Prevalence of CKD and Its Relationship to eGFR-Related Genetic Loci and Clinical Risk Factors in the SardiNIA Study Cohort
Antonello PaniJennifer L. Bragg‐GreshamMarco MasalaDoloretta PirasAlice AtzeniMaria Grazia PiliaLiana FerreliLenuta BalaciNicolò CurreliAlessandro DelitalaFrancesco LoiGonçalo R. AbecasisDavid SchlessingerFrancesco Cucca
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Abstract:
The prevalence of CKD and of renal failure vary worldwide, yet parallel increases in leading risk factors explain only part of the differential prevalence. We measured CKD prevalence and eGFR, and their relationship with traditional and additional risk factors, in a Sardinian founder population cohort. The eGFR was calculated using equations from the CKD Epidemiology Collaboration and Modification of Diet in Renal Disease studies. With use of the Kidney Disease Improving Global Outcomes guidelines, a cross-sectional analysis of 4842 individuals showed that CKD prevalence was 15.1%, including 3.6% of patients in the high-risk and 0.46% in the very-high-risk categories. Longitudinal analyses performed on 4074 of these individuals who completed three visits with an average follow-up of 7 years revealed that, consistent with other populations, average eGFR slope was −0.79 ml/min per 1.73 m2 per year, but 11.4% of the participants had an eGFR decline >2.3 ml/min per 1.73 m2 per year (fast decline). A genetic score was generated from 13 reported eGFR- and CKD-related loci, and univariable and multivariable analyses were applied to assess the relationship between clinical, ultrasonographic, and genetic variables with three outcomes: CKD, change in eGFR, and fast eGFR decline. Genetic risk score, older age, and female sex independently correlated with each outcome. Diabetes was associated with CKD prevalence, whereas hypertension and hyperuricemia correlated more strongly with fast eGFR decline. Diabetes, hypertension, hyperuricemia, and high baseline eGFR were associated with a decline of eGFR. Along with differential health practices, population variations in this spectrum of risk factors probably contributes to the variable CKD prevalence worldwide.Keywords:
Genetic epidemiology
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Background: Chronic kidney disease is a life threatening disease, which is a common cause of mortality and morbidity. The chronic kidney disease patients are at high risk of developing end stage renal disease, cardiovascular complications and stroke. Therefore, we carried out this study to know the functional status of kidneys in chronic kidney disease cases and to classify the chronic kidney disease into different stages by calculating estimated glomerular filtration rate. Material and Methods: Twenty five cases of chronic kidney disease, between 25-70 years of age of either sex, admitted at R.L.Jalappa Hospital and Research Centre, Kolar, India and twenty five healthy age and gender matched controls were enrolled into the study. For calculating estimated glomerular filtration rate serum creatinine values, age, sex, race, and weight of the patients are considered. Results: The mean estimated glomerular filtration rate in cases was 22.096 and in control group 118.28(p<0.001) as per Cockcroft Gault Equation and as per Modification of Diet in Renal Disease equation in cases it was 18.176 and in controls 113.796(p<0.001). The estimated glomerular filtration rate was significantly low in cases when compared with healthy subjects. Conclusion: Estimated glomerular filtration rate better predicts the functional status of kidneys and is more accurate than serum creatinine and can be used to classify chronic kidney disease. Key words: Chronic kidney disease (CKD), Cockcroft Gault Equation (CCG), Estimated Glomerular Filtration Rate (eGFR), End Stage Renal Disease (ESRD), glomerular filtration rate (GFR), Modification of Diet in Renal Disease(MDRD), Serum creatinine.
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The prevalence of chronic kidney disease (CKD) has increased and will continue to increase in the United States and worldwide. This is alarming considering that CKD is an irreversible condition and patients who progress to chronic kidney failure have reduced quality of life and high mortality rates. As such, it is imperative to identify modifiable risk factors to develop strategies to slow CKD progression. One such factor is hyperuricemia. Recent observational studies have associated hyperuricemia with kidney disease. In addition, hyperuricemia is largely prevalent in patients with CKD. Data from experimental studies have shown several potential mechanisms by which hyperuricemia may contribute to the development and progression of CKD. In this article, we offer a critical review of the experimental evidence linking hyperuricemia to CKD, highlight gaps in our knowledge on the topic as it stands today, and review the observational and interventional studies that have examined the potential nephroprotective effect of decreasing uric acid levels in patients with CKD. Although uric acid also may be linked to cardiovascular disease and mortality in patients with CKD, this review focuses only on uric acid as a potential therapeutic target to prevent kidney disease onset and progression. Am J Kidney Dis. 61(1):134-146. © 2012 by the National Kidney Foundation, Inc.
