Medicare patients with cardiovascular disease have a high prevalence of chronic kidney disease and a high rate of progression to end-stage renal disease

The risk of progression to ESRD among individuals with cardiovascular disease and chronic kidney disease (CKD) is not well defined. The purpose of this study was to describe the risk of ESRD among patients with cardiovascular disease. Charts were abstracted for randomly selected hospitalized Medicare beneficiaries with a diagnosis of either congestive heart failure (CHF) or acute myocardial infarction (AMI). The prevalence of CKD, based on the estimated modified diet in renal disease GFR of <60 ml/min per m2, was 60.4% of CHF patients and 51.7% of AMI patients. When compared with patients without CKD, the 30-d readmission rate was higher for CHF patients with CKD (odds ratio [OR], 1.70; 95% confidence interval [CI], 1.18 to 2.44) and for AMI patients with CKD (OR, 1.78; 95% CI, 1.17 to 2.70). CHF patients (OR, 1.62; 95% CI, 1.15 to 2.30) and AMI patients (OR, 3.10; 95% CI, 1.98 to 4.84) with CKD were more likely to die during the year after discharge from the hospital. ESRD after discharge occurred in nine of 517 patients with AMI and 24 of 640 patients with CHF. CKD increased the risk of ESRD among CHF patients (OR, 34.5; 95% CI, 4.23 to 279.43) and AMI patients (0 and 3% for those without and with CKD, respectively). At discharge, 18% of AMI patients and 21% of CHF patients with CKD were discharged with a diagnosis of renal disease. CKD is highly prevalent among patients with cardiovascular disease and is associated with increased risk of adverse outcomes, including progression to ESRD. This study suggests that opportunities may exist to improve the detection of CKD in these patients who are hospitalized with cardiovascular disease.     

Relationship between moderate to severe kidney disease and hip fracture in the United States

People with ESRD are at a high risk for hip fracture. However, the effect of moderate to severe chronic kidney disease (CKD) on hip fracture risk has not been well studied. As part of the Third National Health and Nutrition Examination Survey, information on both kidney function and history of hip fracture was obtained. This survey is a complex, multistage, probability sample of the US noninstitutionalized civilian population and was conducted between 1988 and 1994. A history of hip fracture was identified from the response to a questionnaire that was administered to all participants. There were 159 cases of hip fracture. There was a significantly increased likelihood of reporting a hip fracture in participants with estimated GFR <60 ml/min (odds ratio [OR] 2.12; 95% confidence interval [CI] 1.18 to 3.80). In younger participants (aged 50 to 74 yr), the prevalence of CKD was approximately three-fold higher in those with a history of hip fracture versus in those without a history of hip fracture (19.0 versus 6.2%, respectively; P = 0.04). In multivariate logistic regression analysis, only the presence of CKD (OR 2.32; 95% CI 1.13 to 4.74), a reported history of osteoporosis (OR 2.52; 95% CI 1.08 to 5.91), and low physical activity levels (OR 2.10; 95% CI 1.03 to 4.27) were associated with a history of hip fracture. There is a significant association between hip fracture and moderate to severe degrees of CKD, particularly in younger individuals, that is independent of traditional risk factors for hip fracture.     

Metabolic syndrome and chronic kidney disease in Okinawa, Japan

We assessed the prevalence of chronic kidney disease (CKD) in a hospital-based screening program in Okinawa, Japan. The significance of metabolic syndrome as a determinant of CKD was examined using multivariate logistic regression analysis. A total of 6980 participants, aged 30-79 years, participated in a screening program in Tomishiro Chuo Hospital. Metabolic syndrome was defined according to the criteria of the Adult Treatment Panel III (ATP III). Data were also analyzed according to the modified criteria of the National Cholesterol Education Program (NCEP) that defines abdominal obesity as a waist circumference of > oe =85 cm in men and > or =90 cm in women. CKD was defined as dipstick proteinuria (> or =1+) or a reduced glomerular filtration rate (GFR). GFR was estimated using the abbreviated Modification of Diet in Renal Disease (MDRD) formula. The prevalence of metabolic syndrome and CKD was 12.8 and 13.7%, respectively. Metabolic syndrome was a significant determinant of CKD (adjusted odds ratio (OR) 1.537 and 95% confidence interval (CI) 1.277-1.850, P<0.0001). The adjusted OR (95% CI) was 1.770 (1.215-2.579, P=0.0029) for those with four metabolic syndrome risk factors compared to those with no metabolic syndrome risk factors. Metabolic syndrome was a significant determinant for younger participants (<60 years; OR 1.686, 95% CI 1.348-2.107, P<0.0001), but not for older participants (> or =60 years; OR 1.254, 95% CI 0.906-1.735, NS). The relationship between the number of metabolic syndrome risk factors and the prevalence of CKD was linear using the modified criteria. The results suggest that metabolic syndrome is a significant determinant of CKD in men under 60 years of age, in Okinawa, Japan.     

