Evolution of the stage of chronic kidney disease from the diagnosis of hypertension in primary care

Smartphone-based rapid quantitative detection of serum creatinine: Performance validation and exploration of potential application in chronic kidney disease monitoring

Chronic kidney disease is a progressive condition, and serum creatinine (CR) levels are closely associated with the glomerular filtration rate, serving as a key indicator of renal function and disease progression. This study aimed to develop a smartphone-based colorimetric analysis system for the efficient and rapid quantification of serum CR and validate its performance to determine whether the method meets clinical testing standards. The CR standard solution was analyzed using a smartphone, and the R, G, and B values were plotted against the concentration. The precision, accuracy, detection limit, linear range, and clinically reportable range of the smartphone detection system were evaluated according to the National Committee for Clinical Laboratory Standards guidelines. Subsequently, 65 serum samples from healthy individuals and 26 serum samples from nephropathy patients were collected and tested using the smartphone system and an automated biochemical analyzer, respectively, to further validate the feasibility of the method. Among all the color channels, the G value showed the strongest correlation with CR concentration, and therefore was used to establish the standard curve. The validation of the assay system demonstrated that its precision and accuracy met clinical standards. The limit of blank, limit of detection, and limit of quantification were 29.95 μmol/L, 32.39 μmol/L, and 36.61 μmol/L, respectively. The linear range was 36.75 to 200.46 μmol/L, whereas the clinical reporting range spanned from 36.61 to 801.84 μmol/L. Furthermore, the results obtained from the 2 methods were statistically analyzed, revealing a strong correlation between the 2 sets of data. Smartphone-based serum CR testing meets clinical standards, and its portability and efficiency position it as a valuable tool for screening and monitoring chronic kidney disease.

Diet Supplementation with Ketoanalogues, Inulin, and Calcium Citrate in Chronic Kidney Disease: A Retrospective Cohort

The addition of ketoanalogues (KAs) to a low-protein diet has been shown to mitigate the progression of pre-dialysis chronic kidney disease (CKD). The addition of inulin and calcium citrate may add further benefits, given their nephroprotective effects. In this study, we tested the changes in estimated glomerular filtration rate (eGFR), CKD symptoms, body composition, and biochemical parameters after 6 months of diet supplementation with Cetolán III, a combination of KA, inulin, and calcium citrate. We included 76 adult patients diagnosed with CKD stages 3 and 4 and not treated with renal replacement therapy in a retrospective cohort. In this cohort, participants were followed through two clinic visits at 3 and 6 months after diet supplementation. We found a slight increase in eGFR at 3 and 6 months compared with baseline, as well as a decrease in the severity of CDK-related symptoms, fat mass, and muscle mass. We observed only a slight decrease in creatinine and uric acid after 6 months of follow-up. We did not find a remarkable change in anthropometric parameters (e.g., body mass index, waist circumference, and arm muscle area). This observational study suggests that addition of KA, inulin, and calcium citrate to a low protein- diet could be associated with an improvement in eGFR and symptom severity in CKD pre-dialysis.

Factors Associated with the Development of Chronic Kidney Disease in Patients with Arterial Hypertension

Introduction

Chronic kidney disease affects a large part of the population with hypertension, diabetes mellitus as well as those over 50 years of age. Research reported that male sex and other comorbidities such as obesity and anemia are more frequent in Chronic kidney disease, as well as uncontrolled diabetes mellitus or hypertension.

Objective

To determine the risk factors associated with the development of chronic kidney disease in adults with arterial hypertension.

Material and Methods

Retrospective cohort study of 455 patients with hypertension treated in a primary health care hospital. Medical records and laboratory information were reviewed for the diagnosis of chronic kidney disease and its staging. Patients aged 40 years and older, of both sexes and evaluated between the years 2015 -2017 were included. Logistic regression analysis allowed the identification of risk factors associated with the development of chronic kidney disease.

Results

63.7% were female and 36.3% male. The average age for 2015 was 69.79 ± 9.03, more than half of participants had diabetes mellitus and controlled hypertension and the predominant nephroprotection was with Losartan (53%) that year. Male sex (OR 1.68, CI 1.03-2,76), age: 60 years or older (OR 6.38, CI 2.65-15,37) and anemia (OR 1.71, CI 1.03-2,85), were risk factors for the development of chronic kidney disease (p < 0.05), whereas nephroprotection (OR 0.39, CI 0.18-0,88) and controlled diabetes mellitus (OR: 0.18, CI 0.07-0,47) were shown to be protective factors (p < 0.05). The prevalence of chronic kidney disease between 2015 and 2017 was 19% and 45%, respectively, with predominance of category G2. The comparison group is the same cohort analyzed in each year under study.

Conclusion

Male sex, age over 60 years, and anemia are risk factors for chronic kidney disease. Nephroprotection, controlled diabetes mellitus, and patient follow-up are factors that prevent its development.

Performance indicators of Primary Care of the Previne Brasil Program

OBJECTIVE

to analyze the scope of the performance indicators of the Previne Brasil Program of Primary Health Care.

METHOD

an observational, descriptive study with a quantitative approach was carried out using secondary data, referring to the years 2020 and 2021, in the five Brazilian regions (North, Northeast, South, Southeast and Midwest), available in the Primary Health Care Information System. Descriptive statistics, relative frequencies and measures of central tendency and semiparametric modeling were used considering a 5% confidence interval.

RESULTS

there was evidence of evolution in the rates of performance indicators in most Brazilian regions in 2021, compared to 2020, however, the North and Midwest regions had incipient or negative rates, compared to the Southeast region. Despite the evolution in the rates of the indicators, few States managed to reach the goals established by the Ministry of Health for the strategic actions of prenatal care and women's health; and no state achieved the goal in strategic action on chronic diseases.

CONCLUSION

it is considered important to monitor the evolution of current indicators, envisioning their qualification so that they can evaluate primary health care and assistance, as well as guarantee the achievement of goals by ensuring funding for primary care actions.