KDOQI US Commentary on the KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of CKD

American Journal of Kidney Diseases, Journal Year: 2024, Volume and Issue: unknown

Published: Nov. 1, 2024

Language: Английский

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Association of oxidative balance score with chronic kidney disease: NHANES 1999-2018

Frontiers in Endocrinology, Journal Year: 2024, Volume and Issue: 15

Published: June 11, 2024

Background The Oxidative Balance Score (OBS), which quantifies the balance between antioxidants and pro-oxidants influenced by diet lifestyle, is crucial given oxidative stress’s significant role in Chronic Kidney Disease (CKD). This study aims to determine association OBS CKD using data from National Health Nutrition Examination Survey (NHANES) 1999-2018. Methods We analyzed spanning 1999 2018. was constructed a detailed array of 20 factors, including dietary nutrients lifestyle behaviors. relationship risk evaluated weighted logistic regression models, adjusted for potential confounders, with generalized additive model (GAM) examining non-linear associations. Subgroup analyses interaction effects across diverse demographic clinical groups, along sensitivity analyses, were performed validate findings. Results Among 32,120 participants analyzed, 4,786 identified CKD. Fully analysis revealed that each unit increase associated 2% reduction prevalence [OR: 0.98 (0.98–0.99), P < 0.001]. Higher quartiles significantly correlated decreased [Q4 vs . Q1: OR: 0.82 (0.68–0.98), = 0.03; trend 0.01]. GAM smoothed curve fit indicated linear Stratified further substantiated inverse prevalence. Conclusions Our findings NHANES affirm U.S. population, underscoring optimizing factors managing risk. These results advocate incorporating considerations into prevention treatment strategies.

Language: Английский

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Positive association between blood ethylene oxide levels and metabolic syndrome: NHANES 2013-2020

Frontiers in Endocrinology, Journal Year: 2024, Volume and Issue: 15

Published: April 18, 2024

The exposure of Ethylene oxide (EO) is linked to systemic inflammatory response and various cardiovascular risk factors. Hemoglobin's binding ethylene (HbEO) was used measure serum EO level. This research aims explore the association between metabolic syndrome (MetS) HbEO, HbEO components syndrome.

Language: Английский

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Association of prebiotic/probiotic intake with MASLD: evidence from NHANES and randomized controlled trials in the context of prediction, prevention, and a personalized medicine framework

The EPMA Journal, Journal Year: 2025, Volume and Issue: unknown

Published: Jan. 29, 2025

Language: Английский

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Risk-directed management of chronic kidney disease

Nature Reviews Nephrology, Journal Year: 2025, Volume and Issue: unknown

Published: Jan. 30, 2025

Language: Английский

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Albuminuria in Cardiovascular, Kidney, and Metabolic Disorders: A State-of-the-Art Review

Circulation, Journal Year: 2025, Volume and Issue: 151(10), P. 716 - 732

Published: March 10, 2025

Albuminuria—increased urine albumin excretion—is associated with cardiovascular mortality among patients diabetes, hypertension, chronic kidney disease, or heart failure, as well adults few risk factors. Many authors have hypothesized that albuminuria reflects widespread endothelial dysfunction, but additional work is needed to uncover whether directly pathologic causative of disease. Urinary albumin-to-creatinine ratio an attractive, unifying biomarker cardiovascular, kidney, and metabolic conditions may be useful for identifying monitoring disease trajectory. However, develop through unique mechanisms across these distinct clinical phenotypes. This state-of-the-art review discusses the role in conditions; identifies potential pathways linking adverse outcomes; provides practical approaches screening managing cardiologists. Future research determine how broadly frequently screen albuminuria, it cost-effective treat low-grade (10–30 mg/g), equitably offer newer antiproteinuric therapies spectrum cardiovascular-kidney-metabolic diseases.

Language: Английский

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Dapagliflozin Utilization in Chronic Kidney Disease and Its Real-World Effectiveness Among Patients with Lower Levels of Albuminuria in the USA and Japan

