Association of physical activity with risk of chronic kidney disease in China:A population-based cohort study

Background:Information on the association between physical activity(PA)and the risk of chronic kidney disease(CKD)is limited.We aimed to explore the associations of total,domain-specific,and intensity-specific PA with CKD and its subtypes in China.Methods:The study included 475,376 adults from the China Kadoorie Biobank aged 30-79 years during 2004-2008 at baseline.An interviewer-administered questionnaire was used to collect the information about PA,which was quantified as metabolic equivalent of task hours per day(MET-h/day)and categorized into 4 groups based on quartiles.Cox regression was used to analyze the association between PA and CKD risk.Results:During a median follow-up of 12.1 years,5415 incident CKD cases were documented,including 1159 incident diabetic kidney disease(DKD)cases and 362 incident hypertensive nephropathy(HTN)cases.Total PA was inversely associated with CKD risk,with an adjusted hazard ratio(HR,95%confidence interval(95%CI))of 0.83(0.75-0.92)for incident CKD in the highest quartile of total PA as compared with participants in the lowest quartile.Similar results were observed for risk of DKD and HTN,and the corresponding HRs(95%CIs)were 0.75(0.58-0.97)for DKD risk and 0.56(0.37-0.85)for HTN risk.Increased nonoccupational PA,low-intensity PA,and moderate-to-vigorous-intensity PA were significantly associated with a decreased risk of CKD,with HRs(95%CIs)of 0.80(0.73-0.88),0.85(0.77-0.94),and 0.85(0.76-0.95)in the highest quartile,respectively.Conclusion:PA,including nonoccupational PA,low-intensity PA,and moderate-to-vigorous-intensity PA,was inversely associated with the risk of CKD,including DKD,HTN,and other CKD,and such associations were dose dependent.

Improving Prediction of Chronic Kidney Disease Using KNN Imputed SMOTE Features and TrioNet Model

Chronic kidney disease(CKD)is a major health concern today,requiring early and accurate diagnosis.Machine learning has emerged as a powerful tool for disease detection,and medical professionals are increasingly using ML classifier algorithms to identify CKD early.This study explores the application of advanced machine learning techniques on a CKD dataset obtained from the University of California,UC Irvine Machine Learning repository.The research introduces TrioNet,an ensemble model combining extreme gradient boosting,random forest,and extra tree classifier,which excels in providing highly accurate predictions for CKD.Furthermore,K nearest neighbor(KNN)imputer is utilized to deal withmissing values while synthetic minority oversampling(SMOTE)is used for class-imbalance problems.To ascertain the efficacy of the proposed model,a comprehensive comparative analysis is conducted with various machine learning models.The proposed TrioNet using KNN imputer and SMOTE outperformed other models with 98.97%accuracy for detectingCKD.This in-depth analysis demonstrates the model’s capabilities and underscores its potential as a valuable tool in the diagnosis of CKD.

Potential efficacy and mechanism of medicinal plants on chronic kidney disease-associated vascular calcification:a review

Vascular calcification is a crucial risk factor that affects the incidence and mortality of cardiovascular disease in chronic kidney disease patients.Modern medicine relies on calcium-phosphorus binding agents,calcium mimetics,active vitamin D,and hemodialysis to prevent and treat vascular calcification,however,their efficacy is unsatisfactory and adverse reactions often occur.Medical plant therapy can act as an integrative regulator in patients with chronic kidney disease-associated vascular calcification,which can significantly improve patients’symptoms,but its specific mechanism has not been fully elucidated yet.In this paper,we reviewed the domestic and international theoretical studies on the pathogenesis mechanism of chronic kidney disease-associated vascular calcification in recent years,summarized eight active ingredients of medicinal plants as well as four compound formulas for improving chronic kidney disease-associated vascular calcification,and explored the mechanism of action of herbal medicine,which will provide a new strategy for promoting the prevention and treatment of vascular calcification.

