chronic kidney disease

Globally, the prevalence of chronic kidney disease is estimated to be approximately 850 million cases, with approximately 4 million individuals needing kidney replacement therapy for kidney failure. By 2050, chronic kidney disease is projected to become the fifth leading underlying cause of death worldwide. Despite its numerous causes, chronic kidney disease can be screened for, diagnosed, and staged with simple laboratory tests. Individuals with chronic kidney disease are at increased risk of kidney failure and many other health implications. Risk of premature cardiovascular disease is particularly noteworthy, as most patients with chronic kidney disease develop a disability or die from cardiovascular disease before ever progressing to kidney failure. Since 2019, large randomised trials have identified several effective treatments that both slow progressive kidney function decline and reduce cardiovascular risk, greatly expanding available treatments for chronic kidney disease. The wide range of complications associated with chronic kidney disease means that patients encounter many different specialties. Active engagement in chronic kidney disease identification and timely initiation of cost-effective interventions by all clinicians could now substantially reduce the global burden of complications of chronic kidney disease and kidney failure.

Author/s:

William G. Herrington, Parminder K. Judge, Morgan E Grams, Christoph Wanner

Screening for Hypertension in Adults

Saige Blanchard — Wed, 05 May 2021 05:00:00 +0000

Date Added:

May 5, 2021

Journal/Publication:

Journal of the American Medical Association

Publisher:

U.S. Preventative Services Task Force

Publication Date:

April 27, 2021

Issue:

Volume:

325

Pages:

1650-1656

URL:

Screening for Hypertension in Adults

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Web Page

DOI (1):

10.1001/jama.2021.4987

Keywords

hypertension

heart failure

myocardial infarction

chronic kidney disease

MeSH

blood pressure

Mass Screening

hypertension

myocardial infarction

No surprise that the USPSTF recommends in-office screening for hypertension. What seems interesting is that they suggest getting confirmatory readings from outside the office before making the diagnosis. James W. Mold, MD, MPH

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IMPORTANCE Hypertension is a prevalent condition that affects approximately 45% of the adult US population and is the most commonly diagnosed condition at outpatient office visits. Hypertension is a major contributing risk factor for heart failure, myocardial infarction, stroke, and chronic kidney disease. OBJECTIVE To reaffirm its 2015 recommendation, the US Preventive Services Task Force (USPSTF) commissioned a systematic review to evaluate the benefits and harms of screening for hypertension in adults, the accuracy of office blood pressure measurement for initial screening, and the accuracy of various confirmatory blood pressure measurement methods. POPULATION Adults 18 years or older without known hypertension. EVIDENCE ASSESSMENT Using a reaffirmation deliberation process, the USPSTF concludes with high certainty that screening for hypertension in adults has substantial net benefit. RECOMMENDATION The USPSTF recommends screening for hypertension in adults 18 years or older with office blood pressure measurement. The USPSTF recommends obtaining blood pressure measurements outside of the clinical setting for diagnostic confirmation before starting treatment. (A recommendation)

Author/s:

U.S. Preventative Services Task Force

Diabetes Management in Chronic Kidney Disease: Synopsis of the 2020 KDIGO Clinical Practice Guideline

Devin Evans — Wed, 11 Nov 2020 06:00:00 +0000

Date Added:

November 11, 2020

Journal/Publication:

Annals of Internal Medicine

Publication Date:

November 10, 2020

URL:

Diabetes Management in Chronic Kidney Disease: Synopsis of the 2020 KDIGO Clinical Practice Guideline

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.7326/M20-5938

Keywords

chronic kidney disease

type 2 diabetes

Kidneys

PMID (1):

33166222

MeSH

delivery of health care

Integrated

This is a new guideline from the Kidney Disease – Improving Global Outcomes (KDIGO) group on management of diabetes in people with chronic kidney disease. James W. Mold, MD, MPH

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Description: The Kidney Disease: Improving Global Outcomes (KDIGO) organization developed a clinical practice guideline in 2020 for the management of patients with diabetes and chronic kidney disease (CKD).

Methods: The KDIGO Work Group (WG) was tasked with developing the guideline for diabetes management in CKD. It defined the scope of the guideline, gathered evidence, determined systematic review topics, and graded evidence that had been summarized by an evidence review team. The English-language literature searches, which were initially done through October 2018, were updated in February 2020. The WG used the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach to appraise evidence and rate the strength of the recommendations. Expert judgment was used to develop consensus practice points supplementary to the evidence-based graded recommendations. The guideline document underwent open public review. Comments from various stakeholders, subject matter experts, and industry and national organizations were considered before the document was finalized.

