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Francis A, Harhay MN, Ong ACM, Tummalapalli SL, Ortiz A, Fogo AB, Fliser D, Roy-Chaudhury P, Fontana M, Nangaku M, Wanner C, Malik C, Hradsky A, Adu D, Bavanandan S, Cusumano A, Sola L, Ulasi I, Jha V. Chronic kidney disease and the global public health agenda: an international consensus. Nat Rev Nephrol 2024; 20:473-485. [PMID: 38570631 DOI: 10.1038/s41581-024-00820-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2024] [Indexed: 04/05/2024]
Abstract
Early detection is a key strategy to prevent kidney disease, its progression and related complications, but numerous studies show that awareness of kidney disease at the population level is low. Therefore, increasing knowledge and implementing sustainable solutions for early detection of kidney disease are public health priorities. Economic and epidemiological data underscore why kidney disease should be placed on the global public health agenda - kidney disease prevalence is increasing globally and it is now the seventh leading risk factor for mortality worldwide. Moreover, demographic trends, the obesity epidemic and the sequelae of climate change are all likely to increase kidney disease prevalence further, with serious implications for survival, quality of life and health care spending worldwide. Importantly, the burden of kidney disease is highest among historically disadvantaged populations that often have limited access to optimal kidney disease therapies, which greatly contributes to current socioeconomic disparities in health outcomes. This joint statement from the International Society of Nephrology, European Renal Association and American Society of Nephrology, supported by three other regional nephrology societies, advocates for the inclusion of kidney disease in the current WHO statement on major non-communicable disease drivers of premature mortality.
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Affiliation(s)
- Anna Francis
- Department of Nephrology, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Meera N Harhay
- Department of Medicine, Drexel University College of Medicine, Philadelphia, PA, USA
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA
| | - Albert C M Ong
- Academic Nephrology Unit, Division of Clinical Medicine, School of Medicine and Population Health, University of Sheffield, Sheffield, UK
| | - Sri Lekha Tummalapalli
- Division of Healthcare Delivery Science & Innovation, Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
- Division of Nephrology & Hypertension, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Alberto Ortiz
- IIS-Fundacion Jimenez Diaz UAM, RICORS2040, Madrid, Spain
| | - Agnes B Fogo
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Danilo Fliser
- Department of Internal Medicine IV, Renal and Hypertensive Disease & Transplant Centre, Saarland University Medical Centre, Homburg, Germany
| | - Prabir Roy-Chaudhury
- Department of Medicine, Division of Nephrology and Hypertension, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | | | - Masaomi Nangaku
- Division of Nephrology and Endocrinology, Department of Hemodialysis and Apheresis, The University of Tokyo Hospital, Tokyo, Japan
| | - Christoph Wanner
- Department of Clinical Research and Epidemiology, Renal Research Unit, University Hospital of Würzburg, Würzburg, Germany
| | - Charu Malik
- International Society of Nephrology, Brussels, Belgium
| | - Anne Hradsky
- International Society of Nephrology, Brussels, Belgium
| | - Dwomoa Adu
- Department of Medicine and Therapeutics, University of Ghana Medical School, Accra, Ghana
| | - Sunita Bavanandan
- Department of Nephrology, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia
| | - Ana Cusumano
- Instituto de Nefrologia Pergamino, Pergamino City, Argentina
| | - Laura Sola
- Centro de Hemodiálisis Crónica CASMU-IAMPP, Montevideo, Uruguay
| | - Ifeoma Ulasi
- Renal Unit, Department of Medicine, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Enugu State, Nigeria
| | - Vivekanand Jha
- George Institute for Global Health, University of New South Wales, New Delhi, India.
- School of Public Health, Imperial College, London, UK.
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India.