Renin-angiotensin system inhibitors prescriptions in Chinese hospitalized chronic kidney disease patients

BACKGROUND Many guidelines have recommended renin-angiotensin system inhibitors(RASI)as the first-line treatment for patients with chronic kidney disease(CKD).We studied RASI prescription trends from 2010 to 2019,and analyzed the characteristics associated with RASI prescription in Chinese hospitalized CKD patients.AIM To study the prescription of renin angiotensin system inhibitors in hospitalized patients with CKD in China.METHODS It was retrospectively,cross-sectional reviewed RASI prescriptions in hospitalized CKD patients in China from 2010 to 2019.RASI prescribing trends were analyzed from 2010 to 2019,and bivariate and multivariate logistic regression analyses were conducted to identify characteristics associated with RASI prescription.RESULTS A total of 35090 CKD patients were included,with 10043(28.6%)RASI prescriptions.Among these patients,18919(53.9%)met the criteria for RASI treatments based on the 2012 kidney disease:Improving global outcomes guidelines.Of these,7246(38.3%)patients received RASI prescriptions.RASI prescriptions showed an initial rapid increase from 2011 to 2012,reached its peak around 2015 and 2016,and then exhibited a subsequent slight decreasing trend.Both bivariate and multivariate analyses showed that several characteristics,including the male gender,age less than 60-year-old,nephrology department admission,lower CKD stage,history of hypertension or diabetes,proteinuria,glomerulonephritis as the CKD etiology,and non-acute kidney injury were associated with RASI prescriptions.CONCLUSION The frequency of RASI prescriptions showed an initial increase but a slight decreasing trend in more recent years.CKD patients with certain characteristics such as elderly age,advanced disease stage,surgery department admission,or acute kidney injury were less likely to receive RASI prescriptions.In the application of RASI in hospitalized CKD patients is insufficient.The actual clinical practice needs to be improved.The development of related research is helpful to guide the correct choice of clinical treatment strategy.

Risk factors for cognitive impairment in patients with chronic kidney disease

BACKGROUND Chronic kidney disease(CKD)patients have been found to be at risk of concurrent cognitive dysfunction in previous studies,which has now become an important public health issue of widespread concern.AIM To investigate the risk factors for concurrent cognitive dysfunction in patients with CKD.METHODS This is a prospective cohort study conducted among patients with CKD between October 2021 and March 2023.A questionnaire was formulated by literature review and expert consultation and included questions about age,sex,education level,per capita monthly household income,marital status,living condition,payment method,and hypertension.RESULTS Logistic regression analysis showed that patients aged 60-79 years[odds ratio(OR)=1.561,P=0.015]and≥80 years(OR=1.760,P=0.013),participants with middle to high school education(OR=0.820,P=0.027),divorced or widowed individuals(OR=1.37,P=0.032),self-funded patients(OR=2.368,P=0.008),and patients with hypertension(OR=2.011,P=0.041)had a higher risk of cognitive impairment.The risk of cognitive impairment was lower for those with a college degree(OR=0.435,P=0.034)and married individuals.CONCLUSION The risk factors affecting cognitive dysfunction are age,60-79 years and≥80 years;education,primary school education or less;marital status,divorced or widowed;payment method,selffunded;hypertension;and CKD.

Exploring kidney biopsy findings in congenital heart diseases:Insights beyond cyanotic nephropathy

BACKGROUND The association between congenital heart disease and chronic kidney disease is well known.Various mechanisms of kidney damage associated with congenital heart disease have been established.The etiology of kidneydisease has commonly been considered to be secondary to focal segmental glomerulosclerosis(FSGS),however,this has only been demonstrated in case reports and not in observational or clinical trials.AIM To identify baseline and clinical characteristics,as well as the findings in kidney biopsies of patients with congenital heart disease in our hospital.METHODS This is a retrospective observational study conducted at the Nephrology Depart-ment of the National Institute of Cardiology“Ignacio Chávez”.All patients over 16 years old who underwent percutaneous kidney biopsy from January 2000 to January 2023 with congenital heart disease were included in the study.RESULTS Ten patients with congenital heart disease and kidney biopsy were found.The average age was 29.00 years±15.87 years with pre-biopsy proteinuria of 6193 mg/24 h±6165 mg/24 h.The most common congenital heart disease was Fallot’s tetralogy with 2 cases(20%)and ventricular septal defect with 2(20%)cases.Among the 10 cases,one case of IgA nephropathy and one case of membranoproliferative glomerulonephritis associated with immune complexes were found,receiving specific treatment after histopathological diagnosis,delaying the initiation of kidney replacement therapy.Among remaining 8 cases(80%),one case of FSGS with perihilar variety was found,while the other 7 cases were non-specific FSGS.CONCLUSION Determining the cause of chronic kidney disease can help in delaying the need for kidney replacement therapy.In 2 out of 10 patients in our study,interventions were performed,and initiation of kidney replacement therapy was delayed.Prospective studies are needed to determine the usefulness of kidney biopsy in patients with congenital heart disease.

