Epidemiology and risk factors for chronic kidney disease

Kidney disease is highly prevalent in the United States population and groups at high risk for increased prevalence of CKD include individuals with a family history of ESRD, diabetes, hypertension, and cardiovascular disease. Despite the increased risk of ESRD observed for blacks compared with whites, racial disparities in the prevalence of kidney disease have not been consistently demonstrated in the United States population. Although the reasons for discrepancy in risk of ESRD and CKD have not been established, clinicians should be aware that more rapid progression of CKD among blacks is a possible explanation for this observation and that closer monitoring and intensive care of risk factors associated with progressive renal injury is warranted for blacks with CKD and in other high-risk groups. Therapeutic interventions that delay or prevent progressive kidney disease are well established and incorporated into widely disseminated clinical practice guidelines. These interventions include aggressive blood pressure control with agents that block the renin-angiotensin system, reduction of dietary protein to recommended levels for the American diet, weight loss, smoking cessation, and control of hyperlipidemia. These interventions also reduce the risk of cardiovascular disease and should be regarded as essential components of care of CKD. Achieving high levels of medically appropriate care of CKD patients and reduction in risk of progression to ESRD may be delayed by barriers created by individual and regional poverty.     

The role of the primary care physician in managing early stages of chronic kidney disease

Recent increases in obesity, diabetes, and hypertension, along with the aging of the US population, are driving a dramatic rise in the prevalence of chronic kidney disease (CKD). Despite this increase, the majority of Americans with early-stage CKD remain unaware of their disease. Primary care physicians are at the forefront of efforts for early recognition of CKD and management to control its progression. Patients with CKD should be referred to nephrologists no later than the point at which their estimated glomerular filtration rate reaches 30 mL/min. Nephrology evaluation at this point is essential to facilitate timely preparation for care of end-stage renal disease through preemptive transplantation or planned transition to dialysis. In addition to stringent control of underlying hypertension and/or diabetes, mineral metabolic parameters (serum parathyroid hormone, phosphorus, calcium, and bicarbonate) in patients with advancing CKD should be managed closely to avoid adverse effects on the cardiovascular and skeletal systems.     

Recognizing the link between CKD and CVD in the primary care setting: accurate and early diagnosis for timely and appropriate intervention

Chronic kidney disease (CKD), which is becoming increasingly prevalent in the US and worldwide, eventually progresses to end-stage renal disease (ESRD), requiring renal replacement therapy. Diabetes and hypertension, the two leading causes of CKD, are themselves reaching near epidemic proportions. Hypertension can cause both the development and progression of CKD, and CKD is a significant risk factor for the development of cardiovascular disease. Indeed, CKD patients are more likely to die of cardiovascular complications than progress to ESRD. However, data indicate that early recognition and management of CKD can have a significant positive impact on disease outcome. This creates an important interventional opportunity for the primary care physician. This report describes the major risk factors and comorbidities associated with the development and progression of CKD and offers suggestions for timely diagnosis and management of CKD in the primary care setting.     

Prevalence of abdominal obesity in primary care: the IDEA UK study

Background: Abdominal obesity is known to be a risk factor for cardiovascular and metabolic diseases. However, despite the importance of abdominal obesity as a risk factor for cardiovascular and metabolic disease, there are currently no UK‐specific data on its prevalence in patients attending primary care. Aim: The aim of the International Day for the Evaluation of Abdominal obesity (IDEA)‐UK observational study was to determine the distribution of waist circumference – a marker of abdominal obesity – and its relationship with cardiovascular risk markers in a UK‐based primary care population. Methods: Patients underwent measurements of height, weight and waist circumference and provided data on reported cardiovascular disease (CVD), diabetes, hypertension and dyslipidaemia. Results: A total of 1731 patients were assessed within the study, of which 719 were male and 1012 were female. Of these 1731 patients, 1718 had complete datasets for the presence of reported cardiovascular risk factors. Median waist circumference in the male and female populations respectively was 99.0 cm [interquartile range (IQR) 91.0?108.0 cm] and 89.0 cm (IQR 79.0?100 cm). In all, 38.8% of men and 51.2% of women were abdominally obese (waist circumference > 102 cm and > 88 cm respectively) according to the US National Cholesterol Education Program (NCEP) guidelines. Within both male and female populations, the incidence of reported CVD, lipid disorders, hypertension and diabetes increased with increasing quartiles for waist circumference. Conclusion: Increased waist circumference is widespread in patients attending primary care in the UK and is associated with elevated levels of reported diabetes, hypertension, lipid disorders and CVD.     