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Alcalde-Ortiz ML, Jaramillo-Arriaga F, Ibarra-Orenday D, González-Domínguez SI, Calzada-Gallegos HD, Pinales-Jiménez AA, Carrillo-Aguilera IA, Flota-Marin DA, Collazo-Zamores MG, Aguirre-Moreno PD, Gutiérrez-Hernández SD, Del Toro-Delgado V, Delgadillo-Castañeda R, Sánchez-Ortiz MDR, Sánchez-González I, Ramos-Medellin CL, Chew-Wong A, Macias-Díaz DM, Arreola-Guerra JM. Pediatric kidney dimensions and risk of persistent albuminuria in Mexican adolescents. Kidney Int 2024; 105:824-834. [PMID: 38280517 DOI: 10.1016/j.kint.2023.11.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 11/11/2023] [Accepted: 11/17/2023] [Indexed: 01/29/2024]
Abstract
In Mexico, chronic kidney disease of unknown origin is highly prevalent. Screening studies in adolescents have shown persistent microalbuminuria (pACR), adaptive podocytopathy and decreased kidney volume (KV). Here, we sought to develop normality tables of kidney dimensions by ultrasound in the Mexican state of Aguascalientes pediatric population (0 to 18y) and evaluate the relationship between the KV and pACR among the region's adolescents in a cross-sectional study. Kidney length (KL) and KV were determined by ultrasound. Our findings were compared with those in international literature of different populations where tables and graphs of normal kidney dimensions by ultrasound were reported. We compared organ dimensions in individuals above the age of 11 without albuminuria with those in patients with pACR recruited through screening studies in adolescents in Aguascalientes. This included 1068 individuals to construct percentile tables and graphs of the KL. Kidney dimensions were significantly lower when compared with all international comparisons. From a total 14,805 screen individuals, we compared 218 adolescents with pACR and 377 individuals without significant albuminuria. The Total KV adjusted to body surface (TKVBS) was significantly associated with pACR (odds ratio 1.03, 95% confidence interval 1.02-1.03). The upper quartile of TKVBS was highly associated with pACR (7.57, 4.13-13.87), hypertension (2.53, 1.66-3.86), and hyperfiltration (26 vs 11.5%). Thus, TKVBS is directly associated with pACR while greater KV, arterial hypertension, and hyperfiltration in patients with pACR suggest that the increase in volume is secondary to kidney hypertrophy. Additionally, the adaptative podocytopathy with low fibrosis seen on kidney biopsy which was performed in a subset of patients, and the smaller kidney dimensions in our population point to prenatal oligonephronia as the primary cause of the detected kidney disease.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Alfredo Chew-Wong
- Department of Nephrology, Hospital Centenario Miguel Hidalgo, Aguascalientes, Mexico
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Wang LS, Vangaveti V, Ng MSY, Mallett AJ. Characteristics and clinical outcomes of patients with kidney failure of unknown aetiology from ANZDATA registry. PLoS One 2024; 19:e0300259. [PMID: 38466666 PMCID: PMC10927112 DOI: 10.1371/journal.pone.0300259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 02/23/2024] [Indexed: 03/13/2024] Open
Abstract
INTRODUCTION Kidney failure of unknown aetiology (uESKD) is also heavily location dependent varying between 27% in Egypt to 54% in Aguacalientes, Mexico. There is limited information about the characteristics of people with uESKD in Australia and New Zealand, as well as their clinical outcomes on kidney replacement therapy. METHODS Data on people commencing kidney replacement therapy 1989-2021 were received from the Australia and New Zealand Dialysis and Transplant (ANZDATA) registry. Primary exposure was cause of kidney failure-uESKD or non-uESKD (known-ESKD). Primary outcome was mortality. Secondary outcome was kidney transplantation. Dialysis and transplant cohorts were analysed separately. Cox Proportional Hazards Regression models were used to evaluate correlations between cause of kidney failure and mortality risk. Subgroup analyses were completed to compare mortality risk in people with uESKD to those with diabetic nephropathy, autosomal dominant polycystic kidney disease (ADPKD), glomerular disease and other kidney diseases. RESULTS This study included 60,448 people on dialysis and 20,859 transplant recipients. 1-year, 3-year and 5-year mortality rates in people with uESKD on dialysis were 31.6%, 58.7% and 77.2%, respectively. 1-year, 3-year and 5-year mortality rates in transplant recipients with uESKD were 2.8%, 13.8% and 24.0%, respectively. People with uESKD on dialysis had a higher mortality risk compared to those without uESKD on univariable and multivariable analyses (adjusted hazard ratio [AHR] 1.10, 95% CI 1.06-1.16, p<0.001). Transplant recipients with uESKD have a higher mortality risk compared to those without uESKD on univariable and multivariable analyses (AHR 1.17, 95% CI 1.01-1.35, p<0.05). People with uESKD had similar likelihood of kidney transplantation compared to people with known-ESKD. CONCLUSION People with uESKD on kidney replacement therapy have higher mortality risk compared to people with other kidney diseases. Further studies are required to identify contributing factors to these findings.
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Affiliation(s)
- Lucy S. Wang
- Kidney Health Service, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
| | - Venkat Vangaveti
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
- Townsville Institute of Health Research and Innovation, Townsville University Hospital, Douglas, Queensland, Australia
| | - Monica S. Y. Ng
- Kidney Health Service, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
- Conjoint Internal Medicine Laboratory, Chemical Pathology, Pathology Queensland, Brisbane, Queensland, Australia
| | - Andrew J. Mallett
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
- Townsville Institute of Health Research and Innovation, Townsville University Hospital, Douglas, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
- Institute for Molecular Biosciences, University of Queensland, Brisbane, Queensland, Australia
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Roncal-Jimenez CA, Rogers KL, Stem A, Wijkstrom J, Wernerson A, Fox J, Garcia Trabanino R, Brindley S, Garcia G, Miyazaki M, Miyazaki-Anzai S, Sasai F, Urra M, Cara-Fuentes G, Sánchez-Lozada LG, Rodriguez-Iturbe B, Butler Dawson J, Madero M, Brown JM, Johnson RJ. Intranasal Administration of Sugarcane Ash Causes Chronic Kidney Disease in Rats. Am J Physiol Renal Physiol 2024; 326:F477-F484. [PMID: 38234297 PMCID: PMC11207544 DOI: 10.1152/ajprenal.00251.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 12/15/2023] [Accepted: 12/31/2023] [Indexed: 01/19/2024] Open
Abstract
Background. Silica nanoparticles found in sugarcane ash have been postulated to be a toxicant contributing to chronic kidney disease of unknown etiology (CKDu). However, while the administration of manufactured silica nanoparticles is known to cause chronic tubulointerstitial disease in rats, the effect of administering sugarcane ash on kidney pathology remains unknown. Here we investigate whether sugarcane ash can induce CKD in rats. Methods. Sugarcane ash was administered for 13 weeks into the nares of rats (5 mg/day for 5d/week), and blood, urine and kidney tissues were collected at 13 weeks (at the end of ash administration) and in a separate group of rats at 24 weeks (11 weeks after stopping ash administration). Kidney histology was evaluated, and inflammation and fibrosis (collagen deposition) measured. Results. Sugarcane ash exposure led to the accumulation of silica in the kidneys, lungs, liver and spleen of rats. Mild proteinuria developed although renal function was largely maintained. However, biopsies showed focal glomeruli with segmental glomerulosclerosis, and tubulointerstitial inflammation and fibrosis that tended to worsen even after the ash administration had been stopped. Staining for the lysosomal marker, LAMP-1, showed decreased staining in ash administered rats consistent with lysosomal activation. Conclusion. Sugarcane ash containing silica nanoparticles can cause CKD in rats.