Anti-fibrotic and anti-inflammatory effect of mesenchymal stromal cell-derived extracellular vesicles in chronic kidney disease

Renal fibrosis and inflammation are common pathological features of chronic kidney disease(CKD).Since currently available treatments can only delay the progression of CKD,the outcome of patients with CKD is still poor.One therapeutic option for the prevention of CKD-related complications could be the use of mesenchymal stromal cells(MSCs),which have shown beneficial effects in tissue fibrosis and regeneration after damage.However,safety issues,such as cellular rejection and carcinogenicity,limit their clinical application.Among the bioactive factors secreted by MSCs,extracellular vesicles(EVs)have shown the same beneficial effect of MSCs,without any notable side effects.This heterogeneous population of membranous nano-sized particles can deliver genetic material and functional proteins to injured cells,prompting tissue regeneration.Here we describe the anti-fibrotic and antiinflammatory properties of MSC-derived EVs in CKD preclinical models and summarize the potential molecular mechanisms involved in the regulation of renal fibrosis and inflammation.

Transcriptomic and metabolomic analysis of the effects of Zhenwu decoction on kidney yang deficiency pattern in chronic kidney disease

Objective:To explore the kidney yang deficiency pattern(KYDP)in a chronic kidney disease(CKD)rat model and the mechanisms underlying the effects of Zhenwu decoction(ZWD)by conducting tran-scriptomic and metabolomic analyses.Methods:Adriamycin(ADR)combined with hydrocortisone(HC)was used to induce CKD with KYDP in rats.ADR was injected into the tail vein twice.HC was injected intramuscularly for 8 weeks.ZWD was administered by gavage for 8 weeks.The general condition was observed,24-h urine protein was detected,serum corticosterone,triiodothyronine,thyroxine,TSH,testosterone,cAMP,and cGMP levels were determined,and pathological analysis was conducted.Transcriptomic and metabolomic analyses were conducted to screen differentially expressed genes(DEGs),differentially expressed metabolites(DEMs),and differentially expressed pathways(DEPs).The core DEMs and DEGs were input to Metab-oanalyst 5.0 to identify the pathways affected by ZWD.Results:In the HC group,KYDP symptoms were observed.Compared with control group,the levels of 24-h urine protein,TSH,and cGMP significantly increased(all P<0.01),and corticosterone,triiodothyronine,thyroxine,and cAMP significantly decreased(all P<0.01)in the HC group.After ZWD intervention,the levels of above-mentioned indicators could be reversed to some extent.Pathological analysis in the HC group revealed kidney lesions.DEGs in the ZWD group were mainly associated with pathways such as nucleotide synthesis and endocrine pathways.In the ZWD group,differences in biosynthesis of unsat-urated fatty acids and butanoate metabolism were observed.The following pathways were significantly affected by ZWD:arachidonic acid metabolism,valine,leucine,and isoleucine biosynthesis,linoleic acid metabolism,and alpha-linolenic acid metabolism.Conclusion:ZWD can be used to treat KYDP in CKD through regulating arachidonic acid metabolism,valine,leucine,and isoleucine biosynthesis,linoleic acid metabolism,and alpha-linolenic acid metabolism.

