Prevalence and risk factors of chronic kidney disease in first-degree relatives of chronic kidney disease patients in Southern China

Aim: The aim of this study was to estimate the prevalence and risk factors of chronic kidney disease (CKD) in first‐degree relatives (FDRs) of CKD patients. Methods: A cross‐section study of first‐degree relatives of CKD patients was conducted between November 2007 and March 2009 in southern China. A total of 1187 first‐degree relatives (494 male and 693 female; mean age 41.26 years) of 419 CKD patients (194 male and 225 female; mean age 32.10 years) were reviewed and tested for haematuria, albuminuria and reduced glomerular filtration rate. CKD risk factors, including age, gender, body mass index, hypertension and the causes of index case were also investigated. CKD was diagnosed according to the criteria of the National Kidney Foundation‐Kidney Disease Outcomes Quality Initiative. Results: The prevalence of CKD in first‐degree relatives of CKD patients was 29.7% (95% confidence interval [CI]: 27.1%–32.2%). After adjusting for all the potential confounders, older age, female gender, hypertension, hyperglycaemia, hyperuricaemia, hypertriglyceridemic, low level of high density lipoproteins, increased body mass index and nephrotoxic medications were independently associated with increased risk of CKD. Furthermore, relatives of index cases with chronic glomerulonephritis were at higher risk haematuria (ORs = 2.12, 95% CI: 1.45–3.10) compared with relatives of index cases with other kinds of renal diseases. Conclusion: The first‐degree relatives of CKD patients are at high risk of CKD, especially those relatives of CKD patients with chronic glomerulonephritis. Screening in this high risk population might help to identify early CKD patients and make a proper intervention strategy to prevent the disease from quick progression.     

非透析慢性肾脏病患者高尿酸血症的危险因素分析

目的 探讨和分析非透析慢性肾脏病(non-dialysis chronic kidney disease,ND-CKD)患者高尿酸血症(hyperuricemia,HUA)的发生率及其相关危险因素.方法 收集2015年1月至2019年12月于山西医科大学第二医院肾内科就诊的540例ND-CKD患者的临床资料,依据HUA...     

Chronic kidney disease progression in kidney transplant recipients: A focus on traditional risk factors

Kidney transplant recipients are a subset of patients with chronic kidney disease (CKD) that remain at high risk for progression to dialysis and mortality. Recent advances in immunosuppression have only partially improved long‐term graft and patient survival. Discovery of new immunosuppressive regimens is a slow and resource‐intensive process. Hence, recognition and management of modifiable allogeneic and non‐allogeneic risk factors for progression to CKD among kidney transplant recipients is of major interest for improving long‐term outcomes. Graft survival is mainly determined by the quality of the allograft and by the patient’s alloimmune response, which is influenced by human leukocyte antigen matching and the presence of donor‐specific antibodies. Alloimmune responses manifest as acute and chronic forms of cell‐ and antibody‐mediated rejection, which can be worsened by patient non‐adherence or under‐immunosuppression. However, donor and patient ages, glomerular disease recurrence, time on dialysis, pre‐existing cardiovascular burden, medication side‐effects and traditional risk factors, such as hypertension, proteinuria, anaemia, dyslipidaemia, diabetes and bone mineral disorder, which can ultimately lead to severe endothelial derangement, also contribute to graft loss and mortality. These traditional risk factors, common to pre‐dialysis patients, often are considered of secondary importance when compared to alloimmunity and immunosuppression concerns. In this review article, we focus on the epidemiological, pathophysiological and therapeutic features of non‐allogeneic traditional risk factors for CKD. We also discuss the benefit of adopting a multidisciplinary approach to pursue the same therapeutic targets recommended for pre‐dialysis patients.     

Risk factors for progression of chronic kidney disease: An investigation in prepubertal children

Aim

Previous studies on progression of chronic kidney disease (CKD) in children have included older post-pubertal subjects. This study attempted to evaluate risk factors for progression of CKD in pre-pubertal children.

Methods

An observational study of children aged 2–10 years with an eGFR within the limits of >30 and <75 mL/min/1.73 m² was performed. Presenting clinical and biochemical risk factors, as well as diagnosis, were analysed for their association with progression to kidney failure, time to kidney failure and for the rate of decline of kidney function.