Epidemiology of CKD in Japan

Concept of chronic kidney disease (CKD) is widely accepted, since it is a risk factor for end-stage renal disease (ESRD) and cardiovascular disease. In Japan, the prevalence of ESRD is increasing and is currently more than 2,000 per million populations. More than 40% of incident ESRD is due to diabetes mellitus. The prevalence of a low glomerular filtration rate (GFR < 60 mL/min/1.73 m2) is estimated to be 10% of the adult population. Studies based on several community-based screening programs suggest that Japan has a higher prevalence of CKD than any other countries. Early detection through urine test for proteinuria and measurement of serum creatinine is strongly recommended. Goal of treatment of CKD is to decrease the incidence of ESRD and cardiovascular disease.     

Effects of statins on renal function

Patients with chronic kidney disease (CKD) are much more likely to die of cardiovascular disease than end-stage renal disease. Dyslipidemia is highly prevalent in patients with CKD and may contribute to the elevated cardiovascular risk as well as CKD progression. Statins are lipid-lowering drugs that appear to protect the kidneys via cholesterol reduction as well as noncholesterol-mediated mechanisms. Subgroup analyses of major clinical studies and meta-analyses of smaller trials indicate that statin therapy slows the decline of the glomerular filtration rate. Additionally, statins appear to reduce proteinuria in patients with CKD. Statins are well recognized to reduce cardiovascular morbidity and mortality in patients with and without documented cardiovascular disease and in certain high-risk populations, such as persons with diabetes mellitus. However, conclusive evidence for improved cardiovascular outcomes with statin therapy for CKD is not yet available. Several ongoing studies are evaluating the effect of statins on cardiovascular end points in patients with CKD and may provide data needed to support adjunctive use of these agents in this high-risk population.     

Prevalence of chronic kidney disease in a middle and old-aged population of Beijing

BACKGROUND: Chronic kidney disease (CKD) was epidemic worldwide. The prevalence of CKD indicators, including proteinuria, hematuria/uninfectious leukocyturia and reduced GFR, was investigated in the middle and old-aged population of Beijing Shijingshan district. METHODS: Subjects of 2310 aged > or =40 y were enrolled. Their health conditions were taken by questionnaires and physical check-ups. Spot urine albumin to creatinine ratio, spot urine dipstick and microscopy for urine red cell and leukocyte, and serum creatinine was determined. Using simplified Modification of Diet in Renal Disease Study equation estimated GFR assessed renal function. The associations between age, gender, diabetes mellitus, and hypertension, and indicators of kidney damage were examined. RESULTS: Through the questionnaires, the history of diabetes mellitus, hypertension and CKD were found in 28%, 47.1% and 3.6% of subjects, respectively. Albuminuria was detected in 8.4% of subjects, hematuria and uninfectious leukocyturia in 0.7%, and reduced GFR in 4.9%. Approximately 12.9% had at least 1 indicator of CKD. The known rate of CKD in the studied population was 7.1%. Age, diabetes mellitus, hyper fasting blood glucose and hypertension were independently associated with albuminuria; age, gender, hyper uric acid and albuminuria with reduced GFR. When proteinuria and reduced GFR were determined using spot urine dipstick protein > or =25 mg/dl and serum creatinine > or =133 micromol/l, the prevalence of proteinuria and reduced GFR were 4.7% and 0.8%, respectively. CONCLUSION: The prevalence of CKD is common in middle and old-aged population of Beijing, especially in the elderly, but the known rate was relatively low. These findings highlight the clinical and public health importance of CKD.     

