Impact of Transition in Metabolic Health and Obesity on the Incident Chronic Kidney Disease: A Nationwide Cohort Study

2020 ◽  
Vol 105 (3) ◽  
pp. e148-e157 ◽  
Author(s):  
Yun Kyung Cho ◽  
Jiwoo Lee ◽  
Hwi Seung Kim ◽  
Joong-Yeol Park ◽  
Woo Je Lee ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Confidence Interval ◽  
Dynamic Condition ◽  
National Sample ◽  
Metabolic Health ◽  
Hazard Ratio ◽  
Longitudinal Change ◽  
Increased Risk ◽  
Metabolically Healthy

Abstract Context Metabolically healthy obesity (MHO) is a dynamic condition. Objective To evaluate the risk of chronic kidney disease (CKD) among people with MHO according to its longitudinal change. Design Observational study. Setting A nationwide population-based cohort. Participants A total of 514 866 people from the Korean National Health Insurance Service-National Sample Cohort. Intervention The initial presence and changes of obesity (using body mass index [BMI] and waist circumference [WC]) and metabolic health status. Main outcome Measure Incident CKD from 2011 to 2015. Results Of the people classified as MHO at baseline (BMI criteria), 47.6% remained as MHO in 2011 and 2012, whereas 12.1%, 5.5%, and 34.8% were classified as metabolically healthy, non-obese (MHNO), metabolically unhealthy, non-obese, and metabolically unhealthy, obese, respectively. The risk of incident CKD in the baseline MHO group was higher than that in the MHNO group (hazard ratio, 1.23; 95% confidence interval, 1.12-1.36). However, when transition was taken into account, people who converted to MHNO were not at increased risk (hazard ratio, 0.98; 95% confidence interval, 0.72-1.32), whereas the stable MHO group and the groups that evolved to metabolically unhealthy status had a higher risk of incident CKD than the stable MHNO group. When the risk was analyzed using WC criteria, it showed a similar pattern to BMI criteria except for the stable MHO group. Conclusions MHO was a dynamic condition, and people with MHO constituted a heterogeneous group. Although the MHO phenotype was generally associated with incident CKD, maintenance of metabolic health and weight reduction might alleviate the risk of CKD.

scholarly journals Change in Metabolic Health Status Over Time and Risk of Chronic Kidney Disease: A Prospective Study

2021 ◽  
Author(s):  
Haozhe Cui ◽  
Qian Liu ◽  
Yuntao Wu ◽  
Liying Cao
Keyword(s):  
Chronic Kidney Disease ◽  
Health Status ◽  
Kidney Disease ◽  
Dynamic Condition ◽  
Fasting Blood Glucose ◽  
Metabolic Health ◽  
Metabolic Abnormality ◽  
Increased Risk ◽  
Over Time

Abstract Objective: Metabolically healthy obesity (MHO) is a dynamic condition and is known to increase the risk for chronic kidney disease (CKD). In this study, we aimed to examine the association between metabolic health status and its change over time and CKD risk.Methods: A total of 39463 participants from Kailuan Study were collected body mass index and metabolic health status at 2006/07 and 2010/11 examination. Metabolic abnormality was diagnosed by the presence of any 2 of 4 components (elevated blood pressure, elevated fasting blood glucose, elevated triglyceride and decreased high-density lipoprotein cholesterol). We classified participants into six groups according to metabolic health status and obesity. The changes in obesity and metabolic health status were considered from 2006/07 to 2010/11. Results: Of the participants classified as MHNW or MHO at baseline, 17.25% and 39.64% were classified as MUNW or MUO in 2010/11, respectively. During a mean follow-up of 9.7 years, 5351 participants developed CKD from 2010/11. Compared with participants in the stable MHNW group, the stable MHO group had a significantly higher risk of incident CKD (HR: 1.16; 95% CI: 1.02-1.33), but was lower than that in individuals with MUO. Individuals with metabolic healthy at baseline who changed to metabolic abnormality during follow-up had higher risk of CKD. Conclusions: MHO phenotype or its transition to a metabolically unhealthy phenotype were associated with increased risk of CKD. Stable metabolic health individuals had lower risk of CKD than those with metabolically unhealthy phenotype.

