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Chronic kidney disease (CKD) is an important and common noncommunicable condition globally. In national and international guidelines, CKD is defined and staged according to measures of kidney function that allow for a degree of risk stratification using commonly available markers. It is often asymptomatic in its early stages, and early detection is...
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Context 1
... has been debate about creatinine testing frequency for monitoring eGFR, and recommendations are based more on expert opinion than formal research evidence. The frequen- cies recommended by NICE and KDIGO therefore differ slightly, but those from KDIGO are set out in Table 3 along with the KDIGO color scheme to reflect risk of progression in each category. 5,6 KDIGO guidelines recommend testing with a slightly greater frequency than NICE such as three tests per year for people with CKD stage G4A2 rather than twice a year recommended by NICE. ...
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b> Background: How to manage patients with severe kidney disease in pregnancy is still a matter of discussion, and deciding if and when to start dialysis is based on the specialist’s experience and dialysis availability. The effect of toxic substances usually cleared by the kidney may be more severe and readily evident. The review, and related case...
Citations
... Primary care physicians have a crucial role in CKD risk stratification and accurate diagnosis (e.g. acute kidney injury versus CKD), ideally before consulting with a nephrologist [27,33]. The initial stages tend to be asymptomatic; fewer than 5% of patients are aware that they have early-stage CKD [27], highlighting the importance of a) earlier screening and b) focusing on high-risk patients in primary care to detect CKD. ...
Background Chronic kidney disease (CKD) has a global prevalence of 9.1–13.4%. Comorbidities are abundant and may cause and affect CKD. Cardiovascular disease strongly correlates with CKD, increasing the burden of both diseases. Summary As a group of 15 clinical nephrologists primarily practicing in 12 Central/Eastern European countries, as well as Israel and Kazakhstan, herein we review the significant unmet needs for patients with CKD and recommend several key calls-to-action. Early diagnosis and treatment are imperative to ensure optimal outcomes for patients with CKD, with the potential to greatly reduce both morbidity and mortality. Lack of awareness of CKD, substandard indicators of kidney function, suboptimal screening rates, and geographical disparities in reimbursement often hamper access to effective care. Key Messages Our key calls-to-action to address these unmet needs, thus improving the standard of care for patients with CKD, are: increase disease awareness, such as through education; encourage provision of financial support for patients; develop screening algorithms; revisit primary care physician referral practices; and create epidemiological databases that rectify the paucity of data on early-stage disease. By focusing attention on early detection, diagnosis, and treatment of high-risk and early-stage CKD populations we aim to reduce the burdens, progression, and mortality of CKD.
... The results of these tests are used to divide the severity of CKD into stages from 1 to 5, with stage 1 being mostly normal kidney function and stage 5 being kidney failure [6]. Early in the course of the disease (stages 1-3), patients will often not experience any symptoms [7]. As kidney function continues to decline, patients may experience symptoms such as tiredness, nausea, insomnia, cramps, pain, and itching [8]. ...
Chronic kidney disease (CKD) affects more than one in ten people worldwide. However, results from the REVEAL-CKD study suggest that it is often not diagnosed. Many patients are therefore unaware that they have CKD, putting them at increased risk of disease progression and complications. Empowering patients with knowledge about CKD will allow them to become active participants in their own care, driving improvements in diagnosis rates and changing patient outcomes for the better. In this article, we provide patient and clinician perspectives on the importance of early CKD diagnosis and management. We present an overview of the tests commonly used to diagnose CKD in clinical practice, as well as actionable suggestions for patients, clinicians, and health policymakers that could help improve disease detection and treatment. Navdeep Tangri, a nephrologist and epidemiologist at the University of Manitoba, and Jane DeMeis, a patient living with chronic kidney disease, discuss how results from the REVEAL-CKD study highlight the need for change to improve management of chronic kidney disease. Video Abstract (MP4 141866 KB).