Cardiovascular disease and the kidney. Tracking a killer in chronic kidney disease

The interlinking of CVD with CKD is undeniable. CVD accounts for more than 50% of all morbidity and mortality in patients with kidney disease who have undergone renal replacement therapy, and CVD is also prevalent in patients with mild and moderately severe kidney disease. To help address the elevated risks of these patients, primary care physicians need to maintain vigilance in (1) identifying patients who have CKD and (2) implementing strategies for reducing the prevalence of CVD in this population. It is essential that patients be screened for relatively mild kidney disease by measurement of serum creatinine and urine microalbumin and by calculation of the glomerular filtration rate in mL/min/1.73 m2 using equations based on serum creatinine. Rigorous assessment of conventional risk factors, including dyslipidemia, hypertension, and diabetes, is also necessary to prevent the poor outcomes currently observed in persons with CKD. Routine use of ACE inhibitors and aspirin is encouraged in all patients with CKD, and strict glycemic and blood pressure control is recommended for optimal outcomes. In addition, patients should be screened and treated for risk factors particularly associated with kidney disease and CVD morbidity and mortality, including anemia, hyperphosphatemia, and hyperparathyroidism. Finally, physicians should be careful to avoid therapeutic nihilism in patients with kidney disease; those at highest risk of CVD are likely to receive the greatest benefit from cardiovascular therapies.     

Slowing the Progression of Chronic Kidney Disease

The increasing incidence and prevalence of chronic kidney disease (CKD) make treatment and management to slow the progression of this condition of essential interest to nurse practitioners (NPs) in primary care settings. Early identification and monitoring of patients at risk for CKD can be facilitated by annual testing for albuminuria and serial monitoring of estimated glomerular filtration rate and serum creatinine. Diagnostic evaluation used to determine underlying cause, type, and severity of CKD can help to reduce associated cardiovascular complications by preserving cardiac function. Aggressive primary care treatment and management during the early stages of CKD can reduce associated morbidity and mortality and reduce costs associated with end-stage renal disease.     

Cardiovascular risk in chronic kidney disease: what is new in the pathogenesis and treatment?

The prevalence of chronic kidney disease (CKD) has increased markedly over past decades due to the aging of the worldwide population. Despite the progress in the prevention and treatment, the cardiovascular (CV) morbidity and mortality remain high among patients with CKD. Although CKD is a progressive and irreversible condition, it is possible to slow decreasing kidney function, as well as the development and progression of associated with kidney disease comorbidities. Diabetes mellitus has become major cause of CKD worldwide. It is estimated that the prevalence of diabetes will increase from 425 million worldwide in 2017 to 629 million by 2045, substantially the percentage of diabetic nephropathy among CKD patients is set to rise markedly. The results of multicenter trials concerning novel antidiabetic drugs suggest that efficacy in reducing CV risk is independent of the improvement in glycemic control. This review discusses underlying causes of high CV risk and strategies reducing individual burden among CKD patients.     

Gestational Diabetes Mellitus Alone in the Absence of Subsequent Diabetes Is Associated With Microalbuminuria: Results from the Kidney Early Evaluation Program (KEEP)

OBJECTIVE

Women with gestational diabetes mellitus (GDM) maintain a higher risk for recurrent GDM and overt diabetes. Overt diabetes is a risk factor for development of chronic kidney disease (CKD), but GDM alone, without subsequent development of overt diabetes, may also pose a risk for CKD.

RESEARCH DESIGN AND METHODS

This cross-sectional analysis included Kidney Early Evaluation Program (KEEP) participants from 2000 to 2009. Patient characteristics and kidney function among three categories (GDM alone, overt diabetes, and no history of diabetes) were compared. The prevalence of microalbuminuria, macroalbuminuria, and CKD stages 1–2 and 3–5 was assessed using logistic regression.