scholarly journals Renal dysfunction indicative of outcomes in hospitalized patients with takotsubo syndrome

2017 ◽  
Vol 7 (8) ◽  
pp. 723-731 ◽  
Author(s):  
Kaoru Ando ◽  
Hiroyasu Sukekawa ◽  
Aoi Takahata ◽  
Yusuke Kobari ◽  
Hayato Tsuchiya ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Confidence Interval ◽  
Renal Dysfunction ◽  
Left Ventricular ◽  
Hazard Ratio ◽  
Hospitalized Patients ◽  
Rank Test ◽  
Takotsubo Syndrome ◽  
Pump Failure

Background: Left ventricular dysfunction as part of takotsubo syndrome is reversible, and the long-term prognosis appears favorable. However, life-threatening complications are not uncommon during the acute phase, and it remains unclear whether renal dysfunction is a factor in complications suffered by hospitalized patients with takotsubo syndrome. The present study was conducted to investigate the implications of renal dysfunction in this setting. Methods: Data from 61 consecutive patients (male, 21; female, 40) diagnosed with takotsubo syndrome at our hospital between years 2010 and 2016 were evaluated retrospectively. In-hospital complications by definition were all-cause deaths and severe pump failure (Killip class ≥III). Results: Overall, 30 patients (49%) developed renal dysfunction. In the 32 patients (52%) who suffered in-hospital complications (mortality, 10; severe pump failure, 22), estimated glomerular filtration rate (eGFR) was significantly lower by comparison (51.3±29.8 vs. 69.5±29.0; p=0.019). Low eGFR (<30 ml/min per 1.73m2) proved independently predictive of in-hospital complications (hazard ratio =2.84, 95% confidence interval: 1.20–6.69) in multivariate Cox hazard analysis, also showing a significant association with peak event rate of Kaplan–Meier curve (log-rank test, p=0.0073). Similarly, patients with chronic kidney disease were at significantly greater risk of in-hospital complications (hazard ratio=2.49, 95% confidence interval: 1.01–5.98), relative to non-compromised counterparts (eGFR >60 ml/min per 1.73m2). Conclusion: Renal dysfunction is a simple but useful means of predicting complications in hospitalized patients with takotsubo syndrome, especially those with chronic kidney disease.

scholarly journals Clinical Predictors of Preeclampsia in Pregnant Women with Chronic Kidney Disease

Medicina ◽  
2020 ◽  
Vol 56 (5) ◽  
pp. 213
Author(s):  
Bogdan Marian Sorohan ◽  
Andreea Andronesi ◽  
Gener Ismail ◽  
Roxana Jurubita ◽  
Bogdan Obrisca ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
High Risk ◽  
Kidney Disease ◽  
Confidence Interval ◽  
Pregnant Women ◽  
Cumulative Risk ◽  
Hazard Ratio ◽  
Adjusted Hazard Ratio ◽  
Clinical Predictors ◽  
Mean Time