Renal insufficiency and anemia are independent risk factors for death among patients with acute myocardial infarction

BACKGROUND: Chronic kidney disease (CKD) increases risk of death among patients with coronary artery disease. Mortality risks associated with CKD among patients with cardiovascular disease (CVD) are not well defined. Anemia is associated with increased mortality in end-stage renal disease (ESRD) patients and may also increase risk among patients with CVD. METHODS: A random sample of patients admitted to the hospital in a single southern state with a principal diagnosis of acute myocardial infarction (ICD-9 codes 410.xx) were followed up after hospital discharge. RESULTS: CKD was found in 60% of the cohort. Hematocrit of >or=40 was found in 46% of the patients; 26.0% had a hematocrit between 36% and 39%, 21.8% between 30% and 35%, and 5.9% had a hematocrit of less than 30%. The 1-year death rates among individuals with and without CKD were 31.7% and 10.4% respectively [odds ratio (OR) = 4.00 (2.34, 6.91)]. The mortality at one year was 18.6% for individuals with a hematocrit greater than or equal to 40%; 23.5% (OR = 1.35; 95% CI = 0.78, 2.32) for hematocrit 36% to 39%; 30.7% (OR = 1.94; 95% CI = 1.12, 3.34) for hematocrit between 30% and 35%; and 35.8% (OR = 3.16; 95% CI = 1.35, 7.40) for those with a hematocrit less than 30% (chi2 for trend was 12.2, P = 0.007). Both hematocrit and serum creatinine were independently associated with increased risk of death during follow-up after controlling for other patient risk factors. CONCLUSION: CKD and decreasing hematocrit were frequent among older patients hospitalized for acute myocardial infarction and are independent predictors of subsequent risk of death.     

新疆墨玉县维吾尔族成人牙周炎与慢性肾脏病患病率的流行病学研究

目的 探讨维吾尔族成人牙周炎与慢性肾脏病（CKD）患病率的关系。 方法 采用分层容量随机抽样方法,从墨玉县364个村抽取15个村18岁以上维吾尔族成人1650人,进行问卷调查、慢性肾损伤指标检测、相关危险因素调查及口腔检查。依据慢性牙周炎的诊断标准,将调查对象分为牙周炎组和非牙周炎组,其中牙周炎组按其严重程度进一步分为轻度牙周炎组、中度牙周炎组和重度牙周炎组。 结果 在资料完整的1415人中,慢性牙周炎患病率为65.2％（95%CI：65.0～65.4）,CKD患病率为5.2%（95%CI：5.1～5.3）,蛋白尿的患病率为4.2%（95%CI：4.1～4.3）,慢性肾功能不全的患病率为1.3%（95%CI：1.3～1.4）。牙周炎组和非牙周炎组CKD患病率差异有统计学意义（6.4%比2.9%,χ2 = 7.841,P = 0.005）。单因素Logistic回归分析显示重度牙周炎为CKD的危险因素（OR = 3.2,95%CI：2.0～5.2）。多因素Logistic回归亦显示重度牙周炎是CKD发生的独立危险因素（OR = 1.9,95%CI：1.1～3.3）。 结论 新疆农村维吾尔族成人是牙周炎的高发人群。牙周炎人群CKD患病率明显高于非牙周炎人群。重度牙周炎是CKD的独立危险因素。     