Chronic Kidney Disease Induces Cognitive Impairment in the Early Stage

Objective Previous research indicates a link between cognitive impairment and chronic kidney disease(CKD),but the underlying factors are not fully understood.This study aimed to investigate the progression of CKD-induced cognitive impairment and the involvement of cognition-related proteins by developing early-and late-stage CKD models in Sprague-Dawley rats.Methods The Morris water maze test and the step-down passive avoidance task were performed to evaluate the cognitive abilities of the rats at 24 weeks after surgery.Histopathologic examinations were conducted to examine renal and hippocampal damage.Real-time PCR,Western blotting analysis,and immunohistochemical staining were carried out to determine the hippocampal expression of brain-derived neurotrophic factor(BDNF),choline acetyltransferase(ChAT),and synaptophysin(SYP).Results Compared with the control rats,the rats with early-stage CKD exhibited mild renal damage,while those with late-stage CKD showed significantly increased serum creatinine levels as well as apparent renal and brain damage.The rats with early-stage CKD also demonstrated significantly impaired learning abilities and memory compared with the control rats,with further deterioration observed in the rats with late-stage CKD.Additionally,we observed a significant downregulation of cognition-related proteins in the hippocampus of rats with early-stage CKD,which was further exacerbated with declining renal function as well as worsening brain and renal damage in rats with late-stage CKD.Conclusion These results suggest the importance of early screening to identify CKD-induced cognitive dysfunction promptly.In addition,the downregulation of cognition-related proteins may play a role in the progression of cognitive dysfunction.

Risk estimation of chronic kidney disease in a leptospirosis endemic area: A case-control study from south Andaman Islands of India

Objective:To estimate the risk of chronic kidney disease in patients with leptospirosis.Methods:All reported(41890)and later confirmed leptospirosis(1990)cases from 2010-2020 were traced by universal sampling.386 Laboratory-confirmed leptospirosis cases were enrolled and 413 age,gender,area,and occupation matched healthy persons were included as controls.Variables including socio-demographic characteristics,medical history,and health-related behaviours were compared between the two groups and association between these variables and reduced estimated glomerular filtration rate(eGFR)was analyzed with multiple linear regression.Results:The median of eGFR was 49.0(27.0,75.0)mL/min/1.73 m^(2) in the cases and 96.0(72.0,121.0)mL/min/1.73 m^(2) in the controls,showing significant differences(P<0.001).Bivariate analysis showed that leptospirosis seropositivitiy,repeat leptospirosis infection,diabetes,male gender,working in field(sun exposure),COVID-19 infection and smoking had statistically significant association with reduced eGFR.Leptospirosis seropositivity had negative effects on eGFR.Multiple linear regression confirmed that leptospirosis seropositivity had negative effects on eGFR(unstandardised β coefficients=−30.86,95%CI−49.7 to−11.9,P<0.001).Conclusions:Chronic kidney disease is a complex disease with multiple risk factors involved.Exposure to leptospirosis is one of the essential factors in accelerating its progression.

Role of antidiabetic agents in type 2 diabetes patients with chronic kidney disease

Insulin resistance is a condition in which the target tissues have a decreased response to insulin signaling,resulting in glucose uptake defect,and an increased blood sugar level.Pancreatic beta cells thus enhance insulin production to compensate.This situation may cause further beta cell dysfunction and failure,which can lead diabetes mellitus(DM).Insulin resistance is thus an important cause of the development of type 2 DM.Insulin resistance has also been found to have a strong relationship with cardiovascular disease and is common in chronic kidney disease(CKD)patients.The mechanisms of insulin resistance in CKD are complex and multifactorial.They include physical inactivity,inflammation and oxidative stress,metabolic acidosis,vitamin D deficiency,adipose tissue dysfun-ction,uremic toxins,and renin-angiotensin-aldosterone system activation.Currently,available anti-diabetic agents,such as biguanides,sulfonylureas,thiazolidinediones,alfa-glucosidase inhibitors,glucagon-like peptide-1-based agents,and sodium-glucose co-transporter-2 inhibitors,have different effects on insulin resistance.In this short review,we describe the potential mechanisms of insulin resistance in CKD patients.We also review the interaction of currently available anti-diabetic medications with insulin resistance.