RESULTS

Of 37,716 KEEP female participants, 571 (1.5%) had GDM alone and 12,100 (32.1%) had overt diabetes. Women with GDM had a higher rate of microalbuminuria but not macroalbuminuria than their nondiabetic peers (10.0 vs. 7.7%) that was substantially lower than the 13.6% prevalence in diabetic women. In multivariate analysis, women with GDM alone, compared with nondiabetic women, demonstrated increased odds of CKD stages 1–2 (multivariate odds ratio 1.54 [95% CI 1.16–2.05]) similar to the odds for women with overt diabetes (1.68 [1.55–1.82]). In stratified analyses, age, race, BMI, and hypertension modified the odds for CKD stages 1 –2 but not CKD stages 3–5 among women with GDM.

CONCLUSIONS

Women with GDM alone have a higher prevalence of microalbuminuria than women without any history of diabetes, translating to higher rates of CKD stages 1–2. These results suggest that GDM, even in the absence of subsequent overt diabetes, may increase the risk for future cardiovascular and kidney disease.Most women who develop diabetes during a pregnancy, gestational diabetes mellitus (GDM), are normoglycemic after delivery but still maintain a higher risk for recurrent GDM, impaired glucose tolerance, and overt diabetes. Indeed, the odds of developing subsequent type 2 diabetes for women with GDM is roughly 5 times higher than that for women with normoglycemic pregnancies in the first 5 years after delivery; the odds rise to more than 9 times higher in the years afterward (1).Although overt diabetes is recognized as a potent risk factor for development of chronic kidney disease (CKD), it is currently unclear whether GDM alone, without subsequent development of overt diabetes, also poses any risk to kidney function. Because certain clinical factors (e.g., waist circumference, BMI, and years postdelivery) have been shown to increase the risk for development of overt diabetes in women with GDM (2), these factors could potentially also modify the risk for development of CKD.We hypothesized that GDM alone would impart an increased risk for CKD and, specifically, that women with GDM would have a level of risk intermediate between that of women without any history of glucose abnormalities and women with overt diabetes. Using data from the National Kidney Foundation''s Kidney Early Evaluation Program (KEEP), a program designed to screen participants at higher risk for CKD than the general population, we examined in cross-sectional analyses whether GDM, in the absence of subsequent overt diabetes, increases the odds of abnormal urinary albumin excretion and impaired glomerular filtration rate. In addition, we examined whether age, race, BMI, or hypertension modifies this relationship between GDM and CKD.     

Chronic kidney disease in Japan from early predictions to current facts

Chronic kidney disease (CKD) is considered a risk factor for both end-stage renal disease (ESRD) and cardiovascular disease. Early detection and treatment of CKD is likely to be the key factor to prevent them. According to the Japanese Society for Dialysis Therapy, the prevalence of treated ESRD has increased to >2,000 per million population. More than 40% of ESRD incidents are due to diabetes mellitus. The Japanese Society of Nephrology estimates the prevalence of a low GFR (<60 ml/min/1.73 m(2)) to be around 10% of the community-based screening participants. However, such a high CKD prevalence requires detailed and critical confirmatory studies and analyses, many of which are currently underway in Japan.     

Chronic kidney disease: detection and evaluation

Chronic kidney disease affects an estimated 27 million adults in the United States, and is associated with significantly increased risk of cardiovascular disease and stroke. Patients should be assessed annually to determine whether they are at increased risk of developing chronic kidney disease based on clinical and sociodemographic factors. Diabetes mellitus, hypertension, and older age are the primary risk factors that warrant screening. Other risk factors include cardiovascular disease, family history of chronic kidney disease, and ethnic and racial minority status. Serum creatinine levels can be used to estimate the glomerular filtration rate, and spot urine testing can detect proteinuria. After the diagnosis of chronic kidney disease is made, staging based on estimated glomerular filtration rate determines prognosis, evaluation, and management. Further evaluation should focus on the specific type of kidney disease and on identifying complications related to the disease stage. Patients should be assessed for risk factors leading to the further loss of kidney function and cardiovascular disease. Patients with estimated glomerular filtration rates less than 30 mL per minute per 1.73 m(2), significant proteinuria, or rapid loss of kidney function should be referred to a nephrologist for further evaluation and management.     