Results

One hundred and twenty-five children were studied of whom 42 (34%) had progressed to CKD stage 5 during the median period of follow up of 3.1 (IQR = 1.8–6) years. Hypertension, anaemia and acidosis at entry were associated with progression but they did not predict reaching the end point. Only glomerular disease, proteinuria and stage 4 kidney disease were independent predictors of kidney failure and the time to kidney failure. The rate of kidney function decline was greater in patients with glomerular than non-glomerular disease.

Conclusions

Common modifiable risk factors, when present at initial evaluation, were not independently associated with CKD progression to kidney failure in prepubertal children. Only non-modifiable risk factors and proteinuria predicted eventual stage 5 disease. The physiological changes of puberty may be the major precipitator of kidney failure during adolescence.     

慢性肾脏病4～5期合并肺动脉高压患者的临床特征及危险因素

目的 分析慢性肾脏病(chronic kidney disease,CKD)4 ～5期合并肺动脉高压患者的临床特征及相关危险因素.方法 分析比较2015年1月1日至2015年12月31日于江门市中心医院肾内科就诊的CKD 4～5期患者,根据其是否存在肺动脉高压分为肺动脉高压(pulmonary hypertension,PH)组及非PH组,分析两组患者的临床及实验室检查资料.结果 PH组血红蛋白(Hb)比非PH组低,而全段甲状旁腺激素(iPTH)较非PH组高(P＜0.05).PH组各心室心房内径、肺动脉内径均较非PH组长,射血分数较非PH组低(P＜0.05).PH组瓣膜钙化、心包积液的发生率较非PH组高,差异具有统计学意义(P＜0.05).在血液透析亚组,PH组平均透析次数较非PH组低[(2.44±0.50)次vs (2.83±0.38)次,P=0.00],而PH组Hb较非PH组低,血清尿素氮(BUN)、血清肌酐(SCr)较非PH组高,差异均有统计学意义(P＜0.05).在腹膜透析亚组,PH组平均年龄较非PH组大[(53.49± 11.59)岁vs (46.19±12.82)岁,P=0.033].贫血、甲状旁腺激素增高是CKD发生PH的危险因素;在血液透析患者中,贫血、SCr升高是其发生PH的危险因素.高龄则是腹膜透析患者发生PH的危险因素.结论 CKD合并PH的患者心脏结构发生变化,左心室收缩功能较差.纠正贫血、控制继发性甲状旁腺机能亢进症及透析充分是治疗CKD合并PH的重要措施.     

老年慢性肾脏疾病并发急性肾损伤的临床特点及危险因素分析

目的：探讨老年人慢性肾脏疾病（chronic kidney disease,CKD）基础上伴发急性肾损伤（acute-on-chronic kidney injury,ACKI）患者的临床特点及相关危险因素。方法回顾性调查2007年12月至2013年12月间入住我院的60岁以上CKD老年人出现ACKI患者82例的临床资料,对其性别、年龄、基础疾病、诱发因素、急性肾损伤分期及血常规、尿常规、肝功能、肾功能、血糖、血脂、电解质等进行分析及总结其特点,并进行统计学处理。分析 ACKI 相关危险因素。结果82例 ACKI 中,男49例（占59.76%）,女33例（占40.24%）,平均年龄（67.6±5.2）岁,在导致老年 ACKI 的危险因素中,最常见的是高血压急症42例（占51.22%）,其次是严重感染31例（占37.80%）;肾毒性药物及低血容量导致的肾脏灌注不足分别为5例（占6.10%）及4例（占4.88%）,总病死率52.44%（43/82）,男性病死率高于女性（36.59%比15.85%,P〈0.05）;其中高血压急症、严重感染是 ACKI 的独立危险因素,血液净化治疗是保护因素。结论高血压急症、严重感染是ACKI的独立危险因素,严格控制血压、及时控制感染、避免使用肾毒性药物,适时行肾脏替代治疗,是降低老年 ACKI病死率的关键。     