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Affiliation(s)
- Carlos A Roncal-Jimenez
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
| | - Keegan L Rogers
- Department of Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Arthur Stem
- Department of Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, Adams County, United States
| | - Julia Wijkstrom
- CLINTEC, Division of renal medicine, Karolinska Institute, Stockholm, Sweden
| | - Annika Wernerson
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institute, Stockholm, Sweden
| | - Jacob Fox
- Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | | | - Stephen Brindley
- Toxicology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Gabriela Garcia
- Medicine-Nephrology, University of Colorado Anschutz Medical Campus, Aurora, United States
| | - Makoto Miyazaki
- Division of Renal Diseases and Hypertension, University of Colorado Denver, Auroa, United States
| | - Shinobu Miyazaki-Anzai
- Division of Renal Diseases and Hypertension, University of Colorado Denver, Aurora, CO, United States
| | - Fumihiko Sasai
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
| | - Manuel Urra
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Gabriel Cara-Fuentes
- Medicine-Nephrology, University of Colorado Anschutz Medical Campus, Aurora, United States
| | - L Gabriela Sánchez-Lozada
- Department of Cardio-Renal Physiopathology, Instituto Nacional de CardiologÃ-a, Mexico City, D.F., Mexico
| | - Bernardo Rodriguez-Iturbe
- Nefrología y MetaboismoMineral, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Ciudad de Mexico, Mexico
| | - Jaime Butler Dawson
- Center for Work, Health, and Environment, University of Colorado Anschutz Medical Campus, Aurora, United States
| | - Magdalena Madero
- Division of Nephrology, Instituto Nacional de Cardiologia Ignacio Chávez, Mexico City, Mexico
| | - Jared M Brown
- Department of Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, United States
| | - Richard J Johnson
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
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Alhazmi AI, Alghamdi AHA, Alzahrani KAM, Alzahrani RAAB, Al Ghamdı IAI, Alzahrani MKB. Leading Causes of Chronic Kidney Disease Among Dialysis Patients in Al-Baha Region, Saudi Arabia. Cureus 2023; 15:e49439. [PMID: 38149161 PMCID: PMC10750843 DOI: 10.7759/cureus.49439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2023] [Indexed: 12/28/2023] Open
Abstract
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.
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Affiliation(s)
- Areej I Alhazmi
- Internal Medicine/Nephrology, Faculty of Medicine, Al-Baha University, Al Baha, SAU
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Cisneros-García DL, Sandoval-Pinto E, Cremades R, Ramírez-de-Arellano A, García-Gutiérrez M, Martínez-de-Pinillos-Valverde R, Sierra-Díaz E. Non-traditional risk factors of progression of chronic kidney disease in adult population: a scoping review. Front Med (Lausanne) 2023; 10:1193984. [PMID: 37332753 PMCID: PMC10272583 DOI: 10.3389/fmed.2023.1193984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 05/16/2023] [Indexed: 06/20/2023] Open
Abstract
Chronic kidney disease (CKD) has become a public health concern over the last several years. Nowadays developed countries spend around 3% of their annual health-care budget on patients with CKD. According to the scientific community the most remarkable risk factors for CKD are diabetes and hypertension. Unknown CKD etiology has been reported as a global phenomenon including uncommon risk factors such as: dehydration, leptospirosis, heat stress, water quality, and others. This study aims to report non-traditional risk factors for ESRD based on a scoping review methodology. The scoping review methodology described by Arksey and O'Malley was used by performing an extensive review of the information. A total of 46 manuscripts were reviewed. The non-traditional ESRD risk factors are depicted based on six categories. Gender and ethnicity have been considered as risk factors for ESRD. Erythematous systemic lupus (ESL) is reported as an important risk factor for ESRD. Pesticide use has been an significant risk factor due to its effects on human and environmental health. Some compounds commonly used in homes against insects and plants are related to ESRD. Congenital and hereditary diseases in the urinary tract have been studied as a cause of ESRD in children and young adults. End-stage renal disease is a major concern for public health on a global level. As it can be seen, non-traditional risk factors are several and have different etiologies. It is necessary to put the issue on the table and add it to the public agenda in order to find multidisciplinary solutions.