Executing change in the management of chronic kidney disease: perspectives on guidelines and practice

In this era of escalating information, costly technology, and an increasing prevalence of chronic complex diseases in an aging population, a systematic approach to execute changes in the care of patients with kidney disease must be developed. Specifically, there is a need to facilitate the translation of research and clinical guidelines into the delivery of quality clinical care. At present in nephrology, there is some knowledge of disease processes, accumulating knowledge about risk factors for progression, and knowledge about how to best deliver care to those with a chronic disease. The current health care environment is not suited to either the care of chronic conditions or to prevention. Information technology should facilitate shared models of care delivery for chronic conditions and allow opportunities to add new knowledge and deliver good care to complex patient groups. To execute change in the management of patients with CKD, medical students, healthcare professionals, and established physicians need to be educated about the prevalence and consequences of CKD. These educational initiatives should be done in the context of cases or specific patients especially for established practitioners, and should be simplified to make analogies to familiar concepts. The concept that CKD is a risk factor for cardiovascular disease, and needs to be managed (as does diabetes and dyslipidemia), should be more clearly articulated. Basic and clinical research in kidney disease has been enhanced by discoveries in vascular biology, diabetes, and cardiology. Much of the clinical research has been limited, however, by lack of clear definition of CKD. The development of the new K/DOQI staging system that defines and classifies the severity of kidney disease may improve the execution of ongoing robust clinical trials. Incorporating this classification system into the clinical practice of all physicians by automatic laboratory reporting of estimates of GFR raises awareness and improves communication between all medical professionals. Collaborative management of CKD patients between different physicians and multidisciplinary teams, in conjunction with the ongoing investigation of treatments and treatment strategies by both clinician and researchers, may well lead to improved outcomes for patients with CKD. Executing change in the management of CKD requires an increased awareness on the part of all clinicians, including nephrologists, regarding the prevalence and importance of the problem of earlier stages of kidney disease. The systematic evaluation of all patients and incorporation of simplified definitions and classification systems should enhance the ability to improve the outcomes of patients with kidney disease irrespective of time of identification.     

Abnormalities in renal hemodynamics

Chronic kidney disease (CKD) is a major risk factor for the development of cardiovascular disease (CVD). Abnormalities of renal hemodynamics are associated with CKD. Abnormalities in renal hemodynamics include blood flow into glomeruli, and tubulointerstitial tissue. Renin-angiotensin system, oxidative stress and NOS system affect abnormalities of renal hemodynamics in CKD. Further, intrarenal hemodynamic abnormalities are strongly associated with systemic arteriosclerosis. Appropriate regulation of renal hemodynamics and controls of hypertension and diabetes mellitus retard the progression of both CKD and CVD.     

Chronic kidney disease (CKD) as an independent risk factor for cardiovascular disease (CVD)

Chronic kidney disease (CKD) has been shown to be an independent risk factor for cardiovascular disease (CVD) in a number of recent epidemiological studies. There are possible explanations for the independent association of CKD with CVD. Reduced renal function is associated with a high prevalence of traditional CVD risk factors, such as hypertension, diabetes, dyslipidemia, and left ventricular hypertrophy. In addition, reduced renal function may be associated with increased levels of nontraditional risk factors, such as inflammation and oxidative stress. Subjects with CKD should be considered a high-risk population for CVD and be recommended for more intensive preventive management of CVD, including active detection and strict treatment of CVD risk factors.     

