KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease

Kidney International, Journal Year: 2024, Volume and Issue: 105(4), P. S117 - S314

Published: March 13, 2024

This article is published as part of a supplement sponsored by Kidney Disease: Improving Global Outcomes (KDIGO). The opinions or views expressed in this are those the authors and do not necessarily reflect recommendations International Society Nephrology Elsevier. Dosages, indications, methods use for products that referred to may their clinical experience be derived from professional literature other sources.

Language: Английский

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Cardiovascular-Kidney-Metabolic Health: A Presidential Advisory From the American Heart Association

Circulation, Journal Year: 2023, Volume and Issue: 148(20), P. 1606 - 1635

Published: Oct. 9, 2023

Cardiovascular-kidney-metabolic health reflects the interplay among metabolic risk factors, chronic kidney disease, and cardiovascular system has profound impacts on morbidity mortality. There are multisystem consequences of poor cardiovascular-kidney-metabolic health, with most significant clinical impact being high associated incidence disease events is a prevalence in population, disproportionate burden seen those adverse social determinants health. However, there also growing number therapeutic options that favorably affect function, or both have cardioprotective effects. To improve related outcomes critical need for (1) more clarity definition syndrome; (2) an approach to staging promotes prevention across life course; (3) prediction algorithms include exposures relevant health; (4) strategies management relation reflect harmonization major subspecialty guidelines emerging scientific evidence. It incorporate considerations into care models syndrome reduce fragmentation by facilitating approaches patient-centered interdisciplinary care. This presidential advisory provides guidance definition, staging, paradigms, holistic patients details multicomponent vision effectively equitably enhancing population.

Language: Английский

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Development and Validation of the American Heart Association’s PREVENT Equations

Circulation, Journal Year: 2023, Volume and Issue: 149(6), P. 430 - 449

Published: Nov. 10, 2023

BACKGROUND: Multivariable equations are recommended by primary prevention guidelines to assess absolute risk of cardiovascular disease (CVD). However, current have several limitations. Therefore, we developed and validated the American Heart Association Predicting Risk CVD EVENTs (PREVENT) among US adults 30 79 years age without known CVD. METHODS: The derivation sample included individual-level participant data from 25 sets (N=3 281 919) between 1992 2017. outcome was (atherosclerotic heart failure). Predictors traditional factors (smoking status, systolic blood pressure, cholesterol, antihypertensive or statin use, diabetes) estimated glomerular filtration rate. Models were sex-specific, race-free, on scale, adjusted for competing non-CVD death. Analyses conducted in each set meta-analyzed. Discrimination assessed using Harrell C-statistic. Calibration calculated as slope observed versus predicted decile. Additional predict subtype failure) include optional predictors (urine albumin-to-creatinine ratio hemoglobin A1c), social deprivation index also developed. External validation performed 3 330 085 participants 21 additional sets. RESULTS: Among 6 612 004 included, mean±SD 53±12 years, 56% women. Over a follow-up 4.8±3.1 there 211 515 incident total events. median C-statistics external 0.794 (interquartile interval, 0.763–0.809) female 0.757 (0.727–0.778) male participants. calibration slopes 1.03 0.81–1.16) 0.94 (0.81–1.13) participants, respectively. Similar estimates discrimination atherosclerotic CVD– failure–specific models. improvement small but statistically significant when urine ratio, A1c, added together base model (ΔC-statistic [interquartile interval] 0.004 [0.004–0.005] 0.005 [0.004–0.007] respectively). improved significantly those with marked albuminuria (>300 mg/g; 1.05 [0.84–1.20] 1.39 [1.14–1.65]; P =0.01). CONCLUSIONS: PREVENT accurately precisely subtypes large, diverse, contemporary routinely available clinical variables.