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Affiliation(s)
- Diana Lorena Cisneros-García
- Departamento de Salud Pública, Centro Universitario en Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico
| | - Elena Sandoval-Pinto
- Departamento de Biología Celular y Molecular, Centro Universitario de Ciencias Biológico Agropecuarias, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico
| | - Rosa Cremades
- Departamento de Microbiología y Parasitología, Centro Universitario en Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico
| | - Adrián Ramírez-de-Arellano
- Instituto de Investigación en Ciencias Biomédicas, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico
| | - Mariana García-Gutiérrez
- Centro Metropolitano de Atención de la Diabetes Tipo 1, Secretaría de Salud Jalisco, Guadalajara, Jalisco, Mexico
| | | | - Erick Sierra-Díaz
- Departamentos de Clínicas Quirúrgicas y Salud Pública, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico
- División de Epidemiología, UMAE Hospital de Especialidades Centro Médico Nacional de Occidente del IMSS, Guadalajara, Mexico
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Antonio MEE, Cassandra BGC, Emiliano RJD, Guadalupe OLM, Lilian REA, Teresa TGM, Mario GG, Ivan RCG, Mercedes RV, Alfredo CW, Rafael RA, Lilian GBA, Manuel AGJ. Treatment of asymptomatic bacteriuria in the first 2 months after kidney transplant: A controlled clinical trial. Transpl Infect Dis 2022; 24:e13934. [PMID: 35980169 DOI: 10.1111/tid.13934] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 08/07/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND The incidence of urinary tract infections (UTIs) in the first 2 months postrenal transplantation (pRT) is very high. We evaluate the efficacy of asymptomatic bacteriuria (AB) screening and treatment on the incidence of UTI in the first 2 months pRT METHODS: We conducted a randomized controlled clinical trial. A urine culture was obtained in all patients on the day of the bladder catheter removal, on week three, and before removal of the ureteral catheter. The intervention group received treatment for AB. The control group did not receive treatment. The primary outcomes were the cumulative incidence of UTI and/or graft pyelonephritis and the time to the first episode of UTI and/or graft pyelonephritis RESULTS: Eighty patients were randomized, 40 in each group, and the median follow-up was 63 days (IQR 54-70). The average age was 29.8 years and 33.7% (n = 27) were women. The incidences of UTI (n = 10, 25 % vs. n = 4, 10%, p = .07) and pyelonephritis (n = 6, 15% vs. n = 1, 2.5%, p = .04) were greater in the intervention group, as also shown in the survival analysis: UTI (HR2.8, 95% CI 0.8-9.1, p = .07) and pyelonephritis (HR 6.5, 95% CI 0.8-54.7, p = .08), respectively. The most commonly isolated bacterium was Escherichia coli (n = 28, 59.5%), and over half were E. coli with extended-spectrum beta-lactamases (n = 15). A major limitation was not obtaining the calculated sample size due to a delay in patient recruitment resulting from the COVID-19 pandemic CONCLUSION: Treatment of AB in the first 2 months pRT does not decrease the incidence of UTI or graft pyelonephritis and may actually increase their frequency. Routine treatment of AB during the first months after renal transplantation should not be a standard procedure.
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Affiliation(s)
| | | | | | | | | | | | - Gonzalez Gamez Mario
- Department of Internal Medicine, Hospital Centenario Miguel Hidalgo, Aguascalientes, Mexico
| | | | | | - Chew Wong Alfredo
- Department of Nephrology, Hospital Centenario Miguel Hidalgo, Aguascalientes, Mexico
| | - Reyes Acevedo Rafael
- Department of Transplantation, Hospital Centenario Miguel Hidalgo, Aguascalientes, Mexico
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Aoun M, Chelala D. Where do you live and what do you do? Two questions that might impact your kidney health. FRONTIERS IN NEPHROLOGY 2022; 2:1011964. [PMID: 37675017 PMCID: PMC10479685 DOI: 10.3389/fneph.2022.1011964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 09/13/2022] [Indexed: 09/08/2023]
Abstract
In many cases the social determinants of health need to be assessed through their interaction with environmental factors. This review looks at the impact of physical location and occupation of individuals on their kidney health. It examines the effect of living at high altitude on kidney function and the relationship between extreme cold or hot temperatures and the incidence of kidney injury. It reviews as well the many occupations that have been linked to kidney disease in high-income and low-and-middle-income countries. As a conclusion, this overview proposes preventive recommendations that could be individualized based on weather, altitude, socio-economic level of the country and occupation of the individual.
