 ◽  
Vol 5 (suppl_1) ◽  
Author(s):  
Paul Kolm ◽  
Zugui Zhang ◽  
James Bowen ◽  
Rubeen Israni ◽  
William S Weintraub ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Renal Disease ◽  
Negative Binomial ◽  
Negative Binomial Regression ◽  
Black Females ◽  
Ckd Stage ◽  
Stage Renal Disease ◽  
End Stage ◽  
Event Rates

Background: Obesity and chronic kidney disease (CKD) are well known risk factors for cardiovascular (CV) events. Studies have shown that in patients with end-stage renal disease, the rate of CV events decreases as body mass index (BMI) increases. These studies, however, used only one measurement of BMI to predict CV events. The objective of this study was to assess whether rates of CV events changed according to variations in BMI and glomerular filtration rate (GFR) over time. Methods: A retrospective cohort of patients followed in outpatient practices from 1995 to 2010 was evaluated. Adult patients with at least 2 records of serum creatinine were included. The practices’ electronic health records (EHRs) were linked to the hospital EHR to assess CV events. GFR (mL/min/1.73m 2 ) was calculated using the Modification of Diet in Renal Disease equation and stratified according to the Kidney Disease Outcomes Quality Initiative guidelines as Normal (≥ 60), CKD stage 3 (30-59) and stage 4-5 (< 30) at each patient’s encounter. Outcomes were identified using ICD9 codes for myocardial infarction, congestive heart failure, coronary heart disease, dysrhythmia, stroke and peripheral vascular disease. The data spanned up to 10 years from a patient’s index to last visit. CV events were modeled as a function of age, gender, race, BMI and CKD status by negative binomial regression for count data. The model included interactions of age, gender, race, BMI and CKD. Results: Over the 10-year period, there were a total of 1,024,891 observations from 39,605 patients with 8,901 CV events. There was a significant age by gender by race by BMI interaction as well as a significant CKD main effect (p < 0.01). Increasing age, being male, black, overweight and having CKD, were associated with higher event rates. However, this association between BMI and event rates was not present for black females over 70, thus the 4-way sex by race by age by BMI interaction (Figure). Conclusion: These results support the hypothesis that overweight / obesity is not protective of CV events in CKD patients.

scholarly journals Chronic kidney disease in lithium-treated patients, incidence and rate of decline

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Arjan M. Van Alphen ◽  
Tessa M. Bosch ◽  
Ralph W. Kupka ◽  
Rocco Hoekstra
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Chronic Kidney Disease Stage ◽  
Mood Stabilizer ◽  
Disease Stage ◽  
Stage 4 ◽  
Ckd Stage ◽  
Rate Of Decline ◽  
Stage Renal Disease ◽  
End Stage

Abstract Background Lithium-induced nephropathy is a known long-term complication, sometimes limiting the use of lithium as mood stabilizer. The aim of this study is to establish the incidence of chronic kidney disease and the rate of decline of renal function in patients using lithium and to identify risk factors. Methods We selected 1012 patients treated with lithium from the laboratory database of the Antes Centre for Mental Health Care spanning a period from 2000 to 2015. Serum lithium and creatinine concentrations were retrieved and eGFR was calculated using the 4-variable CKD-EPI formula. We calculated the incidence of renal insufficiency and the rate of decline. We compared patients with and without chronic kidney disease (CKD) stage 3 regarding duration of lithium exposure. Results Incidence of chronic kidney disease was 0.012 cases per exposed patient-year. Average decline of eGFR was 1.8 ml/min/year in patients who developed chronic kidney disease stage 3. Incidence of chronic kidney disease stage 4 was only 0.0004 per patient year. No cases of end stage renal disease were found in this cohort. Odds of reaching chronic kidney disease stage 3 were increased with longer duration of lithium exposure. Conclusions The use of lithium seems to be related to a higher incidence of chronic kidney disease. Longer duration of lithium exposure significantly increased the risk of renal failure.

Sudden cardiac death in chronic kidney disease

2015 ◽  
Author(s):  
Reza Hajhosseiny ◽  
Kaivan Khavandi ◽  
David J. Goldsmith
Keyword(s):  
Chronic Kidney Disease ◽  
Sudden Cardiac Death ◽  
Kidney Disease ◽  
Cardiac Death ◽  
Beta Blockers ◽  
Good Reason ◽  
Epidemiological Data ◽  
Icd Implantation ◽  
Stage Renal Disease ◽  
End Stage

Epidemiological data demonstrate the unique vulnerability of chronic kidney disease (CKD) subjects to cardiovascular disease, the most catastrophic being sudden cardiac death (SCD). In patients with declining kidney function there is a continuum of cardiovascular risk. In those individuals who survive to reach end-stage renal disease (ESRD), the risk of suffering a cardiac event is extremely high. Some of this risk is explained by the common risk factors and traditional cardiovascular events, namely atherosclerotic plaque fissure and rupture, but there is now evidence of a distinct ‘later CKD’ mechanism, notably arrhythmias. This appears particularly true in later stages of CKD and corresponds with the multifaceted range of myocardial and vascular insults operating. The physiological milieu of disordered vessel autoregulation, sequestered vasoprotective agents, loss of conduit and small artery elasticity/compliance, a stiffened and fibrotic myocardium, with calcified and diseased coronary arteries, all within an inflammatory environment, all contribute to arrhythmia generation. The final insult is changes in volume and electrolyte status. Risk stratification tools would be helpful in guiding clinicians to recognize those subjects likely to benefit from specific interventional strategies. These might include the novel, or emerging serum, haemodynamic, or electrocardiographic biomarkers in CKD. Current tools—such as those used for stratifying risk for SCD and determining the need for ICD implantation—are not valid in ESRD patients. Beta blockers appear likely to be generally advisable, blood pressure permitting, for patients with significant cardiomyopathy. Evidence for implantable cardiac defibrillators (ICD) is lacking. There is good reason to think that young dialysis patients at high risk of sudden death may benefit, but the risk/benefit ratio for older patients is less likely to be advantageous. These hypotheses need further investigation.