Recommendations: The guideline includes 12 recommendations and 48 practice points for clinicians caring for patients with diabetes and CKD. This synopsis focuses on the key recommendations pertinent to the following issues: comprehensive care needs, glycemic monitoring and targets, lifestyle interventions, antihyperglycemic therapies, and educational and integrated care approaches.

Author/s:

Navaneethan, Sankar D., Zougas, Sophia, Caramori, M.L., Chan, Juliana C.N., Heerspink, Hiddo J.L., Hurst, Clint, Liew, Adrian, Michos, Erin D., Olowu, Wasiu A., Sadusky, Tami, Tandon, Nikhil, Tuttle, Katherine R., Wanner, Christoph, Wilkens, Katy G., Lytvyn, Lyubov, Craig, Jonathan C., Tunnicliffe, David J., Howell, Martin, Tonelli, Marcello, Cheung, Michael, Earley, Amy, Rossing, Peter, De Boer, Ian H., Khunti, Kamlesh

Proton Pump Inhibitor Use and Risk of Chronic Kidney Disease

Tracy Ashby — Mon, 11 Mar 2019 05:00:00 +0000

Date Added:

March 11, 2019

Journal/Publication:

JAMA Internal Medicine

Publisher:

American Medical Association

Publication Date:

February 1, 2017

Issue:

Volume:

176

Pages:

238-246

URL:

Proton Pump Inhibitor Use and Risk of Chronic Kidney Disease

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1001/jamainternmed.2015.7193

Keywords

proton pump inhibitors

chronic kidney disease

interstitial nephritis

PMID (1):

26752337

MeSH

proton pump inhibitors

nephritis, interstitial

renal insufficiency, chronic

Glomerular Filtration Rate

PPIs appear to be associated with both acute (interstitial nephritis) and chronic kidney problems. While this is an epidemiological study, proving association not causation, it may be the best evidence we will be able to get.

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Context

Proton pump inhibitors (PPIs) are among the most commonly used drugs worldwide, and have been linked to acute interstitial nephritis. Less is known about the relationship between PPI use and chronic kidney disease (CKD).

Objective

To quantify the association between PPI use and incident CKD in a population-based cohort.

Design, Setting and Participants

10,482 participants in the Atherosclerosis Risk in Communities (ARIC) study with an estimated glomerular filtration rate (eGFR) of ≥60mL/min/1.73m2 were followed from a baseline visit (1996–1999) to December 31, 2011. Findings were replicated in an administrative cohort of 248,751 patients with eGFR ≥60mL/min/1.73m2 from Geisinger Health System.

Exposure

Self-reported PPI use in ARIC, or an outpatient PPI prescription in the replication cohort. Histamine-2 receptor (H2) antagonist use was considered a negative control and active comparator.

Main Outcome Measure

Incident CKD, using diagnostic codes indicating CKD at hospital discharge or death. In the replication cohort, incident CKD was defined by outpatient eGFR <60 mL/min/1.73 m2.

Results

Compared to non-users, PPI-users were more often white, obese, and taking antihypertensive medication. In ARIC, PPI use was associated with incident CKD in unadjusted analysis (hazard ratio [HR], 1.45; 95% confidence interval [CI], 1.11–1.90), analysis adjusted for demographic, socioeconomic, and clinical parameters (HR, 1.50; 95% CI, 1.14–1.96), and in analysis with PPI ever-use modeled as a time-varying variable (adjusted HR, 1.35; 95% CI, 1.17–1.55). The association persisted when baseline PPI users were compared directly to H2-antagonist users (adjusted HR, 1.39; 95% CI, 1.01–1.91), and to propensity-score matched non-users (HR, 1.76; 95% CI, 1.13–2.74). In the replication cohort, PPI use was associated with CKD in all analyses, including a time-varying new user design (adjusted HR 1.24; 95% CI, 1.20–1.28). Twice-daily PPI dosing was associated with a higher risk (adjusted HR, 1.46; 95% CI, 1.28–1.67) than once-daily dosing (adjusted HR, 1.15; 95% CI, 1.09–1.21).

Conclusions

PPI use is associated with a 20%–50% higher risk of incident CKD. Future research should evaluate whether limiting PPI use reduces the incidence of CKD.

Author/s:

Lazarus, Benjamin, Chen, Yuan, Wilson, Francis P., Sang, Yingying, Chang, Alex R., Coresh, Josef, Grams, Morgan E.