Prevalence, Risk Factors, and Awareness of Chronic Kidney Disease among Diabetes Mellitus and Hypertensive Individuals at the Buea Regional Hospital, Cameroon

Background: Kidney failure, cardiovascular disease, and early mortality are just a few of the major negative effects of chronic renal disease, a serious global health issue. The considerable financial and public health burden associated with chronic kidney disease can be lessened by raising awareness and adopting better practices for its impact, prevention, and early identification. Objective: In this study, individuals with hypertension and diabetes were evaluated for their knowledge of chronic kidney disease, its prevalence, and its risk factors. Method: It was a hospital-based cross-sectional study conducted on adult (>18 years) patients with diabetes mellitus and hypertension. Each participant provided written informed consent before having their data collected through interviews, medical information, and blood samples for CKD screening. The CKD epidemiology collaboration (CKD-EPI) equation was used to calculate the glomerular filtration rate (GFR) from serum creatinine, and CKD was determined using the estimated GFR (e-GFR). To find independent CKD factors, multivariate logistic regression was employed, with a p-value of 0.05 being regarded as statistically significant. This was accomplished using SPSS (Statistical Program for Social Sciences) version 22.0, IBM Corp., Armonk, NY. Result: A total of 156 participants took part in the study among which 95 (60.9%) were male, most of the participants 82 (52.6%) were aged between 51 - 70 years (mean 59.42 ± 11.007), 76 (48.7%) were unemployed and 97 (62.2%) were single. Overall, the knowledge score of participants on CKD was 65.4% for good knowledge and 34.6% for poor or inadequate knowledge of CKD. More than half of the participants (60%) had chronic kidney disease. Among these, the greatest proportion of CKD patients were those who were hypertensive (88.2%) followed by those who were both hypertensive and diabetic (70.7%). Conclusion: There is poor management of CKD in the South West Region of Cameroon which has contributed greatly to the progression of CKD and increases in the mortality rate.

The effects of cold region meteorology and specific environment on the number of hospital admissions for chronic kidney disease:An investigate with a distributed lag nonlinear model

Objective:To explore the effects of daily mean temperature(°C),average daily air pressure(hPa),humidity(%),wind speed(m/s),particulate matter(PM)2.5(μg/m3)and PM10(μg/m3)on the admission rate of chronic kidney disease(CKD)patients admitted to the Second Affiliated Hospital of Harbin Medical University in Harbin and to identify the indexes and lag days that impose the most critical influence.Methods:The R language Distributed Lag Nonlinear Model(DLNM),Excel,and SPSS were used to analyze the disease and meteorological data of Harbin from 01 January 2010 to 31 December 2019 according to the inclusion and exclusion criteria.Results:Meteorological factors and air pollution influence the number of hospitalizations of CKD to vary degrees in cold regions,and differ in persistence or delay.Non-optimal temperature increases the risk of admission of CKD,high temperature increases the risk of obstructive kidney disease,and low temperature increases the risk of other major types of chronic kidney disease.The greater the temperature difference is,the higher its contribution is to the risk.The non-optimal wind speed and non-optimal atmospheric pressure are associated with increased hospital admissions.PM2.5 concentrations above 40μg/m3 have a negative impact on the results.Conclusion:Cold region meteorology and specific environment do have an impact on the number of hospital admissions for chronic kidney disease,and we can apply DLMN to describe the analysis.

Effectiveness and safety of apixaban and rivaroxaban vs warfarin in patients with atrial fibrillation and chronic kidney disease