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Affiliation(s)
- Mabel Aoun
- Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
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9
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Ortiz A. Benchmarking CKD: incidence of CKD in a European country with low prevalence of CKD and kidney replacement therapy. Clin Kidney J 2022; 15:1221-1225. [PMID: 35756737 PMCID: PMC9217648 DOI: 10.1093/ckj/sfac074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Indexed: 12/03/2022] Open
Abstract
Iceland was one of six European countries with an adjusted incidence of kidney replacement therapy (KRT) in 2018 lower than 100 per million persons (pmp), along with Estonia, Montenegro, Russia, Serbia and Finland. It was also one of 10 countries with an adjusted KRT prevalence <900 pmp. Furthermore, the prevalence of chronic kidney disease (CKD) in Iceland is up to 2.44-fold lower and the death rate from CKD up to 3.44-fold lower than in other countries with a low incidence of KRT, suggesting that the low KRT incidence actually reflects a low need for KRT rather than low uptake or availability of KRT. This identifies Iceland as a benchmark for countries trying to reduce KRT incidence. Iceland also represents one of the best genetically characterized populations in the world, facilitating studies on the influence of the genetic background versus environment and lifestyle on CKD. This issue of CKJ reports the incidence and risk factors for CKD in Icelandic adults. Diabetes, acute kidney injury, hypertension, cardiovascular disease, chronic lung disease, malignancy and major psychiatric illness were associated with an increased risk of incident CKD, as were obesity and sleep apnea in women. However, in 75% of incident CKD cases, CKD was first detected in category G3 or higher, emphasizing the need for new tools that allow an earlier diagnosis of CKD that precedes the loss of >50% of the functioning kidney mass and/or wider use of albuminuria as a screening tool. The European Society of Cardiology just recommended assessing albuminuria for routine cardiovascular risk workups for all.
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Affiliation(s)
- Alberto Ortiz
- IIS-Fundacion Jimenez Diaz UAM,
Madrid, Spain
- RICORS2040, Madrid, Spain
- Department of Medicine, School of Medicine, Universidad Autonoma de
Madrid, Madrid, Spain
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10
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Villalvazo P, Carriazo S, Martin-Cleary C, Sanchez-Niño MD, Ortiz A. Solving the riddle of Aguascalientes nephropathy: nephron number, environmental toxins and family clustering. Clin Kidney J 2022; 15:1226-1230. [PMID: 35756744 PMCID: PMC9217524 DOI: 10.1093/ckj/sfac042] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Indexed: 11/20/2022] Open
Abstract
Aguascalientes, Mexico, has a high incidence and prevalence of advanced chronic kidney disease (CKD). CKD is especially frequent in young people ages 20-40 years in whom the cause of CKD was unknown, although kidney biopsies frequently showed focal segmental glomerulosclerosis (FSGS) and glomerulomegaly. Macias-Diaz et al. have now pursued this lead by screening teenagers in Calvillo, one of the hardest hit municipalities. They uncovered clinical, laboratory, kidney biopsy and exposure findings that define a new entity, Aguascalientes nephropathy, and are consistent with familial exposure to common environmental toxins, potentially consisting of pesticides. They hypothesize that prenatal exposure to these toxins may decrease nephron number. The young age of persons with FSGS would be consistent with a novel environmental toxin introduced more than 50 years ago but not present in the environment before. Key takeaways from this research are the need to screen teenagers for albuminuria, to provide kidney-protective strategies to patients identified as having CKD and for the research community to support Aguascalientes nephrologists and health authorities to unravel the cause and potential solutions for this CKD hotspot. In this regard, the screening approach and the cohort generated by Macias-Diaz et al. represent a giant step forward. The next steps should be to screen younger children for albuminuria and kidney size and to identify the putative toxins.
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Affiliation(s)
| | - Sol Carriazo
- IIS-Fundacion Jimenez Diaz UAM, Madrid, Spain
- RICORS2040, Madrid, Spain
- Department of Medicine, School of Medicine, Universidad Autonoma de Madrid, Madrid, Spain
| | - Catalina Martin-Cleary
- IIS-Fundacion Jimenez Diaz UAM, Madrid, Spain
- RICORS2040, Madrid, Spain
- Department of Medicine, School of Medicine, Universidad Autonoma de Madrid, Madrid, Spain
| | - Maria Dolores Sanchez-Niño
- IIS-Fundacion Jimenez Diaz UAM, Madrid, Spain
- RICORS2040, Madrid, Spain
- Department of Pharmacology, School of Medicine, Universidad Autonoma de Madrid, Madrid, Spain
| | - Alberto Ortiz
- IIS-Fundacion Jimenez Diaz UAM, Madrid, Spain
- RICORS2040, Madrid, Spain
- Department of Medicine, School of Medicine, Universidad Autonoma de Madrid, Madrid, Spain
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11
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Diaz DMM, Aguirre MDCC, Escalera ALR, Gutiérrez MTT, Robles IO, Guzmán MJM, Díaz ALG, Peña MCG, Alvarado-Nájera AN, Domínguez IG, Villavicencio-Bautista JC, Rodríguez AAH, Marín-García R, González FJA, Wong AC, Guerra EG, Castañeda RD, Aguilar CAP, Zúñiga-Macías LP, Guerra JMA. Histologic characterization and risk factors for persistent albuminuria in adolescents in a region of highly prevalent end-stage renal failure of unknown origin. Clin Kidney J 2022; 15:1300-1311. [PMID: 35756733 PMCID: PMC9217647 DOI: 10.1093/ckj/sfac018] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
End-stage renal failure of unknown origin (ESRD-UO) is a public health problem in Mexico and many regions of the world. The prevalence of ESRD-UO in Aguascalientes Mexico is one of the highest worldwide, particularly in adults between 20 and 40 years of age.
