Early Identification and Management of Chronic Kidney Disease: A Narrative Review of the Crucial Role of Primary Care Practitioners

Advances in Therapy, Год журнала: 2024, Номер 41(10), С. 3757 - 3770

Опубликована: Авг. 20, 2024

Early-stage (stage 1–3) chronic kidney disease (CKD) has an asymptomatic presentation such that most people with CKD are unaware of their status and remain undiagnosed. is associated multiple long-term conditions (MLTC), or multimorbidity, the common these being cardiovascular disease, hypertension, type 2 diabetes. Primary care practitioners (PCPs) crucial in early identification management patients CKD. For individuals at high risk CKD, measurements estimated glomerular filtration rate, urine albumin–creatinine ratio, blood pressure should be obtained regularly recorded a timely manner. The importance lifestyle changes prevention also highlighted. A recent addition to treatment without diabetes been recommendation by clinical practice guidelines sodium–glucose co-transporter (SGLT2) inhibitor alongside renin–angiotensin–aldosterone system as foundational therapy. SGLT2 inhibitors prevent progression reduce fatal non-fatal events, hospitalization for heart failure, all-cause mortality, they have favorable safety tolerability profile. However, uptake slow, particularly multifaceted approach required ensure receive optimal protection. Measures raise awareness intervention include local/national campaigns via social media practice-based education; education programs; integration decision support tools into electronic health records; detection programs built around good interdisciplinary communication. PCPs forefront multidisciplinary best placed implement evidence-based modification guideline-directed medical Chronic affects about one ten adults worldwide. Results from many real-world studies show getting worse. because can no symptoms its stages, it often not diagnosed. Many therefore it. People likely other issues well, including hypertension offer holistic, patient-centered those frontline identifying managing factors disease. may advise on changes, diet exercise, well helping them understand what treatments available. Sodium–glucose shown strong kidney-protective effects trials, recently updated recommend use therapy more established These prescribed whether not. primary obtain record function pressure. Public practitioner education, tools, communication between healthcare professionals all important drive change improve

Язык: Английский

---

A network meta-analysis of therapies for hyperphosphatemia in CKD based on randomized trials

Scientific Reports, Год журнала: 2025, Номер 15(1)

Опубликована: Янв. 15, 2025

To update the efficacy and safety of different drugs for treatment patients with hyperphosphatemia in chronic kidney disease, we conducted a network meta-analysis 22 therapies uncontrolled disease (CKD). All randomized controlled trials on published from January 2013 to November 2023 were searched CNKI, VIP database, Wanfang PubMed, Scopus, Cochrane databases. Meta-analysis was used evaluate serum phosphorus, calcium levels, total effective rate adverse events Data collection quality evaluation carried out by three evaluators, RevMan (5.5.3) Stata (1.3.0). A 71 RCTs, strategies included this NMA. The results showed that all improving patients' blood phosphorus levels. Among them, SL + CT, CA CC, TCM had higher overall efficacy, RT, CT lower NAM OAC, safety. seems be most recommended strategy. In addition, multidrug combination usually have profile.

Язык: Английский

---

Impact of hospital-based early detection on management in chronic kidney disease: the CKD Stewardship study (CKD-S) – protocol for a prospective, multicentre, observational cohort study

BMJ Open, Год журнала: 2025, Номер 15(3), С. e094554 - e094554

Опубликована: Март 1, 2025

Chronic kidney disease (CKD) causes significant morbidity and mortality. Medical therapies can reduce the progression of by up to 50%. CKD is undiagnosed in majority people who have it, resulting undertreatment. Stewardship (CKD-S) aims identify hospital inpatients with mid-stage late-stage goal facilitating diagnosis initiating guideline-based therapies. This prospective, multicentre, cohort study compares two models care, CKD-S standard for identification management CKD, across six public hospitals metropolitan Sydney, Australia. entails active case finding using electronic medical record, nephrologist outreach admitting teams nurse provided patient education. Adult an admission estimated glomerular filtration rate (eGFR)<45 mL/min/1.73 m2 not known a will be eligible, excluding those short life expectancy or advanced age (>80 years). Participants enrolled between 1 March 2024 2025. Baseline demographic data collected after discharge from hospital. followed 12 months Pharmaceutical Benefits Schedule data, linked via Australian Institute Health Welfare Hub. We report proportion all adults admitted are already nephrologist, which stage 3b-5 recognised intervention team, compared care. then compare each eGFR urine albumin:creatinine ratio measured, referred prescribed guideline-directed over following The has ethics approval Sydney Local District's Ethics Committee (Concord Hospital Zone). results published peer-reviewed journals presented at academic conferences. ACTRN12624000452594.