Prevalence and determinants of erectile dysfunction in hemodialysis patients

BACKGROUND: The prevalence of erectile dysfunction (ED) among patients with end-stage renal disease (ESRD) is not known. METHODS: A cross-sectional study was conducted to determine the prevalence of ED among a community-based hemodialysis (HD) population using a two-stage cluster random sampling design. The presence and severity of ED were assessed among 302 ESRD patients using the self-administered International Index of Erectile Function-5 (IIEF-5). Logistic regression was used to examine and test associations between ED and other medical conditions. RESULTS: The prevalence of any level of ED was 82% (95% CI, 76 to 87%) for all HD subjects. The prevalence of severe ED was 45% (CI, 36 to 55%). Subjects younger than 50 years had a prevalence of ED of 63% (CI, 53 to 71%), while in subjects 50 years or older, it was 90% (CI, 84 to 94%). A multivariable analysis demonstrated increasing age (50 to 59, OR = 2.04, 95% CI, 1.3 to 3.1; 60 to 69, OR = 5.5, 95% CI, 1.9 to 15.6) and diabetes (OR = 2.0, 95% CI, 1.2 to 3.3) to be independently associated with the presence of any level of ED. However, neither the subjects' age nor history of diabetes predicted the severity of ED among subjects with ED. The use of angiotensin-converting enzyme inhibitors (ACEIs) was inversely associated with ED (OR = 0.41, 95% CI, 0.17 to 0.98). Poor functional status (Karnofsky score or the Index of Physical Impairment) was not associated with ED. CONCLUSIONS: ED is extremely prevalent among HD patients. Increasing age, diabetes, and nonuse of ACEIs were associated with higher prevalence of ED. The high prevalence of ED was seen even among patients with good functional status.     

Risks for end-stage renal disease, cardiovascular events, and death in Hispanic versus non-Hispanic white adults with chronic kidney disease

Rates of ESRD are rising faster in Hispanic than non-Hispanic white individuals, but reasons for this are unclear. Whether rates of cardiovascular events and mortality differ among Hispanic and non-Hispanic white patients with chronic kidney disease (CKD) also is not well understood. Therefore, this study examined the associations between Hispanic ethnicity and risks for ESRD, cardiovascular events, and death in patients with CKD. A total of 39,550 patients with stages 3 to 4 CKD from Kaiser Permanente of Northern California were included. Hispanic ethnicity was obtained from self-report supplemented by surname matching. GFR was estimated from the abbreviated Modification of Diet in Renal Disease equation, and clinical outcomes, patient characteristics, and longitudinal medication use were ascertained from health plan databases and state mortality files. After adjustment for sociodemographic characteristics, Hispanic ethnicity was associated with an increased risk for ESRD (hazard ratio [HR] 1.93; 95% confidence interval [CI] 1.72 to 2.17) when compared with non-Hispanic white patients, which was attenuated after controlling for diabetes and insulin use (HR 1.50; 95% CI 1.33 to 1.69). After further adjustment for potential confounders, Hispanic ethnicity remained independently associated with an increased risk for ESRD (HR 1.33; 95% CI 1.17 to 1.52) as well as a lower risk for cardiovascular events (HR 0.82; 95% CI 0.76 to 0.88) and death (HR 0.72; 95% CI 0.66 to 0.79). Among a large cohort of patients with CKD, Hispanic ethnicity was associated with lower rates of death and cardiovascular events and a higher rate of progression to ESRD. The higher prevalence of diabetes among Hispanic patients only partially explained the increased risk for ESRD. Further studies are required to elucidate the cause(s) of ethnic disparities in CKD-associated outcomes.     