Advances in Therapy, Journal Year: 2024, Volume and Issue: 41(3), P. 1151 - 1167

Published: Jan. 19, 2024

Sodium–glucose cotransporter 2 inhibitors such as dapagliflozin have been proven effective for slowing chronic kidney disease (CKD) progression in large outcomes trials that mainly included patients with higher levels of albuminuria. Understanding the real-world utilization and effectiveness these drugs among CKD lower albuminuria can inform clinical decision-making this population. Claims data from USA Japan were used to describe urinary albumin-to-creatinine ratio (UACR) < 200 mg/g who eligible 10 mg treatment (initiators untreated) following its approval CKD. A quantile regression analysis was performed evaluate effect initiation versus no on estimated glomerular filtration rate (eGFR) slope a propensity score-matched cohort, using prevalent new-user design. Dapagliflozin initiators (n = 20,407) mostly had stage 3–4 (69–81% across databases). The most common comorbidities type diabetes, hypertension cardiovascular disease. At baseline, renin–angiotensin system inhibitor prescribed 53–81% patients. Eligible but untreated older eGFR comorbidity burden than initiators. Following initiation, differences median between matched non-initiators 1.07 mL/min/1.73 m2/year (95% confidence interval [CI] 0.40–1.74) all UACR 1.28 CI − 1.56 4.12) without diabetes. broad range In mg/g, associated clinically meaningful attenuation compared non-initiation. These findings supplement available efficacy evidence suggest may extend mg/g. Graphical Abstract Video article.

Language: Английский

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Cardiovascular-Kidney-Metabolic Health Syndrome

Journal of the American Society of Nephrology, Journal Year: 2024, Volume and Issue: 35(5), P. 649 - 652

Published: Feb. 6, 2024

Overview of the American Heart Association's Cardiovascular-Kidney-Metabolic Syndrome Obesity, diabetes, and CKD are highly prevalent, commonly co-occur, substantially increase cardiovascular disease morbidity mortality. The mechanisms these four states also closely intertwined, with multidirectional relationships, shared risk factors, common therapeutic targets. Given complex interactions among diseases, Association (AHA) recently proposed a new integrated health disorder, cardiovascular-kidney-metabolic (CKM) syndrome, defined as disorder attributable to connections obesity, CKD, disease.1,2 CKM framework aims move beyond individual factor management, proposing systemic staging system for those at for, with, existing (Figure 1). This is designed better reflect pathophysiology, spectrum risk, opportunities prevention care optimization within syndrome. Stage 0 includes individuals who not overweight/obese do have metabolic factors (e.g., hypertension, hypertriglyceridemia), or subclinical/clinical disease. 1 excess and/or dysfunctional adiposity, manifested by high body mass index, waist circumference, fasting blood sugar. Individuals in this stage other CKD. 2 (hypertriglyceridemia, diabetes) 3 subclinical atherosclerotic (atherosclerosis coronary artery calcium) heart failure (elevated cardiac biomarkers echocardiographic parameters) excess/dysfunctional Risk equivalents include G4 G5 Finally, 4 clinical (coronary disease, failure, stroke, peripheral atrial fibrillation) CKD.1,2Figure 1: Stages Reprinted from ref. permission. AFib, fibrillation; ASCVD, disease; CHD, CKM, cardiovascular-kidney-metabolic; CVD, HF, failure; KDIGO, Kidney Disease Improving Global Outcomes; PAD, arterial disease.Nephrologists substantial role caring across stages. What does mean nephrology kidney patients? Earlier Detection Cardiovascular including often silent undetected until clinically apparent present. emphasizes early detection recommends assessment both eGFR urine albumin-creatinine ratio at-risk individuals, hypertriglyceridemia>135 mg/dl, hypertension (stage higher), Notably, calls albuminuria 1, obesity adiposity without We hope that AHA raises awareness promotes screening primary subspecialty clinicians seeing patients course measurement urinary albumin-to-creatinine (UACR) has remained dismally low despite previous guideline recommendations.3 accelerates implementation more broadly United States, expansive recommendation currently being considered US Preventative Services Task Force. using UACR even moderate may delay prevent progression life-years quality life, reduce costs.4,5 Lifespan just affecting older adults. As incidence diseases increases younger children, greater guidance needed on how when screen complications such proposes life (age <21 years) hypertriglyceridemia, hypertension. could impact lifetime survival life.6 Focus Severity, Including Patients Treated Dialysis Until now, outside guidelines, largely been treated single entity, less attention dialysis. With framework, Outcomes resulting designation least CKM. In dialysis separated because unique approaches management treatment (in context lack data guide decisions). Consideration Function Guideline-Directed Medical Therapy Guideline-directed medical therapy therapies, renin-angiotensin-aldosterone inhibitors, mineralocorticoid receptor antagonists, sodium-glucose cotransporter-2 glucagon-like peptide-1 agonists, remain underutilized strong evidence they improve outcomes slow CKD.7 There barriers initiation medications part due social determinants [SDOH]), most likely benefit receive therapies.8 addition, some therapies short-term hemodynamic effects function higher rates adverse which can lead premature discontinuation therapies. approach encourages continuation important current barrier extends nephrology. critical need trials evaluate strategies uptake guideline-directed pace titration. New Score That Includes Previous scores typically included prediction variables. Predicting CVD EVENTs (PREVENT) model traditional (age, total cholesterol, non-HDL HDL systolic BP, smoking, medications, statins) predictors, additional models tailored high-risk inclusion available.9,10 If gets implemented into practice, would prompt earlier wider UACR. PREVENT predicts addition an whom comparable (or exceed) Furthermore, equation race variable, therefore aligning recent race-free equations. Social Determinants Health SDOHs prevalent strongly linked However, there significant gaps identifying our patients. score incorporate deprivation index. step forward recognizing importance biological factors; hopefully will systematic interventions. Patient Education Many people unaware their diagnosis; be symptoms ineffective communication education. help start conversations about treatment) professionals Interdisciplinary Care Models value-based interdisciplinary fragmentation inequitable access occur overlapping conditions. statement suggests team supported coordinator representation care, cardiology, nephrology, endocrinology, pharmacy, nursing, well navigators, workers, community workers. targeted referrals subspecialists activate expertise recommended higher-risk principles espoused here appropriate; however, marked shifts models, particularly States where payers seldom take multiyear perspectives, financial aspects widely. Next Steps: Putting Practice AHA's places center bringing often-overlooked public advance provides opportunity forge partnerships integrating factors. hopeful changes guidelines implement broader newer protective motivate propagation collaborative models. we research field, investigation etiologies disease-specific treatments; severity (including patients); trials.