scholarly journals Comparison of Lipid Profile Among the Different Stages of Chronic Kidney Disease in Children

KYAMC Journal ◽  
2019 ◽  
Vol 10 (3) ◽  
pp. 137-142
Author(s):  
Muhammad Mozammel Haque ◽  
Mosammat Afroza Jinnat ◽  
Shafi Ahmed ◽  
Ranjit Ranjan Roy ◽  
Mohammad Akteruzzaman ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Renal Disease ◽  
Lipid Profile ◽  
End Stage Renal Disease ◽  
Obstructive Uropathy ◽  
Group I ◽  
Ckd Stage ◽  
Stage Renal Disease ◽  
End Stage

Background: Chronic Kidney Disease (CKD) is associated with significantly increased morbidity and mortality. Children with (CKD)/End stage renal disease (ESRD) exhibit various co-morbidities, including dyslipidemia. Hypertriglyceridemia is inversely correlated with renal function. Children with advanced chronic kidney disease or end stage renal disease developed atherosclerosis and cardiovascular disease. Objectives: To measure the lipid profile in kidney disease and comparison of lipid profile among the different stages of CKD. Materials and Methods: A cross sectional analytic study to measure and compare lipid profile in fifty children with different stages of chronic kidney disease during January 2016 to June 2016 by purposive sampling technique and divided into two groups, Children with CKD stage iii and iv included in Group I and CKD stage V and V(D) included in Group II. Results: Out of Fifty children with CKD, 28(56%) were male and 22 (44%) male, 30(60%) were of11-15 year age group and 32(64%) were from rural area and 18(36%) from urban area. The etiology of CKD in two groups glomerulonephritis were 14(28%), obstructive uropathy 15 (30%), hypoplasia/dysplasia 9(18%), polycystic kidney disease 9(18%) and acute kidney injury 3(6%). All the cases were anemic, 26(52%) were hypertensive and 20(40%) had osteodystrophy. Conclusion: Dyslipidemia specially hypertriglyceridemia is common in children with CKD. Hypertriglyceridemia is inversely related to severity of CKD stages. KYAMC Journal Vol. 10, No.-3, October 2019, Page 137-142

Ambulatory Blood Pressure Trajectories and Blood Pressure Variability in Diabetic and Non-Diabetic Chronic Kidney Disease

2020 ◽  
Vol 51 (5) ◽  
pp. 411-420
Author(s):  
Maria Schoina ◽  
Charalampos Loutradis ◽  
Ioanna Minopoulou ◽  
Marieta Theodorakopoulou ◽  
Nikolaos Pyrgidis ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Diabetic Kidney Disease ◽  
Repeated Measurements ◽  
Diabetic Patients ◽  
Ckd Stage ◽  
Average Real Variability ◽  
Stage Renal Disease ◽  
End Stage

Background: Diabetic kidney disease is the leading cause of end-stage renal disease worldwide. Whether diabetes mellitus (DM) is an additional factor leading to elevated blood pressure (BP) levels and BP variability (BPV) in patients with chronic kidney disease (CKD) is unknown. This study aimed to compare ambulatory BP levels, BP trends and BPV in diabetic and non-diabetic patients with CKD. Methods: This study included 48 diabetic and 48 non-diabetic adult patients (>18 years) with CKD (estimated glomerular filtration rate [eGFR] <90 and ≥15 mL/min/1.73 m2), matched in a 1:1 ratio for age, sex and eGFR within each CKD stage (2, 3a, 3b and 4). All patients underwent 24-h ambulatory BP measurement with the Mobil-O-graph device. To evaluate the effect of DM and time on the trajectories of 24-h BP levels, we performed two-way mixed ANOVA analysis for repeated measurements using hourly means. BPV was calculated with validated formulas. Results: In total, patients with DM had significantly higher 24-h systolic BP (SBP; 132.13 ± 10.71 vs. 124.16 ± 11.45; p = 0.001) and pulse pressure (PP; 57.1 ± 9.6 vs. 49.5 ± 10.9; p < 0.001), but similar 24-h diastolic BP (DBP; 75.00 ± 8.43 vs. 74.62 ± 6.86 mm Hg; p = 0.809) compared to patients without DM. A similar trend was evident across all CKD stages. The effect of DM on BP trajectories during the recording period was significant for SBP (F = 18.766, p < 0.001, partial η2 = 0.261) and marginally significant for DBP (F = 3.782, p = 0.057, partial η2 = 0.067). Twenty-four hour SBP SD, weighted SD (wSD) and average real variability (ARV; 10.94 ± 2.75 vs. 9.46 ± 2.10; p = 0.004), as well as 24 h DBP SD, wSD, coefficient of variation (CV) and ARV (8.23 ± 2.10 vs. 7.10 ± 1.33; p = 0.002) were significantly higher in diabetic compared to non-diabetic CKD patients. Conclusions: Ambulatory SBP and PP levels are higher and SBP-profile is different in patients with diabetic compared to those with non-diabetic CKD. Systolic and diastolic BPV are also higher in diabetics. These findings may signify a higher cardiovascular risk for patients with both DM and CKD compared to patients with CKD alone, through higher BP levels and BPV.

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