Abdominal aortic aneurysm in women: prevalence, risk factors, and implications for screening

OBJECTIVE: Accurate data regarding the prevalence and associated risk factors for aneurysmal disease is essential when determining the appropriateness of screening for abdominal aortic aneurysms (AAA). Although women are poorly represented in most large studies of AAA prevalence, the US Preventative Services Task Force recently recommended against primary screening for AAA in women. The purpose of this analysis was to define the prevalence and risk factors associated with the development of AAA in women. METHODS: A free duplex ultrasound screening was offered to men and women with cardiovascular risk factors or a family history of AAA. Patients were recruited through advertising at local screening centers and screenings were performed between 2004 and 2006. Demographic information and cardiovascular and aneurysmal disease risk factors were obtained for each patient through a questionnaire. A total of 17,540 subjects were screened for AAA, including 10,012 women (mean age 69.6 years) and 7528 men (mean age 70.0 years). Univariate and multivariable logistic regression analysis was performed on the subset of women that were screened to determine risk factors for and prevalence of AAA. RESULTS: Seventy-four aneurysms were detected in women (including four aneurysms >5 cm diameter and 70 aneurysms 3 to 5 cm diameter) while 291 were detected in men, resulting in prevalence rates of 0.7% and 3.9%, respectively. Increasing age (odds ratio [OR]= 4.57, 95% confidence interval [CI] 1.98 to 10.54, P < .0001), history of tobacco use (OR = 3.29, 95% CI 1.86 to 5.80, P < .0001), and cardiovascular disease (OR= 3.57, 95% CI 2.19 to 5.84, P < .0001) were independently associated with AAA in women on univariate and multivariable analysis. Women with multiple atherosclerotic risk factors were more commonly found to have AAAs and had a prevalence rate of AAA as high as 6.4%. CONCLUSION: Although the medical literature suggests a low prevalence rate of AAA in women in the general population, specific risk factors are associated with the development of AAA, and subgroups of women can be identified that are at a substantially increased risk of aneurysmal disease. In particular, elevated rates of AAA were found among women of advanced age (> or =65 years) with a history of smoking or heart disease. These data support the notion that women with such risk factors should be considered for AAA screening.     

Association between comorbidity and erectile dysfunction in patients with diabetes

The aims of this study were to determine the prevalence of erectile dysfunction (ED) and its relationship with comorbidity in patients with diabetes. The study population comprised of 312 consecutive patients aged 20 years or over residing in the city of Hamadan in Iran in 2005. Depression was assessed by the modified version of the Beck Depression Inventory (BDI-II) and ED by the short form of the International Index of Erectile Function (IIEF-5) questionnaire. Potential confounding was controlled by stratification and by a logistic regression model. The prevalence of moderate or complete ED (IIEF score 相似文献   

Family history of end-stage renal disease among hemodialyzed patients in Poland

BACKGROUND: In previous reports of end-stage renal disease (ESRD) patients, family history of ESRD was associated with race, younger age, higher education levels and ESRD etiology. This study aimed to analyze how often Polish caucasian dialysis patients reported relatives with ESRD, and to evaluate which risk factors are associated with family history of ESRD. METHODS: 4808 ESRD patients provided data about renal disease etiology, diabetes and hypertensive status of first- and second-degree relatives, socioeconomic status and education level. RESULTS: Reported ESRD etiologies were: chronic glomerular disease, 19.4 %; diabetic nephropathy, 11.3%; interstitial nephritris, 11.2%; hypertension, 7.8%; polycystic kidney disease (PKD), 7.1%; other or no response, 40.0%. Positive ESRD family history was reported by 745 patients (15.5%); positive history of diabetes, 932 (19.4%); hypertension, 1904 (39%). Positive ESRD family history according to kidney disease etiology was: PKD, 53.1%; glomerulonephritis, 12%; diabetic nephropathy, 11.9%; hypertension, 11.8%; interstitial nephritis, 10.8%. PKD as ESRD etiology (odds ratio (OR) 8.06, 95% confidence interval (CI) 6.35-10.23, p < 0.0001), positive family history of diabetes (OR 1.64, 95% CI 1.34-1.99, p < 0.0001) and positive history of hypertension (OR 1.64, 95% CI 1.39-1.95, p < 0.0001), were independently associated with positive ESRD history. Patients with later ESRD onset had a less frequent positive ESRD family history: for ESRD < 45 yrs, 16% (OR 1.0); 45-64 yrs, 14.4% (OR 0.83, 95% CI 0.70-0.99); > or = 65 yrs, 9.2 % (OR 0.5, 95% CI 0.35-0.72). CONCLUSIONS: Results of our study strongly support the contention that familial predisposition contributes to ESRD development.     