崇明地区中老年人群慢性肾脏病的流行病学研究

目的研究崇明地区中老年人群慢性肾脏病的患病率及其相关危险因素。方法2011年9月至2012年3月崇明地区城桥镇城乡交界的社区40～70岁常住居民1358人,进行慢性肾脏病及相关危险因素的问卷调查、体格检查、实验室检查采集相关数据。对于被调查者如出现下列情况：尿蛋白阳性、镜下血尿、血肌酐≥110 mmol/L、血尿酸男≥0.42μmol/L、女≥0.36μmol/L,3个月后至医院复查。结果在1092例资料完整的居民中,白蛋白尿、血尿、肾功能下降的患病率分别10.7％、2.2％、1.0％。该人群慢性肾脏病患病率为13.2％,知晓率为17.3％。经多因素Logistic回归提示：高尿酸血症、高血压、糖尿病、性别、年龄为慢性肾脏病独立相关因素。结论在上海崇明慢性肾脏病的患病率为13.2％,知晓率为17.3％。高尿酸血症、高血压、糖尿病、性别、年龄为慢性肾脏病独立影响因素。     

Causes and characteristics of CKD

Chronic kidney disease (CKD) is common in Japan and worldwide. The estimated prevalence of CKD in Japanese adults was 10.6% in 2005, based on the survey conducted by the Japanese Society of Nephrology. The most common risk factors for CKD include diabetes, hypertension and cardiovascular disease. Major outcomes of CKD include progression to kidney failure and increased risk for cardiovascular disease. CKD is usually silent until its late stages, thus many patients with CKD are detected only shortly before the onset of symptomatic kidney failure, when there are few opportunities to prevent adverse outcomes. Earlier detection allows for more time for evaluation and treatment but requires explicit testing strategies for asymptomatic individuals at increased risk. Understanding the strengths and limitations of CKD testing and risk factors of CKD is critical for appropriate management of CKD patients. The goal of this paper is to discuss CKD testing and early detection in clinical practice and its application to public health initiatives, with attention to limitations and appropriate interpretation.     

Algorithm of early detection and diagnosis of CKD

CKD is a common, harmful but treatable disease. Since the number of CKD patients is huge, the efficient and practical measures for early detection and diagnosis are needed. To achieve this goal, systematic screening and collaborative work between nephrologists and primary care physicians should be established. Urinalysis, especially urinary protein detection, and measurement of serum creatinine level (estimation of GFR) are the two major tests to detect CKD. These two clinical tests should be done for those people who have higher risk of CKD, i.e., those with diabetes, hypertension, metabolic syndrome, obesity, family history of CKD. Urine testing for general population is also necessary to detect glomerulonephritis. The earlier CKD is diagnosed, the better the outcome is.     

Clinical and demographic characteristics of various types of arterial hypertension in elderly patients (based on results of Russian scientific-practical program ARGUS

AIM: It is the fragment of the trial aimed at the study of demographic indices and components of cardiovascular risk in patients over 55 with known and newly diagnosed arterial hypertension (AH) by referral to outpatient clinic depending on AH type. MATERIAL AND METHODS: For a week, 140 therapists from 14 regions of the Russian Federation measured AP in all persons aged 55 and older visiting outpatient clinics. A total of 5582 persons were examined. 3847 of them were already diagnosed to have hypertension. Primary diagnosis of hypertension was made in 5.7 examinees out of 2442. RESULTS: Patients with previous diagnosis of hypertension vs those with primary diagnosis had significantly greater index of body mass, had more often overweight, obesity and diabetes mellitus. Isolated systolic AH was encountered in 56% of all the primary cases. High and very high risk to develop cardiovascular complications was encountered in 59.9% of primary patients and 85.8% of those previously diagnosed. CONCLUSION: Patients aged 55 and older with newly diagnosed isolated systolic AH had the following most common factors of risk of cardiovascular complications: overweight, obesity, smoking, dyslipidemia, diabetes mellitus. In treated patients these risk factors are: overweight, obesity, dyslipidemia, diabetes mellitus, smoking.