BACKGROUND Randomized controlled trials(RCTs)of direct oral anticoagulants(DOACs)included a low proportion of atrial fibrillation(AF)patients with chronic kidney disease(CKD),and suggested that DOACs are safe and effective in patients with mild-to-moderate CKD.In a metanalysis of RCTs and observational studies,DOACs were associated with better efficacy(vs warfarin)in early CKD and had similar efficacy and safety profiles in patients with stages IV-V CKD.But few studies have provided data on the safety and effectiveness of each DOAC vs warfarin in patients with stage III CKD.The effectiveness and safety of DOACs in those patients are still subject to debate.AIM To assess and compare the effectiveness and safety of apixaban and rivaroxaban vs warfarin in this patient population.METHODS A cohort of patients with an inpatient or outpatient code for AF and stage III CKD who were newly prescribed apixaban and rivaroxaban was created using the administrative databases from the Quebec province of Canada between 2013 and 2017.The primary effectiveness outcome was a composite of ischemic stroke,systemic embolism,and death,whereas the primary safety outcome was a composite of major bleeding within a year of DOAC vs warfarin initiation.Treatment groups were compared in an under-treatment analysis using inverse probability of treatment weighting and Cox proportional hazards.RESULTS A total of 8899 included patients filled out a new oral anticoagulation therapy claim;3335 for warfarin and 5564 for DOACs.Compared with warfarin,15 mg and 20 mg rivaroxaban presented a similar effectiveness and safety composite risk.Apixaban 5.0 mg was associated with a lower effectiveness composite risk[Hazard ratio(HR)0.76;95%confidence interval(CI):0.65-0.88]and a similar safety risk(HR 0.94;95%CI:0.66-1.35).Apixaban 2.5 mg was associated with a similar effectiveness composite(HR 1.00;95%CI:0.79-1.26)and a lower safety risk(HR 0.65;95%CI:0.43-0.99.Although,apixaban 5.0 mg was associated with a better effectiveness(HR 0.76;95%CI:0.65-0.88),but a similar safety risk profile(HR 0.94;95%CI:0.66-1.35).The observed improvement in the effectiveness composite for apixaban 5.0 mg was driven by a reduction in mortality(HR 0.61;95%CI:0.43-0.88).CONCLUSION In comparison with warfarin,rivaroxaban and apixaban appear to be effective and safe in AF patients with stage III CKD.

Saudi Consensus on the Usage of Sodium-Glucose Cotransporter-2 Inhibitors on the Management of Chronic Kidney Diseases

According to recent epidemiological data, chronic kidney diseases (CKDs) affect approximately 10% of the global population. Like many countries, CKD is a significant public health issue in Saudi Arabia. The prevalence of CKD in Saudi Arabia is estimated to be around 4.5% of the adult population, with a higher prevalence in older age groups. Sodium-glucose cotransporter-2 inhibitors (SGLT2is) are a class of oral medications used to treat type 2 diabetes mellitus (T2DM). In addition to their glucose-lowering effects, SGLT2i have been shown to have beneficial effects on kidney function in patients with or without T2DM. Therefore, a Saudi task force gathered to develop an explicit, evidence-based consensus on SGLT2i use in CKD Saudi patients. A panel of 14 experts made up a task force. An initial concept proposal was obtained. The proposal was divided into several topics discussed on 24 May 2023. A literature review was carried out. The literature search was completed on 3rd June 2023. A drafted report was distributed to the entire panel. Approval of the recommendations required consensus, defined as a majority approval (i.e. above 75%). The recommendations were revised to accommodate any differences of opinion until a consensus was reached. Recommendations were finally formulated on 21st June 2023. Subsequently, the panel reviewed and discussed the supporting rationale of the revised recommendations. This article presents these practical recommendations.

Helicobacter Pylori Infection and Gastroduodenal Lesions in Patients with Chronic Kidney Disease: A Comparative Study