Prevalence and risk factors for chronic bronchitis in Pelotas,RS, Brazil: a population-based study.

BACKGROUND--Chronic bronchitis causes high morbidity and mortality throughout the world. It is basically a preventable disease. However, few population based studies of chronic bronchitis have been carried out in less developed countries. METHODS--A population based cross sectional survey was conducted to determine the prevalence of chronic bronchitis and associated risk factors in an urban area (Pelotas) of southern Brazil. 1053 subjects aged 40 years and over (90.3% of eligible subjects) were interviewed using the ATS-DLD-78 questionnaire. RESULTS--Of the subjects interviewed 12.7% were classified as having chronic bronchitis. In univariate analyses a significant increase in the relative odds of chronic bronchitis was seen in men (OR = 2.17, 95% CI 1.50 to 3.13), low family income (OR = 2.60, 95% CI 1.47 to 4.47 for lowest quartile), low schooling (OR = 4.65, 95% CI 2.36 to 9.18 for those with no schooling), smoking habits (OR = 6.92, 95% CI 4.22 to 11.36 for smokers of 20 or more cigarettes per day), high occupational exposure to dust (OR = 2.48, 95% CI 1.56 to 3.94), inadequate housing (OR = 2.09, 95% CI 1.22 to 3.58), high level of indoor air pollution (OR = 1.86, 95% CI 1.16 to 2.99), and reported childhood respiratory illnesses (OR = 2.08, 95% CI 1.25 to 3.49). Multiple logistic regression resulted in the identification of the following independent risk factors: family income (OR = 1.99, 95% CI 1.04 to 3.81 for subjects in the lowest quartile compared with those in the highest quartile), schooling (OR = 5.60, 95% CI 2.52 to 12.45 for subjects with no schooling compared with those with nine or more years), smoking (OR = 8.10, 95% CI 4.46 to 14.71 for smokers of 20 or more cigarettes per day compared with non-smokers), and history of major respiratory illnesses in childhood (OR = 2.16, 95% CI 1.20 to 3.85). CONCLUSIONS--Low family income, poor schooling, smoking, and childhood respiratory illnesses were significantly associated with chronic bronchitis.     

ESRD and Death after Heart Failure in CKD

CKD is a risk factor for heart failure, but there is no data on the risk of ESRD and death after recurrent hospitalizations for heart failure. We sought to determine how interim heart failure hospitalizations modify the subsequent risk of ESRD or death before ESRD in patients with CKD. We retrospectively identified 2887 patients with a GFR between 15 and 60 ml/min per 1.73 m² referred between January of 2001 and December of 2008 to a nephrology clinic in Toronto, Canada. We ascertained interim first, second, and third heart failure hospitalizations as well as ESRD and death before ESRD outcomes from administrative data. Over a median follow-up time of 3.01 (interquartile range=1.56–4.99) years, interim heart failure hospitalizations occurred in 359 (12%) patients, whereas 234 (8%) patients developed ESRD, and 499 (17%) patients died before ESRD. Compared with no heart failure hospitalizations, one, two, or three or more heart failure hospitalizations increased the adjusted hazard ratio of ESRD from 4.89 (95% confidence interval [95% CI], 3.21 to 7.44) to 10.27 (95% CI, 5.54 to 19.04) to 14.16 (95% CI, 8.07 to 24.83), respectively, and the adjusted hazard ratio death before ESRD from 3.30 (95% CI, 2.55 to 4.27) to 4.20 (95% CI, 2.82 to 6.25) to 6.87 (95% CI, 4.96 to 9.51), respectively. We conclude that recurrent interim heart failure is associated with a stepwise increase in the risk of ESRD and death before ESRD in patients with CKD.     

身体成分与慢性肾脏病患者心血管疾病的相关因素分析

目的:探讨慢性肾脏病（chronic kidney disease,CKD）患者身体成分与心血管疾病（cardiovascular disease,CVD）的相关关系。方法:纳入2017年1月至2019年12月于重庆市人民医院肾脏内科住院治疗且临床生化资料完整的CKD患者,根据病史及相应辅助检查分为CKD伴CVD组、C...     