Language: Английский

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A focused update to the 2019 NLA scientific statement on use of lipoprotein(a) in clinical practice

Journal of clinical lipidology, Journal Year: 2024, Volume and Issue: 18(3), P. e308 - e319

Published: April 1, 2024

Language: Английский

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Metabolic syndrome

Nature Reviews Disease Primers, Journal Year: 2024, Volume and Issue: 10(1)

Published: Oct. 17, 2024

Language: Английский

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The impact of population ageing on the burden of chronic kidney disease

Nature Reviews Nephrology, Journal Year: 2024, Volume and Issue: 20(9), P. 569 - 585

Published: July 18, 2024

Language: Английский

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Projected Changes in Statin and Antihypertensive Therapy Eligibility With the AHA PREVENT Cardiovascular Risk Equations

JAMA, Journal Year: 2024, Volume and Issue: 332(12), P. 989 - 989

Published: July 29, 2024

Importance Since 2013, the American College of Cardiology (ACC) and Heart Association (AHA) have recommended pooled cohort equations (PCEs) for estimating 10-year risk atherosclerotic cardiovascular disease (ASCVD). An AHA scientific advisory group recently developed Predicting Risk EVENTs (PREVENT) equations, which incorporated kidney measures, removed race as an input, improved calibration in contemporary populations. PREVENT is known to produce ASCVD predictions that are lower than those produced by PCEs, but potential clinical implications not been quantified. Objective To estimate number US adults who would experience changes categorization, treatment eligibility, or outcomes when applying existing ACC guidelines. Design, Setting, Participants Nationally representative cross-sectional sample 7765 aged 30 79 years participated National Health Nutrition Examination Surveys 2011 March 2020, had response rates ranging from 47% 70%. Main Outcomes Measures Differences predicted risk, eligibility statin antihypertensive therapy, projected occurrences myocardial infarction stroke. Results In a nationally (median age, 53 years; 51.3% women), it was estimated using reclassify approximately half categories (53.0% [95% CI, 51.2%-54.8%]) very few higher (0.41% 0.25%-0.62%]). The receiving preventive decrease 14.3 million (95% 12.6 million-15.9 million) therapy 2.62 2.02 million-3.21 therapy. study that, over 10 years, these decreases could result 107 000 additional Eligibility affect twice many men women greater proportion Black White adults. Conclusion Relevance By assigning predictions, application thresholds reduce among 15.8

Language: Английский

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The importance of LDL-C lowering in atherosclerotic cardiovascular disease prevention: Lower for longer is better

American Journal of Preventive Cardiology, Journal Year: 2024, Volume and Issue: 18, P. 100649 - 100649

Published: March 18, 2024

Cumulative exposure to low-density lipoprotein cholesterol (LDL-C) is a key driver of atherosclerotic cardiovascular disease (ASCVD) risk. An armamentarium therapies achieve robust and sustained reduction in LDL-C can reduce ASCVD The gold standard for assessment ultracentrifugation but routine clinical practice usually calculated the most accurate calculation obtained through Martin/Hopkins equation. For primary prevention, consideration estimated risk frames decision making regarding use statins other therapies, tools such as enhancing factors coronary artery calcium enable tailoring making. In patients with diabetes, lipid lowering therapy recommended an opportunity tailor based on factors. Patients hypercholesterolemia familial (FH) baseline greater than or equal 190 mg/dL are at elevated risk, high-intensity statin often combined non-statin prevent ASCVD. Secondary prevention ASCVD, including prior myocardial infarction stroke, requires intensive lifestyle modification approaches. There no established level below which benefit ceases safety concerns arise. When further required beyond modifications therapy, additional medications include oral ezetimibe bempedoic acid, injectables PCSK9 monoclonal antibodies siRNA therapy. A novel agent that acts independently hepatic LDL receptors evinacumab, approved homozygous FH. Other emerging agents targeted Lp(a) CETP. Given dyslipidemia, this manuscript reviews importance early, intensive, LDL-C-lowering secondary

Language: Английский

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Screening, identifying, and treating chronic kidney disease: why, who, when, how, and what?

BMC Nephrology, Journal Year: 2024, Volume and Issue: 25(1)

Published: Jan. 25, 2024

Abstract 1 in 7 American adults have chronic kidney disease (CKD); a that increases risk for CKD progression, cardiovascular events, and mortality. Currently, the US Preventative Services Task Force does not screening recommendation, though evidence suggests can prevent progression is cost-effective. Populations at CKD, such as those with hypertension, diabetes, age greater than 50 years should be targeted screening. diagnosed stratified estimated glomerular filtration rate utilizing serum creatinine measuring urine albumin-to-creatinine ratio. Once identified, staged according to C-G-A classification, managed lifestyle modification, interdisciplinary care recently expanding repertoire of pharmacotherapy which includes angiotensin converting enzyme inhibitors or angiotensin-II receptor blockers, sodium-glucose-cotransporter-2 inhibitors, mineralocorticorticoid antagonists. In this paper, we present why, who, when, how, what

Language: Английский

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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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