Introduction: Gastroduodenal lesions are common in chronic kidney disease (CKD). They are linked to various factors including Helicobacter pylori infection (H. pylori). Few data are available in Africa on H. pylori infection and chronic kidney disease. The aim of this study was to assess the impact of H. pylori infection and to describe the gastroduodenal lesions found in patients with chronic kidney disease. Patients and Methods: A cross-sectional study was conducted, February 1st to May 31st, 2021, at the Douala General Hospital in Cameroon. We included patients with CKD classified as stages 3 to 5 according KDIGO classification, on hemodialysis or not, who agreed to participate in the study. They were matched with a “control” population including patients with normal renal function according to sex and age (ratio 1:2). Patients on antibiotics and/or proton pump inhibitors were excluded. We collected data from CKD patients and from medical records for non-CKD group. Each patient underwent an upper digestive endoscopy and identification of H. pylori using a urease rapid test. Logistic regression was used to identify independent associations for a significance level set at p Results: We included 99 patients including 33 with CKD and 66 control patients. Among patients with CKD, the predominance was male (n = 18/33 or 54.5%). The mean age was 51.2 ± 12.8 years. Arterial hypertension was the first etiology of CKD (n = 13 or 39.4%). The prevalence of H. pylori in patients with CKD was 63.6% versus 37.9% in control patients (p-value = 0.015). The main endoscopic lesions were erosive gastropathy (n = 14 or 42.4%) and erythematous gastropathy (n = 7 or 21.2%). Patients with CKD were 5 times more likely to have H. pylori infection (OR = 5.69;CI 95% 0.14 - 0.82;p = 0.017). Factors associated with H. pylori infection were chronic kidney disease (aOR = 1.02;CI 95% 0.14 - 0.82;p = 0.017) and hemodialysis (aOR = 10;CI 95% 1.08 - 91.9;p = 0.042). Conclusion: The prevalence of H. pylori infection is higher in patients with CKD. Endoscopic lesions are inflammatory. Factors associated with H. pylori infection are chronic kidney disease and hemodialysis.

Complexity and Management of Chronic Kidney Disease

Chronic Kidney Disease (CKD) is ongoing damage of the kidneys, which affects their ability to filter the blood the way they should. Worldwide CKD is considered as the 16th leading cause of death and affects 8% - 16% of the population. CKD often goes unnoticed and is revealed as an incidental finding. Healthcare providers diagnose the condition as CKD based on persistent abnormal kidney function tests revealing kidney damage markers > 3 months, urine albumin creatinine ratio (UACR) > or equal to 30 mg/g per 24 hours, and GFR < 60 mL/min/1.73m2. In this article, we have discussed chronic kidney disease in terms of kidney physiology, chronic kidney disease pathophysiology, etiology, diagnosis, signs and symptoms, and management.

Antihypertensive prescribing patterns in non-dialysis dependent chronic kidney disease:Findings from the Salford Kidney Study

BACKGROUND Hypertension is commonly observed in patients living with chronic kidney disease(CKD).Finding an optimal treatment regime remains challenging due to the complex bidirectional cause-and-effect relationship between hypertension and CKD.There remains variability in antihypertensive treatment practices.AIM To analyze data from the Salford Kidney Study database in relation to antihypertensive prescribing patterns amongst CKD patients.METHODS The Salford Kidney Study is an ongoing prospective study that has been recruiting CKD patients since 2002.All patients are followed up annually,and their medical records including the list of medications are updated until they reach study endpoints[starting on renal replacement therapy or reaching estimated glomerular filtration rate(eGFR)expressed as mL/min/1.73 m2≤10 mL/min/1.73 m2,or the last follow-up date,or data lock on December 31,2021,or death].Data on antihypertensive prescription practices in correspondence to baseline eGFR,urine albumin-creatinine ratio,primary CKD aetiology,and cardiovascular disease were evaluated.Associations between patients who were prescribed three or more antihypertensive agents and their clinical outcomes were studied by Cox regression analysis.Kaplan-Meier analysis demonstrated differences in survival probabilities.RESULTS Three thousand two hundred and thirty non-dialysis-dependent CKD patients with data collected between October 2002 and December 2019 were included.The median age was 65 years.A greater proportion of patients were taking three or more antihypertensive agents with advancing CKD stages(53%of eGFR≤15 mL/min/1.73 m2 vs 26%of eGFR≥60 mL/min/1.73 m2,P<0.001).An increased number of patients receiving more classes of antihypertensive agents was observed as the urine albumin-creatinine ratio category increased(category A3:62%vs category A1:40%,P<0.001),with the upward trends particularly noticeable in the number of individuals prescribed renin angiotensin system blockers.The prescription of three or more antihypertensive agents was associated with all-cause mortality,independent of blood pressure control(hazard ratio:1.15;95%confidence interval:1.04-1.27,P=0.006).Kaplan-Meier analysis illustrated significant differences in survival outcomes between patients with three or more and those with less than three antihypertensive agents prescribed(log-rank,P<0.001).CONCLUSION Antihypertensive prescribing patterns in the Salford Kidney Study based on CKD stage were consistent with expectations from the current United Kingdom National Institute of Health and Care Excellence guideline algorithm.Outcomes were poorer in patients with poor blood pressure control despite being on multiple antihypertensive agents.Continued research is required to bridge remaining variations in hypertension treatment practices worldwide.