Attitudes and behaviors of African Americans regarding early detection of kidney disease

BACKGROUND: Chronic kidney disease (CKD) is an African American public health crisis. To inform interventions, the National Kidney Disease Education Program surveyed African Americans about their attitudes and behaviors regarding early detection of kidney disease and screening. STUDY DESIGN: Cross-sectional study. SETTING & PARTICIPANTS: 2,017 African Americans from 7 states (Georgia, Maryland, Ohio, Mississippi, Louisiana, Missouri, and Tennessee) selected by using a random-digit dialing telephone survey (response rate, 42.4%). PREDICTORS: Demographic, risk, knowledge, and behavior variables. OUTCOMES & MEASUREMENTS: Perception of CKD as a top health concern, perceived risk of getting kidney disease, and accurate knowledge about CKD and its prevention. RESULTS: Only 23.5% of African Americans were screened for kidney disease in the last year. Although almost half (43.7%) of African Americans had a CKD risk factor, only 2.8% reported that CKD was a top health concern. Almost half knew the correct definition of kidney disease (48.6%), but few knew a test to diagnose CKD (23.7%) or that African Americans were at greater risk of developing CKD (18.1%). African Americans who had diabetes (odds ratio [OR], 3.22; 95% confidence interval [CI], 2.17 to 4.76), hypertension (OR, 1.78; 95% CI, 1.28 to 2.44), at least a bachelor's degree (OR, 1.77; 95% CI, 1.17 to 2.66), who had spoken with a medical professional (OR, 1.85; 95% CI, 1.19 to 2.85) or their family (OR, 1.61; 95% CI, 1.11 to 2.38) about kidney disease, who knew that a family history of kidney disease is a risk factor (OR, 2.32; 95% CI, 1.08 to 5.0), and who had been tested for CKD in the last year (OR, 1.45; 95% CI, 1.03 to 2.0) were more likely to correctly perceive themselves at increased risk. LIMITATIONS: Respondents were primarily African American women from urban areas. CONCLUSIONS: Most African Americans have poor knowledge about CKD, do not perceive it as an important health problem, and are not getting screened. To increase early detection of kidney disease through screenings, educational efforts linking kidney disease prevention to other diseases that are health priorities for African Americans are necessary.     

Chronic kidney disease as a risk factor for Clostridium difficile infection

Introduction: Clostridium difficile‐associated diarrhoea (CDAD) is the most common cause of nosocomial diarrhoea in the USA. In this study, we sought to determine the association between chronic kidney disease (CKD) and CDAD. Methods: A case–control study was designed to determine the association between CKD and CDAD in an urban hospital. Over a 2‐year period, all patients diagnosed with CDAD (n = 188) were included as cases and the prevalence of CKD was calculated. Age‐ and sex‐matched patients without CDAD were considered as controls with a ratio of 2:1 controls to cases. The prevalence of different stages of advanced CKD (stages 3–5) was determined and compared between groups. Also the calculated odds ratios (OR) were adjusted for multiple possible confounding variables using logistic regression analysis. Results: There was no significant difference in prevalence of advanced CKD between cases and controls (OR = 1.38, 95% confidence intervals (CI) = 0.90–2.12, P = 0.1365). The association between CKD and CDAD remained insignificant in subjects with CKD stages 3–5 who were not on dialysis (OR = 1.07, 95% CI = 0.65–1.77), P = 0.7970). However, the group with end‐stage renal disease on dialysis showed a significant association (OR = 2.60, 95% CI = 1.25–5.41, P = 0.0165). Controlling for antibiotics as a possible confounding variable, yielded an OR that was not statistically significant (OR = 2.05, 95% CI = 0.94–4.47, P = 0.07), but still showing a trend towards increased risk. Conclusion: End‐stage renal disease may increase the risk of acquiring CDAD through unknown mechanisms. This suggests implementing better surveillance strategies for these patients and eliminating the known risk factors for CDAD.     

Risk factor profiles based on estimated glomerular filtration rate and dipstick proteinuria among participants of the Specific Health Check and Guidance System in Japan 2008

Background

Estimated glomerular filtration rate (eGFR) and albuminuria (proteinuria) are both important determinants of the risk of cardiovascular disease (CVD), end-stage renal disease (ESRD), and mortality. Few studies, however, have examined the risk factor profiles based on eGFR and proteinuria among the general population.