成都市铁路职工糖尿病人群慢性肾脏病患病情况及相关危险因素

目的探讨成都市铁路职工糖尿病人群慢性肾脏病(chronic kidney disease,CKD)的患病情况及相关危险因素。方法从2009年9月至2013年12月在成都铁路分局医院健康体检的铁路职工(分散居住在成都市各区)的资料中,选取有完整资料的967例糖尿病人群列入本次研究,资料包括问卷调查(性别、年龄、吸烟、饮酒、既往病史)、体格检查(血压、身高和体质量)、血液和尿液检测(尿素氮、血肌酐、血尿酸、血糖、胆固醇、三酰甘油、尿微量白蛋白、尿肌酐和尿常规)等,根据CKD诊断标准[白蛋白尿:尿微量白蛋白/肌酐≥30 mg/g;血尿:尿沉渣红细胞3个/高倍镜;肾小球滤过率(estimated glomerular filtration rate,eGFR)下降:简化肾脏病饮食改良(modification of diet inrenal disease,MDRD)公式计算eGFR60 ml·min~(-1)·(1.73 m~2)~(-1)]对资料进行分析。结果①糖尿病人群白蛋白尿、血尿和eGFR下降的发生率分别为28.02%、1.45%和13.75%。该人群中CKD的患病率为37.64%。糖尿病人群白蛋白尿发生率明显高于糖尿病前期人群和无高血糖的人群。糖尿病合并高血压、高血脂和高尿酸人群白蛋白尿、eGFR下降和CKD的患病率均明显高于单纯高尿酸血症人群。②空腹血糖水平与尿微量白蛋白/肌酐比值呈正直线相关。③年龄、体质量指数、高血压和空腹血糖水平是白蛋白尿的独立危险因素,女性是血尿的独立危险因素,年龄、高尿酸和空腹血糖水平是eGFR下降的独立危险因素,年龄、体质量指数、高血压、高尿酸和空腹血糖水平是CKD的独立危险因素。结论成都市铁路职工糖尿病人群,CKD的患病率与空腹血糖、体质量指数、血压、血尿酸和血脂相关。     

Analysis of occurrence and risk factors ofchronic kidney disease in the ICU patients

Objective To analyze the occurrence and clinical features of chronic kidney disease (CKD) in the ICU patients and identify the possible risk factors. Methods A retrospective study was performed in 2281 ICU patients enrolled from Shengjing hospital between January 2007 and December 2010, in which 1860 cases had complete data and were followed-up, the other 421 cases were excluded for the reasons of dying, suffering from CKD originally, lacking complete data and missing. The cases were divided into CKD and non-CKD groups according to SCODRED and CKD diagnosis standards. Assessment was performed to screen risk factors of CKD. Results There were obvious differences between CKD and non-CKD groups at age, pregnancy,AKI and liver function (P﹤0.05). The CKD’s annual morbidity rate of ICU patients was 20%-30%,and the incidence showed an increasing trend with time. Age, pregnancy, AKI, APACHE-II score, invasive diagnosis and treatment, mechanical ventilation, organ failure and kidney-hurt drugs were risk factors for CKD in the ICU patients. Conclusions The morbidity rate of CKD in the ICU patients is high,and the number of CKD patients show an increasing trend with time. Age, APACHE-II score＞15, the number of failed organs≥2, the variety of kidney-hurt drug≥2, pregnancy, AKI, the number of invasive diagnosis and treatment≥3, mechanical ventilation are independent risk factors of CKD in the ICU patients.     

Semen quality in men with chronic kidney disease and its correlation with chronic kidney disease stages

The aim of this study was to assess whether chronic kidney disease (CKD) has any impact on semen quality parameters in men with CKD stage 1–5. Results were collected from 66 men with different CKD stages (age 18–50 years). Age and BMI (body mass index) were recorded for each male. Higher CKD stage had a significant negative linear trend on semen volume (P < 0.05), progressive motility (P < 0.01), nonprogressive motility (P < 0.001), sperm concentration (P < 0.01), total sperm number (P < 0.01), cytoplasmic droplets (P < 0.01), teratozoospermia index (P < 0.05) and accessory gland markers, α‐glucosidase activity (P < 0.05), zinc (P < 0.01) and fructose (P < 0.01). BMI per se had no significant effect on semen volume, sperm number, sperm concentration, morphology, α‐glucosidase activity, fructose concentration or zinc level. A significant negative correlation between BMI and sexual‐hormone‐binding globulin (SHBG) (P < 0.01) was observed but not with other sex hormones. Age per se was related to a significant decrease of sperm concentration (P < 0.05), normal forms (P < 0.01) and testosterone level (P < 0.05). Our results indicate that CKD stage per se is a factor determining the number of spermatozoa available in the epididymis for ejaculation, in part independent of age‐related decrease of testosterone level and BMI.     