... Evaluating albumin excretion in urine is best done using the ACR index in the first, morning urine sample. ACR is defined as the urine albumin to creatine ratio [53]. To make a full diagnosis of chronic kidney disease it is needed to assess eGFR, albuminuria and its cause. ...
Civilization diseases affect more and more people globally. As a World Health Organization reports in 2016 more than 1.9 billion of adults were overweight and excess body mass is the leading risk factor for developing diabetes affecting approximately 422 million people worldwide (90% is DM2). It has seemed that the link between obesity, diabetes, and cardiovascular complications is a low-grade chronic inflammation that is observed in all tissues involved in energy homeostasis and is characterized by the activation of pro-inflammatory macrophages so-called M1. The increasing number of patients suffering from diabetes has challenged scientists to develop more and more powerful and pleiotropic antidiabetic drugs, which apart from better glycemia control will be able to decrease the total cardiovascular risk (a leading cause of death in diabetic patients). SGLT-2 inhibitors seem to show pleiotropic effects – cardioprotective, nephroprotective, and anti-inflammatory one.
... 11,12,[25][26][27][28] Data from a global report and several studies show that the etiologies of ESKD are mostly diabetic (ranging from 30 to 50%) and hypertension (27%). [29][30][31][32][33] In Indonesia, hypertension is still the most common etiology for ESKD (39%), followed by diabetes (22%). In this study, the major etiology for ESKD was hypertension (78.5%), followed by both hypertension and diabetes (11.7%). ...
Background
End-stage kidney disease (ESKD) is associated with a tremendous financial burden. Data in Indonesia shows an increasing number of patients with ESKD taking hemodialysis as a routine procedure every year. Establishment and maintenance of vascular access are important in the management of ESKD. Vascular complications that often arise due to hemodialysis are common and one of the main reasons for hospitalization. Cannulation complications ranged from minor hematomas to acute bleeding from pseudoaneurysms that required emergency surgical procedures. This study aims to assess the different clinicopathological characteristics of ESKD patients with vascular access cannulation complications and the surgical management related to the complications.
Materials and Methods
This research is a retrospective observational study. The research subjects in this study were ESKD patients in the vascular and endovascular surgery division of the tertiary hospital in West Java, Indonesia. There were 121 study subjects. Clinicopathological characteristics of vascular cannulation complications and surgical management are extracted from the medical record.
Results
Three major vascular complications were ruptured pseudoaneurysms 64/121 (52.9%), impending rupture pseudoaneurysms 28/121 (23.1%), and pseudoaneurysms 21/121 (17.4%). Common surgical procedures were ligation of the draining vein 47/121 (38.8%), arterial primary repair 28/121 (23.1%), and arterial patch repair 18/121 (14.9%). There was a significant relationship between symptoms of bleeding in ruptured pseudoaneurysms and bulging masses in pseudoaneurysms (p = 0.001). There was a significant relationship between the diameter of the vascular mass, vascular defect size, and hematoma and the type of surgical procedure taken (p < 0.010).
Conclusion
Ruptured, impending rupture, and pseudoaneurysms are major complications of vascular access in ESKD patients, and there was a significant relationship between the carried-out surgical procedure and the size of the vascular mass, defect, and hematoma.
... Understanding these mechanisms is crucial for the effective management and development of targeted therapies for diabetic nephropathy. Early detection, glycemic control, blood pressure management, and targeted therapies are essential for slowing disease progression and preserving kidney function [34,35]. Additionally, interventions targeting pro-inflammatory pathways, oxidative stress, and ECM accumulation may hold promise in preventing or mitigating the progression of diabetic nephropathy [34,35]. ...
... Early detection, glycemic control, blood pressure management, and targeted therapies are essential for slowing disease progression and preserving kidney function [34,35]. Additionally, interventions targeting pro-inflammatory pathways, oxidative stress, and ECM accumulation may hold promise in preventing or mitigating the progression of diabetic nephropathy [34,35]. ...