Methods

Data of the newly developed nationwide screening program of the Specific Health Check-up and Guidance System (Tokutei-Kensin) initiated in 2008 were used in this study. The aim of this screening, targeting people 40?C74?years of age, was to detect those with metabolic syndrome and to offer those services regarding lifestyle modifications that will lead to the reduction of diabetes mellitus (DM) and DM-related ESRD. Individual records of 580,000 participants in 69 cities and towns and 3 union cohorts throughout Japan were anonymously provided and included in the present study.

Results

Details of 332,174 participants (57.3% of the total) with both serum creatinine and dipstick urine test data were analyzed. Mean (SD) age was 63.6 (8.3) years and 40.6% were men. The mean (SD) eGFR was 75.0 (16.2) ml/min/1.73?m² and 5.4% had proteinuria. The prevalence of chronic kidney disease (CKD) stage 3, 4, and 5 was 14.2%, 0.2%, and 0.07%, respectively. The prevalence of DM, hypertension, and history of stroke and heart disease was correlated with the combination of eGFR and degree of proteinuria.

Conclusion

The findings of the present study indicate that CKD and risk factors for CVD are quite common among middle-aged Japanese. CKD classification based on eGFR and proteinuria may be useful for predicting CVD, mortality rate, and ESRD in the Japanese population.     

Sodium intake, ACE inhibition, and progression to ESRD

High sodium intake limits the antihypertensive and antiproteinuric effects of angiotensin-converting enzyme (ACE) inhibitors in patients with CKD; however, whether dietary sodium also associates with progression to ESRD is unknown. We conducted a post hoc analysis of the first and second Ramipril Efficacy in Nephropathy trials to evaluate the association of sodium intake with proteinuria and progression to ESRD among 500 CKD patients without diabetes who were treated with ramipril (5 mg/d) and monitored with serial 24-hour urinary sodium and creatinine measurements. Urinary sodium/creatinine excretion defined low (<100 mEq/g), medium (100 to <200 mEq/g), and high (≥200 mEq/g) sodium intake. During a follow-up of >4.25 years, 92 individuals (18.4%) developed ESRD. Among those with low, medium, and high sodium intakes, the incidence of ESRD was 6.1 (95% confidence interval [95% CI], 3.8-9.7), 7.9 (95% CI, 6.1-10.2), and 18.2 (95% CI, 11.3-29.3) per 100 patient-years, respectively (P<0.001). Patients with high dietary sodium exhibited a blunted antiproteinuric effect of ACE inhibition despite similar BP among groups. Each 100-mEq/g increase in urinary sodium/creatinine excretion associated with a 1.61-fold (95% CI, 1.15-2.24) higher risk for ESRD; adjusting for baseline proteinuria attenuated this association to 1.38-fold (95% CI, 0.95-2.00). This association was independent from BP but was lost after adjusting for changes in proteinuria. In summary, among patients with CKD but without diabetes, high dietary salt (>14 g daily) seems to blunt the antiproteinuric effect of ACE inhibitor therapy and increase the risk for ESRD, independent of BP control.     

A population-based assessment of the familial component of chronic kidney disease mortality