Diabetic patients with chronic kidney disease: Non-invasive assessment of cardiovascular risk

The prevalence and burden of diabetes mellitus and chronic kidney disease on global health and socioeconomic development is already heavy and still rising. Diabetes mellitus by itself is linked to adverse cardiovascular events, and the presence of concomitant chronic kidney disease further amplifies cardiovascular risk. The culmination of traditional (male gender, smoking, advanced age, obesity, arterial hypertension and dyslipidemia) and non-traditional risk factors (anemia, inflammation, proteinuria, volume overload, mineral metabolism abnormalities, oxidative stress, etc.) contributes to advanced atherosclerosis and increased cardiovascular risk. To decrease the morbidity and mortality of these patients due to cardiovascular causes, timely and efficient cardiovascular risk assessment is of huge importance. Cardiovascular risk assessment can be based on laboratory parameters, imaging techniques, arterial stiffness parameters, ankle-brachial index and 24 h blood pressure measurements. Newer methods include epigenetic markers, soluble adhesion molecules, cytokines and markers of oxidative stress. In this review, the authors present several non-invasive methods of cardiovascular risk assessment in patients with diabetes mellitus and chronic kidney disease.     

Prognosis and risk factors of chronic kidney disease progression in patients with diabetic kidney disease and non-diabetic kidney disease: a prospective cohort CKD-ROUTE study

Diabetic kidney disease (DKD) is emerging rapidly as the leading cause of chronic kidney disease (CKD) worldwide. In this 3-year prospective, multicenter cohort study, a total of 1138 pre-dialysis CKD patients were recruited. Patients were categorized into two groups according to the etiologies of DKD and non-diabetic kidney disease (NDKD). Propensity score matching was performed to adjust for confounding factors, resulting in 197 patients being assigned to DKD and NDKD groups, respectively. The primary endpoints were 50% estimated glomerular filtration rate (eGFR) decline and initiation of kidney replacement therapy (KRT). The secondary endpoints were all-cause death and the development of cardiovascular disease (CVD) events. We found that DKD patients have a higher risk to develop 50% eGFR decline endpoint (HR:2.30, 95%CI [1.48–3.58], p < 0.001) and KRT endpoint (HR:1.64, 95%CI [1.13–2.37], p < 0.05) than NDKD patients. The 3-year cumulative incidence of 50% eGFR decline and KRT endpoint was significantly higher in DKD patients (26.90% vs.13.71% and 35.03% vs. 22.34%, respectively). The Cox regression analyses showed that the increased systolic blood pressure (SBP), DKD, decreased serum albumin (Alb), and higher CKD stages were risk factors for the 50% eGFR decline endpoint; the increased SBP, DKD, decreased serum Alb, serum creatinine (Scr), higher CKD stages, presence of proteinuria and CVD were risk factors for KRT endpoint; the increased age, decreased hemoglobin (Hb), decreased serum Alb were risk factors for all-cause death endpoint; the increased age, decreased serum Alb were risk factors for CVD events endpoint. Appropriate preventive or therapeutic interventions should be taken to control these predictive factors to delay the development of CKD complications, thereby improving the prognosis and reducing the disease burden of the high-risk populations.     

Derivation and validation of a disease-specific risk score for cardiac risk stratification in chronic kidney disease.