Background and Objectives: Pregnant women with chronic kidney disease (CKD) are at high risk of adverse maternal and fetal outcomes. Preeclampsia (PE) superimposed on CKD is estimated to occur in 21%–79% of pregnancies. Both conditions share common features such as proteinuria and hypertension, making differential diagnosis difficult. Objective: The aim of this study was to evaluate the incidence and the clinical-biological predictors of preeclampsia in pregnant women with CKD. Material and Methods: We retrospectively analyzed 34 pregnant women with pre-existing CKD admitted to our department between 2008 and 2017. Results: Among the 34 patients, 19 (55.8%) developed PE and the mean time of occurrence was 31.26 ± 2.68 weeks of gestation. The median value of 24-h proteinuria at referral was 0.87 g/day (interquartile range 0.42–1.50) and 47.1% of patients had proteinuria of ≥1 g/day. Patients with PE tended to be more hypertensive, with a more decreased renal function at referral and had significantly higher proteinuria (1.30 vs. 0.63 g/day, p = 0.02). Cox multivariate analysis revealed that proteinuria ≥1 g/day at referral and pre-existing hypertension were independently associated with PE (adjusted hazard ratio = 4.10, 95% confidence interval: 1.52–11.02, p = 0.005, adjusted hazard ratio = 2.62, 95% confidence interval: 1.01–6.77, p = 0.04, respectively). The cumulative risk of PE was significantly higher in pregnant women with proteinuria ≥1 g/day at referral (log-rank, p = 0.003). Proteinuria ≥ 1 g/day at referral and pre-exiting hypertension predicted PE development with accuracies of 73.5% and 64.7%, respectively. Conclusions: Pregnant patients with pre-existing CKD are at high risk of developing preeclampsia, while proteinuria ≥ 1 g/day at referral and pre-existing hypertension were independent predictors of superimposed preeclampsia.

Increased risk of sudden sensorineural hearing loss in patients with depressive disorders: population-based cohort study

2015 ◽  
Vol 130 (1) ◽  
pp. 42-49 ◽  
Author(s):  
C-S Lin ◽  
Y-S Lin ◽  
C-F Liu ◽  
S-F Weng ◽  
C Lin ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Chronic Kidney Disease ◽  
Hearing Loss ◽  
Kidney Disease ◽  
Sensorineural Hearing Loss ◽  
Depressive Disorders ◽  
Sudden Sensorineural Hearing Loss ◽  
Hazard Ratio ◽  
Sensorineural Hearing ◽  
Increased Risk

AbstractObjectives:To evaluate the incidence rates and risk of sudden sensorineural hearing loss among patients with depressive disorders.Method:Data for 27 547 patients with newly diagnosed depressive disorders and 27 547 subjects without depressive disorders between 2001 and 2008 were yielded from the Taiwan National Health Insurance Research Database. Sudden sensorineural hearing loss incidence at the end of 2011 was determined. Cumulative incidence and adjusted hazard ratio were computed.Results:Sudden sensorineural hearing loss incidence was 1.45 times higher in the depressive disorders group compared to the non-depressive disorders group (p = 0.0041), with an adjusted hazard ratio of 1.460. A significant increased risk of developing sudden sensorineural hearing loss was noted in patients with diabetes mellitus, chronic kidney disease and hyperlipidaemia (p < 0.05).Conclusion:The results suggest an increased risk of developing sudden sensorineural hearing loss in patients with depressive disorders. Co-morbidities such as diabetes mellitus, chronic kidney disease and hyperlipidaemia significantly aggravated the risk. Depressive disorders might be considered a risk factor for sudden sensorineural hearing loss. It remains to be seen whether control of depressive disorders can decrease the incidence of sudden sensorineural hearing loss in patients with depressive disorders.

scholarly journals Association between serum phosphorus levels and adverse outcomes in chronic kidney disease: an observational cohort study

2021 ◽  
Author(s):  
Akira Oda ◽  
Kenichi Tanaka ◽  
Hirotaka Saito ◽  
Tsuyoshi Iwasaki ◽  
Shuhei Watanabe ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Cohort Study ◽  
Kidney Disease ◽  
Cardiovascular Events ◽  
Cox Regression ◽  
Hazard Ratio ◽  
Adverse Outcomes ◽  
Serum Phosphorus ◽  
Increased Risk ◽  
Phosphorus Levels