Diabetic nephropathy is a progressive condition characterized by kidney damage and functional decline, primarily attributed to hyperglycemia. Special keywords and probes related to diabetic nephropathy were utilized by Google search engine to obtain relevant information from Google, Google Scholar, PubMed, Science Alert, and Google Scholar databases. This review explores the interconnected mechanisms underlying its pathogenesis. Hyperglycemia initiates glomerular hypertrophy and increased glomerular filtration rate as compensatory responses, but persistent hyperglycemia leads to renal inflammation, oxidative stress, abnormal extracellular matrix (ECM) accumulation, and increased albuminuria. These processes contribute to structural changes, declining glomerular filtration rate, and potential end-stage renal disease (ESRD) progression. Advanced glycation end products (AGEs) and the renin-angiotensin system (RAS) play key roles in hyperglycemic-induced glomerular hypertrophy. Glomerular hyperfiltration, mediated by the renin-angiotensin-aldosterone system (RAAS), impaired tubuloglomerular feedback, and increased capillary filtration coefficient, further contributes to increased glomerular filtration rate. Inflammation and oxidative stress, triggered by hyperglycemia and AGEs, promote kidney damage. Abnormal ECM accumulation, driven by hyperglycemia and the transforming growth factor-beta pathway, leads to structural changes. Hyperglycemia-induced microalbuminuria and proteinuria reflect early signs of kidney damage. Managing diabetic nephropathy poses challenges, but ongoing research offers potential solutions. Novel therapeutic targets, combination therapies, personalized medicine approaches, regenerative medicine, and gene therapy are being explored. Advancements in diagnostics, including targeted therapies and non-invasive tools, show promise in preventing or mitigating the progression of diabetic nephropathy. Understanding these mechanisms is crucial for early detection, glycemic control, blood pressure management, and targeted therapies to slow disease progression. Collaboration among healthcare stakeholders is essential in finding effective solutions for this complex condition. This review therefore highlights the importance of a comprehensive approach to managing diabetic nephropathy and improving patient outcomes.
... Böbrek hastalıkları kısmen, renal enfeksiyon ve hasara karşı fizyolojik yanıt üzerinde etkileri olan ve muhtemelen geri dönüşümsüz böbrek hasarının gelişmesine katkıda bulunan inflamatuar süreçler tarafından gelişmektedir 34,35 ...
Kısa zincirli yağ asitleri (KZYA'lar), kısmen ve sindirilemeyen polisakkaritlerin fermentasyonu sırasında bağırsak mikrobiyotası tarafından üretilen yağ asitlerinin bir alt kümesidir. En yüksek KZYA seviyeleri, enterositler tarafından lokal olarak kullanıldıkları veya bağırsak epiteli boyunca kan dolaşımına taşındıkları proksimal kolonda bulunur. İki ana KZYA sinyal mekanizması tanımlanmıştır. Bunlar; histon deasetilazların (HDAZ'lar) inhibisyonu ve G-protein-bağlı reseptörlerin (GPR'ler) aktivasyonudur. HDAZ'lar gen ekspresyonunu düzenlediğinden, HDAZ'ların inhibisyonunun çok çeşitli down regule sonuçları vardır. HDAZ'ların KZYA aracılı inhibisyonuna ilişkin anlayışımız henüz başlangıç aşamasındadır. GPR'ler, özellikle GPR43, GPR41 ve GPR109A, KZYA'lar için reseptörler olarak tanımlanmıştır. Çalışmalar, bu GPR'lerin hastalıkların ve metabolizmanın düzenlenmesinde önemli bir rol oynadığını göstermiştir. Bunlar reaktif oksijen türlerini (ROT) indüklemek, hücre çoğalmasını ve işlevini değiştirmek, anti-enflamatuar, antitümorijenik ve antimikrobiyal etkilere sahip ve bağırsak bütünlüğünü değiştirmektedir. Son zamanlarda yapılan araştırmalar, KZYA'ların yalnızca bağırsaktaki sinyal iletim yolunu etkilemekle kalmayıp, aynı zamanda kandaki dolaşımları yoluyla bağırsak dışındaki doku ve organlara da ulaştıkları bulmuştur. Bu çalışmada; KZYA'ların geniş etkileri ve seviyelerinin diyetle düzenlendiği göz önüne alındığında, dünyada enflamatuar hastalıklar için yeni terapötik strateji geliştirilmesi amaçlamak ve konak fizyolojisi üzerindeki etkilerine ilişkin mevcut anlayışı gözden geçmekteyiz.