Aim
To screen adolescents for chronic kidney disease (CKD), identify risk factors, and histologically characterize adolescents with persistent albuminuria (pACR).
Methodology
This is a cross-sectional, observational, and comparative study of adolescents in whom serum creatinine and the albumin creatinine ratio (ACR) were determined when screening for CKD. A clinical evaluation and risk factor survey were conducted. Patients with an abnormal ACR (≥ 30 mg/gr) or a low glomerular filtration rate (GFR) (≤75 ml/min/1.73 m2) were reevaluated and a renal ultrasound was obtained (rUS). A kidney biopsy was performed in patients with pACR.
Results
Five-hundred and thirteen (513) students were included, 19 had pACR and 494 were controls. The prevalence of pACR was 3.7% (95%CI 2.1 – 5.3). Only one patient had a decreased GRF. None of the patients with pACR had anatomical abnormalities of the urinary tract by rUS. Patients with pACR had a decreased total renal volume in comparison with the control group (150 vs 195 ml/m2, p <0.01). Eighteen (18) kidney biopsies were performed, 72% had glomerulomegaly, and only one patient had mild fibrosis. Podocyte abnormalities were evident on electron microscopy: partial fusion (100%), microvillous degeneration (80%), and increased organelles (60%). Risk factors for pACR were: homestead proximity to maize crops, the use of pesticides at the father´s workplace, a family history of CKD, and blood pressure abnormalities. The body mass index and breastfeeding were protective factors.
Conclusions
The prevalence of pACR in adolescents in Aguascalientes is high, and histologic compromise is characterized by podocyte injury in the absence of fibrosis. The renal volume of pACR patients was decreased, suggesting oligonephronia. Exposure to environmental toxins such as pesticides, even prenatally, may be responsible for this pathological entity. Screening programs in adolescents by determining ACR are necessary in our milieu.
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Affiliation(s)
| | - Myriam del Carmen Corrales Aguirre
- Department of Nephrology, Hospital Centenario Miguel Hidalgo, Mexico
- Department of Pediatrics, Hospital Centenario Miguel Hidalgo, Mexico
| | | | | | | | | | | | | | | | | | | | | | | | | | - Alfredo Chew Wong
- Department of Nephrology, Hospital Centenario Miguel Hidalgo, Mexico
| | | | - Rodolfo Delgadillo Castañeda
- Department of Nephrology, Hospital Centenario Miguel Hidalgo, Mexico
- Department of Pediatrics, Hospital Centenario Miguel Hidalgo, Mexico
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12
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Abou-Bakr A, Hussein RR, Khalil E, Ahmed E. The frequency of periodontitis in end-stage renal disease on hemodialysis in a sample of Egyptian population: multi-center clinical cross-sectional study. BMC Oral Health 2022; 22:1. [PMID: 34980089 PMCID: PMC8725326 DOI: 10.1186/s12903-021-02032-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 12/22/2021] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND There is a general assumption that periodontal disease is highly prevalent among patients with chronic renal failure undergoing hemodialysis. The aim of the study to estimate the frequency of periodontitis in patients on hemodialysis among a sample of the Egyptian population, as well as the correlation between different clinical parameters of periodontal status with serum creatinine and blood urea. This may rule out the bidirectional relationship between periodontitis and renal failure in patients on hemodialysis. METHODS The study was conducted on 263 hemodialysis patients (165 males and 98 females) at three dialysis centers in Benha Governorate, Egypt (Benha Hospital, Tukh hospital, Qalyub hospital). Periodontal parameters including plaque index (PI), gingival index (GI), clinical attachment level (CAL), and probing pocket depth (PPD) had been recorded in these patients. Serum urea and creatinine levels had been measured, the data had been collected and undergone statistical analysis. RESULTS Frequency of periodontitis was 85.6% with stage III is the most prevalent stage. There was a significant positive strong correlation between age and periodontitis stage (rs = 0.707, p < 0.001). There was a positive correlation between clinical parameters and serum creatinine level. CONCLUSION In the present study, a high frequency of periodontitis had been found among ESRD patients on hemodialysis in the severe form (stage III) periodontitis. There was a significant direct correlation between the severity of periodontitis and CAL with a duration of hemodialysis. There was a weak insignificant association between periodontal indices (PD, BOP, and plaque score) and duration of hemodialysis.