Abstract Background Although an association between serum phosphorus levels and poor prognosis has been noted in dialysis patients, these associations have been insufficiently reported in non-dialysis dependent chronic kidney disease (NDD-CKD) patients. This study attempted to determine the association between serum phosphorus levels and adverse outcomes in Japanese NDD-CKD patients. Methods We investigated the relationships between serum phosphorus levels and adverse outcomes such as kidney events, cardiovascular events, and all-cause death in Japanese NDD-CKD patients, using the longitudinal data of the Fukushima CKD Cohort Study. The study evaluated 822 patients with NDD-CKD enrolled between June 2012 and July 2014. A kidney event was defined as a combination of doubling of the baseline serum creatinine or end-stage renal disease. Cox regression was performed to analyze the relationships of the quartile of the serum phosphorus with kidney events, cardiovascular events, and all-cause death. Results Over a median follow-up period of 2.8 years, 46 patients died, there were 50 cardiovascular events, and 102 kidney events occurred. Increased risk of kidney events was observed in patients with higher serum phosphorus, with the lowest risk shown to be a second quartile of serum phosphorus level of 2.9–3.2 mg/dL. Multivariable Cox regression analysis showed an increased risk of kidney events for the highest quartile of the serum phosphorus levels (≥ 3.7 mg/dL) versus the second quartile (2.9–3.2 mg/dL, hazard ratio, 3.62; 95% confidence interval, 1.65–7.94; P = 0.001). A 1 mg/dL increase of the serum phosphorus was associated with an adjusted hazard ratio of 1.66 (95% CI; 1.24–2.20) for the kidney events. There were no significant associations between the serum phosphorus levels at baseline and the risk of cardiovascular events and all-cause death. Conclusions Serum phosphorus levels were associated with an increased risk of CKD progression in Japanese NDD-CKD patients.

scholarly journals Investigating the Relationship Between Age and Kidney Failure in Adults With Category 4 Chronic Kidney Disease

2020 ◽  
Vol 7 ◽  
pp. 205435812096681
Author(s):  
Huda Al-Wahsh ◽  
Ngan N. Lam ◽  
Ping Liu ◽  
Robert R. Quinn ◽  
Marta Fiocco ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Confidence Interval ◽  
Risk Prediction ◽  
Kidney Failure ◽  
Cox Regression ◽  
Hazard Ratio ◽  
Administrative Databases ◽  
The Relationship

Background: In people with severe chronic kidney disease (CKD), there is an inverse relationship between age and kidney failure. If this relationship is the same at any age (linear), one effect (hazard ratio) will be sufficient for accurate risk prediction; if it is nonlinear, the effect will vary with age. Objective: To investigate the relationship between age and kidney failure in adults with category G4 chronic kidney disease (G4 CKD). Methods: We performed a population-based study using linked administrative databases in Alberta, Canada, to study adults with G4 CKD (estimated glomerular filtration rate [eGFR] = 15-30 mL/min/1.73 m2) and without previously documented eGFR <15 mL/min/1.73 m2 or renal replacement. We used cause-specific Cox regression to model the relationship between age and the hazard of kidney failure (the earlier of eGFR <10 mL/min/1.73 m2 or receipt of renal replacement) and death, incorporating spline terms to capture any nonlinear effect of age. We included sex, diabetes mellitus, cardiovascular disease, albuminuria, and eGFR in all models. Results: Of the 27 823 participants (97 731 patient-years at risk; mean age = 76 years, ±13), 19% developed kidney failure and 51% died. The decline in the hazard of kidney failure associated with a given increase in age was not constant but became progressively larger as people aged; that is, the hazard ratio became progressively smaller (closer to 0). Assuming an eGFR of 25 mL/min/1.73 m2, for every 10-year increase in age, the hazard ratio declined from 0.76 (95% confidence interval = 0.73-0.79) at age 50 years to 0.43 (95% confidence interval = 34-56) at age 80 years in people without cardiovascular disease, and from 0.75 (95% confidence interval = 0.70-0.79) at age 50 years to 0.36 (95% confidence interval = 0.29-0.45) at age 80 years in people with cardiovascular disease. Conclusions: The relationship between kidney failure and age varies with age. An age-dependent effect, rather than a constant effect, needs to be specified to accurately predict risk. These findings have implications for risk prediction and advanced care planning.