BACKGROUND/AIM: While the familial nature of chronic kidney disease (CKD) has been recognized, it has primarily been defined from studies of first-degree relatives of selected sets of cases. The goal of this study is an evaluation of the familial clustering of end-stage renal disease (ESRD) and CKD mortality using a population-based genealogy of Utah. This is the first population-based analysis of the familial component of ESRD and non-ESRD CKD. METHODS: We have defined two distinct patient groups for this analysis, using individuals with death certificates in the Utah Population Database indicating ESRD (n = 192) and non-ESRD CKD (n = 335) as the cause of death. Two measures of familiality were used: (1) relative risk (RR) of CKD or ESRD death in relatives of cases and (2) an average relatedness statistic, i.e., the Genealogical Index of Familiality. RESULTS: The RR for dying with ESRD among the first-degree relatives of individuals dying with ESRD is estimated to be 10.1 (p = 0.0007, 95% confidence interval CI 2.76-25.95), but is not significantly elevated among second-degree relatives. The RR for dying with non-ESRD CKD among first- and second-degree relatives of individuals dying with non-ESRD CKD was 3.89 (p = 0.0051, 95% CI 1.43-8.46) and 3.11 (p = 0.04, 95% CI 0.85-7.95), respectively. The Genealogical Index of Familiality statistic demonstrated that the individuals dying with ESRD are significantly more related than expected in this population (p = 0.013); significant excess relatedness was also observed for individuals dying with non-ESRD CKD (p = 0.006), suggesting a familial component for both, with evidence for common environmental and genetic effects. CONCLUSION: The results of this analysis of individuals dying with ESRD and non-ESRD CKD supports a significant and independent familial component to both conditions, suggesting a heritable factor playing a role.     

Significance of past history of renal failure for the detection of high-risk individuals for cardiovascular and end-stage renal disease: analysis of data from a nationwide health checkup

Background

Clinical information regarding risk factors may be helpful in the detection of various diseases. This cross-sectional study examined the characteristics of subjects with past history of renal failure, and assessed whether this information would be useful for the efficient detection of high-risk individuals for chronic kidney disease (CKD) and cardiovascular disease (CVD) at health checkup.

Methods

This study utilized data from a nationwide health checkup, ??The Specific Health Check and Guidance in Japan,?? and data for 250,130 adult subjects were analyzed. Subjects with self-reported history of renal failure and receiving dialysis therapy were defined as having a history of renal failure.

Results

Among total participants, there were 1,400 (0.6%) with a history of renal failure. The prevalence of a history of renal failure was higher in subjects with CKD than in those without CKD (1.5 vs. 0.3%, P?2) and a higher prevalence of CKD (50.5%) and CVD (31.9%), compared with subjects with hypertension, diabetes or metabolic syndrome. Multivariate logistic regression analysis showed an independent association between a history of CVD and renal failure (odds ratio 3.68, 95% confidence interval 3.26?C4.15), after adjustment for confounding factors.

Conclusions

A history of renal failure was strongly associated with advanced CKD and CVD. Information regarding history of renal failure could be utilized to efficiently detect high-risk individuals at health checkup.     

Coronavirus-associated kidney outcomes in COVID-19, SARS,and MERS: a meta-analysis and systematic review

ObjectivesA meta-analysis and systematic review was conducted on kidney-related outcomes of three recent pandemics: SARS, MERS, and COVID-19, which were associated with potentially fatal acute respiratory distress syndrome (ARDS).MethodsA search of all published studies until 16 June 2020 was performed. The incidence/prevalence and mortality risk of acute and chronic renal events were evaluated, virus prevalence, and mortality in preexisting hemodialysis patients was investigated.ResultsA total of 58 eligible studies involving 13452 hospitalized patients with three types of coronavirus infection were included. The reported incidence of new-onset acute kidney injury (AKI) was 12.5% (95% CI: 7.6%–18.3%). AKI significantly increased the mortality risk (OR = 5.75, 95% CI 3.75–8.77, p < 0.00001) in patients with coronavirus infection. The overall rate of urgent-start kidney replacement therapy (urgent-start KRT) use was 8.9% (95% CI: 5.0%–13.8%) and those who received urgent-start KRT had a higher risk of mortality (OR = 3.43, 95% CI 2.02–5.85, p < 0.00001). Patients with known chronic kidney disease (CKD) had a higher mortality than those without CKD (OR = 1.97, 95% CI 1.56–2.49, p < 0.00001). The incidence of coronavirus infection was 7.7% (95% CI: 4.9%–11.1%) in prevalent hemodialysis patients with an overall mortality rate of 26.2% (95% CI: 20.6%–32.6%).ConclusionsPrimary kidney involvement is common with coronavirus infection and is associated with significantly increased mortality. The recognition of AKI, CKD, and urgent-start KRT as major risk factors for mortality in coronavirus-infected patients are important steps in reducing future mortality and long-term morbidity in hospitalized patients with coronavirus infection.