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Affiliation(s)
- Asmaa Abou-Bakr
- Oral Medicine and Periodontology, Faculty of Dentistry, The British University in Egypt, El Sherouk City, Egypt
| | - Radwa R. Hussein
- Oral Medicine and Periodontology, Faculty of Dentistry, Ain Shams University, Cairo, Egypt
| | - Eman Khalil
- Oral Medicine and Periodontology, Faculty of Dentistry, The British University in Egypt, El Sherouk City, Egypt
| | - Enji Ahmed
- Oral Medicine and Periodontology, Faculty of Dentistry, Cairo University, Giza, Egypt
- Oral Medicine and Periodontology, Faculty of Dentistry, The British University in Egypt, El Sherouk City, Egypt
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13
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Villalvazo P, Carriazo S, Martin-Cleary C, Ortiz A. Aguascalientes: one of the hottest chronic kidney disease (CKD) hotspots in Mexico and a CKD of unknown aetiology mystery to be solved. Clin Kidney J 2021; 14:2285-2294. [PMID: 34754425 PMCID: PMC8573004 DOI: 10.1093/ckj/sfab136] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 07/06/2021] [Indexed: 01/05/2023] Open
Abstract
In a recent issue of Clinical Kidney Journal (CKJ), Gutierrez-Peña et al. reported a high incidence and prevalence of advanced chronic kidney disease (CKD) in Aguascalientes, Mexico. This contradicts Global Burden of Disease estimates, which should be updated. A key component of this high burden of CKD relates to young people ages 20-40 years in whom the cause of CKD was unknown [CKD of unknown aetiology (CKDu)]. The incidence of kidney replacement therapy in this age group in Aguascalientes is among the highest in the world, second only to Taiwan. However, high-altitude Aguascalientes, with a year-round average temperature of 19°C, does not fit the geography of other CKDu hotspots. Furthermore, kidney biopsies in young people showed a high prevalence of focal segmental glomerulosclerosis. Potential causes of CKDu in Aguascalientes include the genetic background (no evidence, although podocytopathy genes should be explored) and environmental factors. The highest prevalence of CKD was found in Calvillo, known for guava farming. Thus guava itself, known to contain bioactive, potentially nephrotoxic molecules and pesticides, should be explored. Additionally, there are reports of water sources in Aguascalientes contaminated with heavy metals and/or pesticides. These include fluoride (increased levels found in Calvillo drinking water) as well as naturally occurring arsenic, among others. Fluoride may accumulate in bone and cause kidney disease years later, and maternal exposure to excess fluoride may cause kidney disease in offspring. We propose a research agenda to clarify the cause of CKDu in Aguascalientes that should involve international funders. The need for urgent action to identify and stem the cause of the high incidence of CKD extends to other CKD hotspots in Mexico, including Tierra Blanca in Veracruz and Poncitlan in Jalisco.
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Affiliation(s)
| | - Sol Carriazo
- IIS-Fundacion Jimenez Diaz UAM and School of Medicine, UAM, Madrid, Spain
| | | | - Alberto Ortiz
- IIS-Fundacion Jimenez Diaz UAM and School of Medicine, UAM, Madrid, Spain
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14
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Reza-Escalera AL, Tiscareño-Gutiérrez MT, Ovalle-Robles I, Macias-Guzmán MJ, Garcia-Díaz AL, Gutierrez-Peña CM, Chew-Wong A, Ricalde-Ríos G, Romo-Franco L, Reyes-Acevedo R, Galvan-Guerra E, Lagunas-Rodríguez AB, Delgado-Beltran MI, Rojas-Terán JF, Delgadillo-Castañeda R, Macias-Diaz DM, Alberu-Gomez J, Arreola-Guerra JM. Chronic Kidney Disease Risk Profile in Renal Donors in Aguascalientes, Mexico: A Retrospective Cohort Study. Transplant Proc 2021; 54:1701-1706. [PMID: 34756716 DOI: 10.1016/j.transproceed.2021.09.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 09/27/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND In the last decade, kidney donation has been recognized as a risk factor for end-stage renal disease (ESRD). ESRD risk calculators have been recently perfected in North American populations. In Mexico, the rates of overweight, obesity, and diabetes mellitus (DM) are among the highest worldwide; nevertheless, most kidney transplants are obtained from living donors. This study aims to describe the risk profile for chronic kidney disease (CKD) development in kidney donors in a highly active transplant center in Central Mexico. METHODS We conducted a retrospective, observational, descriptive cohort study of kidney donors followed at the Hospital Centenario Miguel Hidalgo (CHMH). We used the pretransplant CKD risk calculator at 15 years and over a lifetime (www.transplantmodels.com/esrdrisk). Aside from the calculator of kidney failure risk, we also used the calculator for postdonation CKD risk (www.transplantmodels.com/donesrd/). Factors associated with a glomerular filtration rate (GFR) <60 mL/min were evaluated by univariate and multivariate analysis. RESULTS The study included 543 donors. The average follow-up period was 1.7 years (±2.7) with a median of 0.7 years (interquartile range, 0.2-2.1). The average predicted risk for ESRD development at 15 years was 0.08% (±0.1); 25.6% had a risk >0.1%, and only 1 patient had a risk >1%. The lifetime ESRD risk was 0.62% (±0.5); 15% had a risk >1%, and the greatest risk was 3.5%. The median of patients at risk of developing postdonation ESRD was 1 in 10,000 donors (0.6-1.5) at 5 years, 5.7 in 10,000 donors (3.5-8.8) at 10 years, 15 in 10,000 donors (9.1-23.2) at 15 years, and 31 in 10,000 donors (18.9-47.7) at 20 years. During the follow-up period, 52 patients developed a GFR of <60 mL/min. Both risk estimation formulas were significantly associated with a GFR of <60 mL/min. Among the individual factors, the GFR (hazard ratio 0.96, 95% confidence interval 0.94-0.97, P < .001) and the urinary albumin to creatinine ratio (hazard ratio 1.009, 95% confidence interval 1.005-1.01, P < .001) remained statistically significant. CONCLUSION The risk of ESRD in kidney donors in Aguascalientes, Mexico, is similar to that described in the United States. Risk calculators are an indispensable decision-making tool to better understand kidney donors in our milieu.