Determining the Bulk of the Iceberg of Proteinuric Chronic Kidney Disease in School Children, in South West Nigeria

Introduction: Chronic kidney disease [CKD], as defined by the National Kidney Foundation/Kidney Disease and Outcome Quality Initiative (KDOQI) Group, refers to bilateral kidney injury and/or impaired kidney function of at least 3 months duration. Persistent proteinuria has been recognized as one of the early markers of chronic kidney disease and has been associated with persistent and progressive damage in both children and adult. This study was conducted with the aim of determining the prevalence and severity of persistent proteinuria over three months in primary school children in Ile-Ife. It was a cross-sectional study done over a period of six months. The subjects were 1335 primary school pupils, aged 6 to 14 years selected by multi stage random sampling method from twelve primary schools from a total of 96,301 pupils in the two Local Government Areas (LGA) of Ile-Ife, after meeting the recruitment criteria. The biodata, physical examination, blood pressure measurements and urine testing by dipstick were carried out on all the recruited pupils according to standard protocols while serial monitoring of proteinuria and estimated glomerular filtration rate was done for those with persistent proteinuria over 6 months. Results: Initially 34 (2.6%) of the subjects recruited had significant proteinuria with a M:F ratio of 1:1.6 following first screening and it was persistent in six (0.4%) of them subsequently over three months with a M:F ratio of 1:1.5. The severity of the persistent proteinuria was in the range of 30 mg/dL to 100 mg/dL. Three of them (50%) had worsened level of proteinuria from 30 mg/dL to 100 mg/dl on follow up. Conclusion: Children with undetected persistent proteinuria stand the risk of further glomerular damage over time.

Can Peripheral Venous Gases Replace Arterial Gases in a Patient with Chronic Kidney Disease?

Introduction: Metabolic acidosis (MA) is a frequent alteration in chronic kidney disease (CKD) that is associated with numerous complications, which is why its correction is recommended. Oral sodium bicarbonate is currently the treatment of choice. Objective: The objective is to determine if venous bicarbonate is equal to arterial bicarbonate in the follow-up of a patient with chronic kidney disease. Materials Methods: Single-center Cross-sectional studies in a cohort of adult patients with stage 4 - 5 CKD. Samples were taken between January 2022 and January 2023, in a Clinic in the city of Ibague/ Colombia obtained from the radial artery. The inclusion criteria were: not being treated with alkaline at the time of inclusion. Results: A total of 71 patients were included, 73.2% male (52) and 26.8% female (19), with different stages: stage 3 with 5.6% (4), stage 4 with 60.6% (43), stage 5 with 33.8% (23). 66.2% were diabetic, 88.7% had arterial hypertension, and 15.5% of the patients presented hematoma as a complication and pain associated with arterial puncture. The result of mean venous bicarbonate was 18.8 with a standard deviation of 2.3, arterial bicarbonate a mean of 19.4 with a standard deviation of 2.1 with a value of P 0.46, venous pH with a mean of 7.37 with a standard deviation of 0.48 and a mean arterial pH of 7.38 with a standard deviation of 0.48 with a P value of 0.01. Values of venous bicarbonate compared to arterial bicarbonate showed no statistically significant difference in patients with chronic kidney disease, but there were more complications such as hematoma and pain in patients in the arterial puncture cohort, because of this result venous bicarbonate corresponds to arterial bicarbonate, but has less risk of complications associated with the procedure. Conclusion: Metabolic acidosis is a frequent alteration in advanced chronic kidney disease, these results showed that the values of arterial and venous bicarbonate have no statistically significant differences, but there is a greater risk of complications with arterial blood gases, due to this, venous bicarbonate could be a useful tool for patients with chronic kidney disease.