scholarly journals Dulaglutide in Diabetes and Chronic Kidney Disease: AWARD-7 Exploratory Analysis of Clinical Outcomes

Kidney360 ◽  
2020 ◽  
pp. 10.34067/KID.0005852020
Author(s):  
Katherine R. Tuttle ◽  
Brian Rayner ◽  
Mark C. Lakshmanan ◽  
Anita Y.M. Kwan ◽  
Manige Konig ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Confidence Interval ◽  
Proportional Hazards Model ◽  
Cox Proportional Hazards ◽  
Hazard Ratio ◽  
Cox Proportional Hazards Model ◽  
Clinical Event ◽  
Composite Outcome ◽  
Egfr Decline

Background: In the AWARD-7 trial of participants with type 2 diabetes (T2DM) and moderate-to-severe chronic kidney disease (CKD), dulaglutide (DU) treatment slowed decline in estimated glomerular filtration rate (eGFR) compared to insulin glargine (IG). Treatment with doses of either DU or IG resulted in similar levels of glycemic control and blood pressure. The aim of this analysis was to determine the risk of clinical event outcomes between treatment groups. Methods: Participants with T2DM and CKD categories 3-4 were randomized (1:1:1) to DU 0.75 mg or 1.5 mg weekly or IG daily as basal therapy, with titrated insulin lispro, for one year. The time to occurrence of the composite outcome of ≥40% eGFR decline, end-stage kidney disease (ESKD), or death due to kidney disease was compared using a Cox proportional hazards model. Results: Patients treated with DU 1.5 mg weekly versus IG daily for 1 year had a lower risk of ≥40% eGFR decline or ESKD events in the overall study population (5.2% versus 10.8%; hazard ratio 0.45, 95% confidence interval 0.20-0.97, P=0.042). Most events occurred in the subset with macroalbuminuria, where risk of the composite outcome was substantially lower for DU 1.5 mg versus IG (7.1% versus 22.2%; hazard ratio 0.25, 95% confidence interval 0.10-0.68, P=0.006). No deaths occurred. Conclusions: Treatment with DU 1.5 mg weekly was associated with a clinically relevant risk reduction of ≥40% eGFR decline or ESKD compared to IG daily, particularly in the macroalbuminuria subgroup of participants with T2DM and moderate-to-severe CKD.

Mineralocorticoid Receptor Antagonists and Renal Outcomes in Heart Failure Patients with and without Chronic Kidney Disease

2019 ◽  
Vol 10 (1) ◽  
pp. 32-41 ◽  
Author(s):  
Thomas A. Mavrakanas ◽  
Nadia Giannetti ◽  
Ruth Sapir-Pichhadze ◽  
Ahsan Alam
Keyword(s):  
Heart Failure ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Confidence Interval ◽  
Mineralocorticoid Receptor ◽  
Tertiary Care ◽  
Hazard Ratio ◽  
Control Group ◽  
Mineralocorticoid Receptor Antagonists ◽  
Receptor Antagonists

Introduction: The effect of mineralocorticoid receptor antagonists (MRAs) on chronic kidney disease (CKD) progression in patients with heart failure (HF) and with or without preexisting CKD has not been adequately studied. Methods: We conducted a retrospective cohort study including consecutive adult patients followed at the HF clinic of a tertiary care center who had already been on an angiotensin-converting enzyme inhibitor (ACEI) or an angiotensin receptor blocker (ARB). Exposure to MRAs was assessed at 6 months from registration. Patients who were never exposed to an MRA were the control group. Results: A total of 314 patients who were prescribed an MRA were compared to 1,116 patients who never received an MRA. Among them, 121 and 408 patients, respectively, had CKD (estimated glomerular filtration rate <60 mL/min/1.73 m2). MRAs had to be discontinued in 36/121 patients with CKD (29.8%) and 57/165 patients without CKD (34.5%) (p = 0.39). MRA treatment was associated with a higher risk for persistent creatinine doubling among patients without CKD (hazard ratio 4.07, 95% confidence interval 1.41–11.73). A numerically lower risk was identified among CKD patients (hazard ratio 0.33, 95% confidence interval 0.04–2.78) (p for interaction = 0.009). The primary safety outcome, a composite of any doubling of serum creatinine or any episode of serious hyperkalemia (K+ >6 mmol/L), occurred more commonly in MRA users compared with nonusers in the subgroup of patients without CKD, but not in CKD patients (p for interaction = 0.02). Conclusion: MRA treatment in addition to an ACEI or an ARB could be safely prescribed in HF patients with CKD as it is not associated with persistent renal function decline, acute kidney injury, or serious hyperkalemia, compared with ACEI/ARB monotherapy.