Язык: Английский

---

Effectiveness of a systematic home-based albuminuria screening programme to detect chronic kidney disease in high-risk individuals in primary care (SALINE): a cross-sectional screening study

EClinicalMedicine, Год журнала: 2025, Номер 82, С. 103185 - 103185

Опубликована: Апрель 1, 2025

Although guidelines recommend opportunistic screening for chronic kidney disease (CKD) in individuals with established risk factors, such as diabetes, hypertension, or cardiovascular disease, CKD these remains suboptimal. This study aimed to evaluate the effectiveness of a systematic home-based albuminuria program primary care patients at CKD. A cross-sectional was performed ten general practices and five pharmacies Netherlands from November 2021 May 2024. random selection aged 45-80 years based on factors registered their electronic medical record invited using urine collection device measurement urinary albumin-to-creatinine ratio (ACR). In those confirmed increased (ACR ≥3 mg/mmol), an elaborate assess presence performed, followed by referral practitioner (GP) evaluation findings. The outcome yield detect GP pharmacy setting. SALINE is ClinicalTrials.gov, NCT05321095. total, 6380 (3802 via GPs 2578 pharmacies) were screening. participation rate 40·1% among (1524/3802), compared 21·8% (562/2578) (P < 0·001). 8·7% participants had (133/1524), 6·0% (34/562). Of 115 detected who completed screening, 102 (88·7%) identified one more newly diagnosed factor(s) (n = 46, 40·0%), known factor that outside target range treatment 75, 65·2%). completing 26 those, 22 (84·6%) 6, 2·3%), 21, 80·8%). Systematic care, when addition regular has acceptable GPs, whereas it less effective pharmacies. Such identifies yet unknown may benefit starting optimizing cardioprotective treatment. introduction programs merits further optimize yield. funded AstraZeneca Netherlands.

Язык: Английский

---

Dietary addition of magnesium hydride nanoparticles: a breakthrough in combating high-fat diet-induced chronic kidney disease

Medical Gas Research, Год журнала: 2025, Номер 15(3), С. 374 - 382

Опубликована: Апрель 17, 2025

A substantial body of evidence indicates a positive correlation between dyslipidemia and an elevated risk chronic kidney disease, with renal interstitial fibrosis frequently serving as common pathway in the advanced stages disease progression. Hydrogen has anti-inflammatory antioxidant properties, magnesium hydride nanoparticle is material high hydrogen storage capacity. Magnesium -fortified feed capable releasing gas steadily continuously within digestive tract. 12-week high-fat diet significantly serum urea creatinine levels mice. In contrast, dietary addition demonstrated notable protective effect against pathological conditions. Additionally, was found to reduce thereby improve function. support these findings, vitro study utilizing human cortical proximal tubule epithelial cells (HK-2 cells) exposed palmitic acid under conditions mimicking confirmed renoprotective effects hydride. Furthermore, primary target phosphatase tensin homologue deleted on chromosome 10 molecular mechanisms underlying hydride, specifically its ability inhibit transforming growth factor-beta -Smad family member 2 3 (Smad2/3) axis through downregulating expression 10, were elucidated. overexpression Hes BHLH transcription factor 1 can negate beneficial suggesting that may serve upstream regulatory context conclusion, this functions safe effective source inhibiting activation factor-beta/Smad2/3 protein kinase B/mechanistic rapamycin pathways by increasing 10. This mechanism counteracts progression diet-induced damage.