... Chronic kidney disease (CKD) is a widespread health concern characterized by gradually losing kidney function over time [1]. This complex disorder affects many individuals worldwide and is associated with significant morbidity, mortality, and healthcare costs [2]. CKD is classified into various stages based on kidney function, ultimately leading to end-stage renal disease (ESRD), which requires renal replacement therapies such as dialysis or kidney transplantation [3]. ...
Introduction
Chronic kidney disease (CKD) and its progression to end-stage renal disease (ESRD) represent a growing health concern globally, with hypertension and diabetes commonly identified as primary etiological factors. This study evaluates the demographic and health profiles of individuals undergoing dialysis treatment in the Al-Baha region of Saudi Arabia, aiming to identify the predominant causes of ESRD and the associated socioeconomic and healthcare-related factors.
Methodology
This cross-sectional study analyzed data from patients receiving dialysis in Al-Baha. We assessed variables including etiology of ESRD, demographic data, presence of comorbid conditions, initial symptoms, and pre-dialysis health care engagement. Statistical analysis focused on the prevalence and correlations between the different variables and ESRD. The study also examined patients’ educational background and employment status to ascertain ESRD’s socioeconomic impact.
Results
The study found hypertension and diabetes as the leading causes of ESRD. Unknown etiologies accounted for 10.1% of cases, highlighting an area for further research. Notably, coronavirus disease 2019 (COVID-19) and cardiogenic shock emerged as potential new contributors, each representing 1.7% of cases. Most patients resided in urban areas, with the largest age group being 46 to 55 years. Men had a higher prevalence of ESRD than women. Low educational attainment was significant among patients, and unemployment due to ESRD was prevalent, pointing towards the need for vocational support. Clinical findings revealed late referrals to nephrologists, with a substantial proportion of diagnoses occurring in emergency settings. Family history suggested a higher-than-expected genetic component of CKD in the region.
Conclusion
The study confirms hypertension and diabetes as principal contributors to ESRD in Al-Baha while also pointing to the emergence of COVID-19 as a potential risk factor. Socioeconomic factors, including educational and employment status, are critical to patient management and outcomes. The high percentage of unknown etiologies and familial CKD prevalence warrants additional research. Improving early detection, enhancing patient education, and fostering timely nephrology consultations could mitigate the progression to ESRD and enhance patient quality of life.
... The intent is to provide preventative interventions earlier to reduce the rates of CKD, which can lead to rapid progression in the Aboriginal and Torres Strait Islander population [23]. Early identification and management typically happen at the primary care level, [24] in northern Australia this involves GP's, rural nurses and Aboriginal and/or Torres Strait Islander health workers. The results from this study have identified reasonable screening and identification of clients with hypertension, hyperlipidaemia and diabetes (risk factors for CKD) at the primary care level, however there was inadequate management, with only a third reaching the recommended blood pressure target of 130/80, and the average Hba1c considerably higher than evidence-based targets. ...
Background
Chronic Kidney disease (CKD) is over-represented amongst First Nation people with more than triple the rate of CKD in those aged 15 years and over. The impact of colonisation, including harmful experiences of health practices and research, has contributed to these health inequities. Cape York Kidney Care (CYKC) has been created as an unique service which provides specialist care that aims to centre the client within a multidisciplinary team that is integrated within the primary care setting of the remote health clinics in six communities in western Cape York, Australia. This research aims to describe the Cape York Kidney Care service delivery model, and baseline service data, including aggregated client health measures.