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Affiliation(s)
| | | | - Itzel Ovalle-Robles
- Nephrology Department, Centenario Hospital Miguel Hidalgo, Aguascalientes, Mexico
| | | | | | | | - Alfredo Chew-Wong
- Nephrology Department, Centenario Hospital Miguel Hidalgo, Aguascalientes, Mexico
| | | | - Luis Romo-Franco
- Transplantation Department, Centenario Hospital Miguel Hidalgo, Aguascalientes, Mexico
| | - Rafael Reyes-Acevedo
- Transplantation Department, Centenario Hospital Miguel Hidalgo, Aguascalientes, Mexico
| | | | | | | | | | | | | | - Josefina Alberu-Gomez
- Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Mexico
| | - Jose Manuel Arreola-Guerra
- Nephrology Department, Centenario Hospital Miguel Hidalgo, Aguascalientes, Mexico; Internal Medicine Department, Centenario Hospital Miguel Hidalgo, Aguascalientes, Mexico.
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15
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Liu X, Wei W, Wu Y, Jiang X, Liu X, Zhang Y, Yeh CH, Zhang Y. Auricular Point Acupressure Combined with Compound Lidocaine Cream to Manage Arteriovenous Fistula Puncture Pain: A Multicenter Randomized Controlled Trial. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2021; 2021:5573567. [PMID: 34367303 PMCID: PMC8337141 DOI: 10.1155/2021/5573567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 07/15/2021] [Indexed: 12/02/2022]
Abstract
BACKGROUND Arteriovenous fistula (AVF) puncture pain is an inevitable problem for maintenance hemodialysis (MHD) patients and may seriously endanger the physical and mental health of patients with MHD. Studies have shown that drug or nondrug measures can reduce AVF puncture pain, but much improvement is needed. When combined with compound lidocaine cream (CLC) in the treatment of AVF puncture pain, auricular point acupressure (APA)-a therapeutic method in which specific points on the auricle of the outer ear are stimulated to treat various disorders of the body-and the therapeutic value and synergistic effects of auriculotherapy merit further investigation. METHODS 120 MHD patients were recruited at blood purification centers in three hospitals between January 2016 and April 2019. After completion of the baseline survey, all patients were randomly divided by the envelope method into a control group, APA group, CLC group, and APA combined with CLC, with 30 subjects per group. The numerical rating scale (NRS) of pain was used to measure the pain before intervention and 1, 4, and 8 weeks after intervention. The State-Trait Anxiety Inventory (STAI), General Comfort Questionnaire (GCQ), blood pressure, and heart rates were obtained before and after the intervention. RESULTS Pain, anxiety, comfort, blood pressure (BP), and heart rates (HR) of the three groups were better than those of the control group; the difference was statistically significant (P < 0.05). In addition, the APA combined with CLC group was better than the APA group and CLC group, respectively, in those outcomes (P < 0.05). CONCLUSION Both APA and CLC can effectively relieve AVF puncture pain, and the combined application has more outstanding effects.
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Affiliation(s)
- Xiaohui Liu
- Department of Nursing, The First Affiliated Hospital of Hunan University of Chinese Medicine, Changsha, Hunan 410007, China
- Department of Traditional Chinese Medicine Nursing, Nursing College of Henan University of Traditional Chinese Medicine, Zhengzhou, Henan 473005, China
| | - Wei Wei
- College of Nursing, Henan University of Traditional Chinese Medicine, Zhengzhou, Henan 473005, China
| | - Yaqi Wu
- College of Nursing, Henan University of Traditional Chinese Medicine, Zhengzhou, Henan 473005, China
| | - Xiao Jiang
- College of Nursing, Henan University of Traditional Chinese Medicine, Zhengzhou, Henan 473005, China
| | - Xueqin Liu
- College of Nursing, Henan University of Traditional Chinese Medicine, Zhengzhou, Henan 473005, China
| | - Ying Zhang
- College of Nursing, Henan University of Traditional Chinese Medicine, Zhengzhou, Henan 473005, China
| | - Chao Hsing Yeh
- Johns Hopkins University School of Nursing, 525 N. Wolfe Street, Room 421, Baltimore, MD 21205, USA
| | - Yuejuan Zhang
- Department of Nursing, The First Affiliated Hospital of Hunan University of Chinese Medicine, Changsha, Hunan 410007, China
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