scholarly journals Inflammatory Markers and Incidence of Hospitalization With Infection in Chronic Kidney Disease

2019 ◽  
Vol 189 (5) ◽  
pp. 433-444 ◽  
Author(s):  
Junichi Ishigami ◽  
Jonathan Taliercio ◽  
Harold I Feldman ◽  
Anand Srivastava ◽  
Raymond Townsend ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Confidence Interval ◽  
Plasma Levels ◽  
Inflammatory Markers ◽  
Clinical Population ◽  
Low Grade ◽  
Major Infection ◽  
Increased Risk ◽  
Tnf Α

Abstract Persons with chronic kidney disease (CKD) are at high risk of infection. While low-grade inflammation could impair immune response, it is unknown whether inflammatory markers are associated with infection risk in this clinical population. Using 2003–2013 data from the Chronic Renal Insufficiency Cohort Study (3,597 participants with CKD), we assessed the association of baseline plasma levels of 4 inflammatory markers (interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), interleukin-1 receptor antagonist (IL-1RA), and transforming growth factor-β (TGF-β)) with incident hospitalization with major infection (pneumonia, urinary tract infection, cellulitis and osteomyelitis, and bacteremia and sepsis). During follow-up (median 7.5 years), 36% (n = 1,290) had incident hospitalization with major infection. In multivariable Cox analyses with each inflammatory marker modeled as a restricted cubic spline, higher levels of IL-6 and TNF-α were monotonically associated with increased risk of hospitalization with major infection (for 95th vs. 5th percentile, hazard ratio = 2.11 (95% confidence interval: 1.68, 2.66) for IL-6 and 1.88 (95% confidence interval: 1.51, 2.33) for TNF-α), while corresponding associations for IL-1RA or TGF-β were nonsignificant. Thus, higher plasma levels of IL-6 and TNF-α, but not IL-1RA or TGF-β, were significantly associated with increased risk of hospitalization with major infection. Future studies should investigate whether inflammatory pathways that involve IL-6 and TNF-α increase susceptibility to infection among individuals with CKD.

Stroke in chronic renal failure

2008 ◽  
Vol 149 (15) ◽  
pp. 691-696
Author(s):  
Dániel Bereczki
Keyword(s):  
Risk Factors ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Renal Disease ◽  
Chronic Renal Disease ◽  
Kidney Diseases ◽  
Cerebrovascular Diseases ◽  
Lipid Lowering ◽  
Increased Risk ◽  
Intracerebral Hemorrhages

Chronic kidney diseases and cardiovascular diseases have several common risk factors like hypertension and diabetes. In chronic renal disease stroke risk is several times higher than in the average population. The combination of classical risk factors and those characteristic of chronic kidney disease might explain this increased risk. Among acute cerebrovascular diseases intracerebral hemorrhages are more frequent than in those with normal kidney function. The outcome of stroke is worse in chronic kidney disease. The treatment of stroke (thrombolysis, antiplatelet and anticoagulant treatment, statins, etc.) is an area of clinical research in this patient group. There are no reliable data on the application of thrombolysis in acute stroke in patients with chronic renal disease. Aspirin might be administered. Carefulness, individual considerations and lower doses might be appropriate when using other treatments. The condition of the kidney as well as other associated diseases should be considered during administration of antihypertensive and lipid lowering medications.

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