Methods
The model of care is described in detail. Review of the first 12 months of service provision has been undertaken with client demographic and clinical profile baseline data collected including kidney health measures. Participants are adults (> 18 years if age) with CKD grades 1–5. This data has been de-identified and aggregated.
Results
CYKC reviewed 204 individuals, with 182 not previously been reviewed by specialist kidney health services. Three quarters of clients identified as Aboriginal. The average age was 55 with a high level of comorbidity, with majority having a history of hypertension and Type 2 diabetes (average Hba1c 8.2%). Just under one third had cardiovascular disease. A large proportion of people had either Grade 2 CKD (32%) or Grade 3 CKD (~ 30%), and over half had severely increased albuminuria (A3), with Type 2 diabetes being the predominant presumed cause of CKD. Most clients did not meet evidence-based targets for diabetes, blood pressure or lipids and half were self-reported smokers. The proportion of clients reviewed represents 6.2% of the adult population in the participating First Nation communities.
Conclusion
The CYKC model was able to target those clients at high risk of progression and increase the number of people with chronic kidney disease reviewed by specialist kidney services within community. Baseline data demonstrated a high burden of chronic disease that subsequently will increase risk of CKD progression and cardiovascular disease. People were seen to have more severe disease at younger ages, with a substantial number demonstrating risk factors for rapid progression of kidney disease including poorly controlled Type 2 diabetes and severely increased albuminuria. Further evaluation concerning implementation challenges, consumer and community satisfaction, and health outcomes is required.
... Studies suggest that proper maintenance of the comorbidities can effectively lower the risk of progression of kidney damage in CKD. CKD in initial stages are asymptomatic, but in later stages (stage 3 -5) symptoms are positively related to the progressive kidney abnormalities [3]. Protein intake in CKD is considered as a major determinant in the function of the kidneys and consumption of high protein diet is associated cross-sectionally with higher GFR (Glomerular Filtration Rate) but longitudinally with greater GFR decline over time. ...
... Exclusion criteria included patients with previous aortic valve replacement (AVR) or other aortic interventions, patients with connective tissue disorders or syndromes, patients with metal body implants or permanent metal fragments, pregnancy, claustrophobia and severe kidney dysfunction (i.e., estimated glomerular filtration rate < 60 mL/min/1.73 m 2 ) [23]. Demographic and clinical data were obtained from the patients' hospital records, including valve phenotype (i.e., right-left (RL), rightnon-coronary (RNC) and left-non-coronary (LCN) fusion), degree of aortic stenosis (AS) and regurgitation (AR), type of dilation (one sided/overall) and presence of calcification. ...
Congenital heart defects (CHD) introduce haemodynamic changes; e.g., bicuspid aortic valve (BAV) presents a turbulent helical flow, which activates aortic pathological processes. Flow quantification is crucial for diagnostics and to plan corrective strategies. Multiple imaging modalities exist, with phase contrast magnetic resonance imaging (PC-MRI) being the current gold standard; however, multiple predetermined site measurements may be required, while 4D MRI allows for measurements of area (A) and velocity (U) in all spatial dimensions, acquiring a single volume and enabling a retrospective analysis at multiple locations. We assessed the feasibility of gathering hemodynamic insight into aortic hemodynamics by means of wave intensity analysis (WIA) derived from 4D MRI. Data were collected in n = 12 BAV patients and n = 7 healthy controls. Following data acquisition, WIA was successfully derived at three planes (ascending, thoracic and descending aorta) in all cases. The values of wave speed were physiological and, while the small sample limited any clinical interpretation of the results, the study shows the possibility of studying wave travel and wave reflection based on 4D MRI. Below, we demonstrate for the first time the feasibility of deriving wave intensity analysis from 4D flow data and open the door to research applications in different cardiovascular scenarios.