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Hyperuricemia is indicative of a high level of uric acid in the blood (>7mg/dl for men, >6mg/dl for women).The hyperuricemia may indicate an increased risk of gout.It is estimated that approximately 15 of every 1,000 males between 35 and 45 years of age have hyperuricemia. Hyperuricemia afflicts an estimated 840 out of 100,000 people. Hyperuricemia can also result in uric acid nephrolithiasis and possible nephropathy if uric acid accumulates in the renal interstitium and tubules.This book comprises of a clinical study conducted for the management of Hyperuricemia in Hamdard University Karachi,Pakistan.Hence it will provide its reader a better understanding of risk factors,causes,clinical features,diagnosis and treatment of Hyperuricemia and its relevant complications with allopathic as well as with modern herbal medicines.
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Chronic kidney disease from medical causes is present in 25% to 30% of patients before surgery for renal cancer. Although chronic kidney disease due to medical causes is typically associated with a 2% to 5% annual renal functional decline and decreased overall survival, reduced glomerular filtration rate occurring only after surgery may not have the same negative consequences.All patients undergoing surgery for suspected renal malignancy were identified in an institutional registry. Median clinical followup was 6.6 years.Of 4,180 patients 28% had a preoperative glomerular filtration rate of less than 60 ml/minute/1.73 m(2) (chronic kidney disease due to medical causes) and in 22% the glomerular filtration rate decreased to less than 60 ml/minute/1.73 m(2) only after surgery (surgically induced chronic kidney disease). Preoperative glomerular filtration rate was a strong predictor of overall survival on univariable and multivariable analysis. The risk of death after renal surgery was 1.8, 3.5 and 4.4-fold higher in patients with preoperative chronic kidney disease stages 3, 4 and 5, respectively, vs normal preoperative glomerular filtration rate. Average overall loss of renal function was 23%, including 13% within 90 days after surgery and 3.5% annually thereafter. Postoperative glomerular filtration rate only predicted survival for patients with preexisting chronic kidney disease due to medical causes. Neither surgically induced chronic kidney disease nor postoperative glomerular filtration rate was a significant predictor of survival in patients without preexisting chronic kidney disease due to medical causes. Annual renal functional decline was 4.7% and 0.7% for patients with chronic kidney disease due to medical causes and surgically induced chronic kidney disease, respectively, with a greater than 50% reduction in glomerular filtration rate in 7.3% and 2.2%, respectively (p <0.0001). Annual renal functional decline greater than 4.0% was associated with a 43% increase in mortality (p <0.0001).Surgically induced chronic kidney disease is associated with a relatively low risk of progressive renal functional decline and impact on survival does not appear to be substantial during intermediate term followup. In contrast, preoperative chronic kidney disease due to medical causes places patients at increased risk, indicating nephron sparing surgery for such patients.
Nephrology
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Objective To survey the prevalence of hyperuricemia and its relations with cerebrovascular disease in the officials in Zhongshan City. Methods Uric acid level in serum and physical examination results of 1 116 cadres were performed. Results The rate of hyperuricemia in the officials were 30.2 %. There was a significant difference in female and male groups. Positive correlation was noticed between the incidence of hyperuricemia and age. The incidence of cerebrovascular disease in patients with hyperuricemia was higher than those without. Conclusion The incidence of hyperuricemia accompanied by cerebrovascular diseases in the officials is higher than those without, thus attention be paid to the health of official staff.
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Renal replacement therapy
Nephrology
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Correlation of detection of hyperuricemia with hypertension in healthy population in Guangzhou City.
Objective To analyze the correlation of hyperuricemia and the incidence of hypertension.Methods The hyperuricemia and hyertension of 29 115 healthy people above 20 years old incuding 18 589 males and 10 526 females were determined in 2007 in Guangzhou City.Results The increase of level of hyperuricemia was correlated with that of high incidence of hypertension(P0.0005).The relative risk of hypertension of females with high level of hyperuricemia(from 3.58 to 1.74).Blood uric acid increase and hypertension were significantly related in males(except those above 70).However,the relative risk decreased as age increased.Conclusion The level of hyperuricemia is closely correlated with hypertension.Thus.Conventional examination of hyperuricemia should,therefore,be carried out so as to detect and cure hyperuricemia and prevent occurrence of complications.
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Objective To study the causes and preventing strategies of hyperuricemia for cadres in island areas.Method Review the data of physical examination of 7520 cadres and analyze the average value of blood uric acid and the rate of hyperuricemia for patients with different age level and gender.Result The average value of blood uric acid is(388.8±69.7)μmol/L in male group and(283.9±54.4)μmol/L in female group.The rate of hyperuricemia is 32.4% for male and 9.5% for female.Conclusion The rate of hyperuricemia is high for cadres in island areas and health education should be enhanced.
Value (mathematics)
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