OBJECTIVE: Cardiac events (CE; cardiac death, non-fatal myocardial infarction and acute coronary syndrome) are the principal causes of death in patients with chronic kidney disease (CKD). We sought to devise and validate a cardiac risk score to risk-stratify patients with CKD. METHODS: Clinical history and biochemical data were obtained in 167 CKD patients. CE were recorded over a median follow-up of 22 months. The hazard ratio (HR) of each independent variable using Cox regression analysis was used to derive a cardiac risk score for the prediction of events. The cardiac risk score was then applied to a validation population of 99 CKD patients to confirm its validity in predicting CE. RESULTS: CE occurred in 20 patients in the derivation group. The independent predictors of CE were cardiac history (HR 9.83, P = 0.001), body mass index (BMI; HR 1.15, P = 0.002), dialysis duration (HR 1.24, P = 0.004) and serum phosphate (HR 4.29, P = 0.001). The resulting cardiac risk score (range 26-67) gave an area under the receiver operating characteristic curve of 0.86. CE occurred in 25 patients in the validation group; the ROC curve area was similar (0.84, P = 0.11). An optimal cardiac risk score cut-off of 50 assigned high risk to 29% of the derivation and 35% of the validation group (P = 0.26). CE occurred in 35 and 57% of the high-risk derivation and validation groups, respectively (P = 0.09), and in 2 and 8% of the low-risk groups (P = 0.15). CONCLUSION: Application of a cardiac risk score using cardiac history, dialysis duration, BMI and phosphate identifies CKD patients at risk of future CE.     

慢性肾脏病患者钙磷代谢紊乱对心血管事件的影响

目的探讨钙磷代谢紊乱在慢性肾脏病（CKD）患者心血管事件发生中的作用。方法选取我科住院的225例CKD2～5期患者,分为4组,以是否发生心血管事件分为2组,比较各期CKD患者钙磷代谢的差异及发生心血管事件者与未发生心血管事件者之间的差异。结果CKD5期血清钙离子浓度低于CKD2～4期,CKD5期血清磷离子浓度高于CKD2～4期,CKD5期钙磷乘积高于CKD3、4期。225例CKD患者住院期间,64例发生心血管事件,发生率为28．44％。结论对CKD患者,尤其是终末期肾脏病患者存在低钙、高磷、高钙磷乘积;与既往高钙增加一般人群心血管事件发生风险不同的是,低钙是其独立心血管事件危险因素。     

慢性肾脏病急性加重的诊治与预防

慢性肾脏病(CKD)是对健康产生影响的肾脏结构或功能异常>3个月的总称。多数CKD缓慢进展,但在有效血容量不足、感染、使用肾毒性药物等危险因素影响下可急性加重。详细的病史、清楚的病程、规律的随访和肾脏的大小有利于鉴别诊断。积极治疗原发病、避免和纠正CKD进展的危险因素,预防和及时发现并积极清除CKD急性加重的危险因素,有助于肾功能保持稳定。     

Cardiovascular complications of pediatric chronic kidney disease

Cardiovascular disease (CVD) mortality is a leading cause of death in adult chronic kidney disease (CKD), with exceptionally high rates in young adults, according to the Task Force on Cardiovascular Disease. Recent data indicate that cardiovascular complications are already present in children with CKD. This review summarizes the current literature on cardiac risk factors, mortality and morbidity in children with CKD.     

Pseudoexfoliation syndrome in chronic kidney disease patients

Abstract

This study was performed to determine whether chronic kidney disease (CKD) is associated with an increased risk of pseudoexfoliation (PEX) syndrome. This is an age-matched case control study evaluating frequency of PEX in patients over age 40 with the diagnosis of stage 1–4 CKD and those undergoing hemodialysis (HD). Subjects over age 40 with hypertension and/or diabetes mellitus (DM) and normal kidney functions were studied as a control group. CKD was diagnosed as decreased glomerular filtration rate (GFR) of less than 60?mL/min/1.73?m² for at least 3 months. Study groups were arranged as group 1 consisting of HD receiving CKD patients, group 2 consisting of CKD patients who do not need HD and group 3 as a control. Demographic properties and the prevalence of PEX were evaluated and compared between groups. Because of the effect of DM on PEX occurrence, it was also evaluated after exclusion of diabetic patients. A total of 101 cases in group 1, 106 cases in group 2 and 117 cases in group 3 were included in the study. Pseudoexfoliation was found in 7 (6.9%) patients in group 1, 5 (4.7%) patients in group 2 and 7 (5.9%) patients in group 3 (p?>?0.05). After exclusion of diabetic patients the prevalence of PEX changed as 4 (5.6%) in group 1, 2 (4.4%) in group 2 and 1 (1.8%) in group 3 (p?>?0.05). In conclusion, CKD was not associated with increased prevalence of PEX in this study.