Language: Английский

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Concordance With Screening and Treatment Guidelines for Chronic Kidney Disease in Type 2 Diabetes

JAMA Network Open, Journal Year: 2024, Volume and Issue: 7(6), P. e2418808 - e2418808

Published: June 26, 2024

Importance Chronic kidney disease (CKD) is an often-asymptomatic complication of type 2 diabetes (T2D) that requires annual screening to diagnose. Patient-level factors linked inadequate and treatment can inform implementation strategies facilitate guideline-recommended CKD care. Objective To identify risk for nonconcordance with in patients T2D. Design, Setting, Participants This retrospective cohort study was performed at 20 health care systems contributing data the US National Patient-Centered Clinical Research Network. evaluate concordance guidelines, adults outpatient clinician visit T2D diagnosis between January 1, 2015, December 31, 2020, without known were included. A separate analysis reviewed prescription angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) sodium-glucose cotransporter (SGLT2) (estimated glomerular filtration rate [eGFR] 30-90 mL/min/1.73 m urinary albumin-to-creatinine ratio [UACR] 200-5000 mg/g) October 2019, 2020. Data analyzed from July 8, 2022, through June 22, 2023. Exposures Demographics, lifestyle factors, comorbidities, medications, laboratory results. Main Outcomes Measures Screening required measurement creatinine levels UACR within 15 months index visit. Treatment reflected ACEIs ARBs SGLT2 12 before 6 following Results Concordance guidelines assessed 316 234 (median age, 59 [IQR, 50-67] years), whom 51.5% women; 21.7%, Black; 10.3%, Hispanic; 67.6%, White. Only 24.9% received screening, 56.5% 1 measurement, 18.6% neither. Hispanic ethnicity associated lack (relative [RR], 1.16 [95% CI, 1.14-1.18]). In contrast, heart failure, peripheral arterial disease, hypertension a lower nonconcordance. 4215 albuminuria, 3288 (78.0%) ACEI ARB; 194 (4.6%), inhibitor; 885 (21.0%), neither therapy. Peripheral eGFR treatment, while diuretic statin treatment. Conclusions Relevance this T2D, fewer than one-quarter recommended screening. 21.0% did not receive inhibitor ARB, despite compelling indications. may improve people

Language: Английский

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Estimating the population-level impacts of improved uptake of SGLT2 inhibitors in patients with chronic kidney disease: a cross-sectional observational study using routinely collected Australian primary care data

The Lancet Regional Health - Western Pacific, Journal Year: 2023, Volume and Issue: 43, P. 100988 - 100988

Published: Dec. 18, 2023

Sodium glucose co-transporter 2 (SGLT2) inhibitors reduce the risk of kidney failure and death in patients with chronic disease (CKD) but are underused. We evaluated number CKD Australia that would be eligible for treatment estimated cardiorenal events could averted improved uptake SGLT2 inhibitors.

Language: Английский

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