Язык: Английский

---

Are there lost opportunities in chronic kidney disease? A region-wide cohort study

BMJ Open, Год журнала: 2024, Номер 14(4), С. e074064 - e074064

Опубликована: Апрель 1, 2024

Objectives Identify the windows of opportunity for diagnosis chronic kidney disease (CKD) and prevention its adverse outcomes quantify potential population gains such prevention. Design setting Observational, population-wide study residents in Stockholm Skåne regions Sweden between 1 January 2015 31 December 2020. Participants All patients who did not yet have a CKD healthcare but had according to laboratory measurements biomarkers available electronic health records. Outcome measures We assessed proportions patient that received subsequent healthcare, used guideline-directed pharmacological therapy (statins, renin-angiotensin aldosterone system inhibitors (RAASi) and/or sodium-glucose cotransporter-2 (SGLT2i)) experienced (all-cause mortality, cardiovascular mortality or major events (MACE)). The prevent was using simulations untreated subsets population. Results identified 99 382 with undiagnosed during period. Only 33% those after 5 years. proportion statins RAASi similar size didn’t, regardless how advanced their was. use SGLT2i negligible. In optimal treatment, 22% 21 870 deaths, 27% 14 310 deaths 39% 22 224 MACE could been avoided if every an indicated medication laboratory-confirmed treated CKD. Conclusions While we noted underdiagnosis undertreatment this large contemporary population, also substantial realisable improve reduce burden by treating early therapy.

Язык: Английский

---

Suboptimal monitoring and management in patients with unrecorded stage 3 chronic kidney disease in real‐world settings: Insights from REVEAL‐CKD

European Journal of Clinical Investigation, Год журнала: 2024, Номер 54(11)

Опубликована: Июль 18, 2024

Abstract Background Clinical practice guidelines for patients with chronic kidney disease (CKD) recommend regular monitoring and management of function CKD risk factors. However, the majority stage 3 lack a diagnosis code, data on implementation these recommendations in real world are limited. Aim To assess guideline‐directed practices without recorded code. Methods REVEAL‐CKD (NCT04847531) is multinational, observational study CKD. Eligible had ≥2 consecutive estimated glomerular filtration rate (eGFR) measurements indicative >90 ≤730 days apart, lacked an International Classification Diseases 9/10 code corresponding to any time before up 6 months after second eGFR measurement. Testing key measures care quality were assessed. Results The included 435,971 from 9 countries. In all countries, prevalence urinary albumin–creatinine ratio albuminuria testing was low. Angiotensin‐converting enzyme inhibitor, angiotensin receptor blocker statin prescriptions highly variable, sodium–glucose cotransporter‐2 inhibitor remained below 21%. Blood pressure 20.2%–89.9% patients. Conclusions Overall, large proportion evidence did not receive recommended, management. variability standard among countries demonstrates clear opportunity improve patients, most likely improving long‐term outcomes.

Язык: Английский

---

Dapagliflozin treatment of patients with chronic kidney disease without diabetes across different albuminuria levels (OPTIMISE-CKD)

Clinical Kidney Journal, Год журнала: 2024, Номер 17(8)

Опубликована: Апрель 4, 2024

We compared kidney and cardiorenal protection in patients without type 2 diabetes across urine albumin-creatinine ratio (UACR) levels after initiation on dapagliflozin for the treatment of chronic disease (CKD).

Язык: Английский

---

Impact of primary aldosteronism on kidney function: results from the SPAIN-ALDO registry

Journal of Hypertension, Год журнала: 2024, Номер 42(10), С. 1805 - 1812

Опубликована: Июль 5, 2024

To evaluate the impact of aldosterone excess on renal function in individuals with primary aldosteronism and to compare its evolution after surgery or mineralocorticoid receptor antagonist (MRA) treatment.

Язык: Английский

---

Angiotensin Receptor-Neprilysin Inhibitor for Chronic Kidney Disease: Strategies for Renal Protection

Kidney & Blood Pressure Research, Год журнала: 2024, Номер 49(1), С. 916 - 932

Опубликована: Окт. 11, 2024

Chronic kidney disease (CKD) and hypertension are significant global health challenges that often coexist aggravate each other. Renin-angiotensin system inhibitors important to the management of these conditions; however, their efficacy for advanced CKD remains uncertain.

Язык: Английский

---