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Issa I, Skov J, Falhammar H, Franko MA, Lindh JD, Mannheimer B. Establishment and representativeness of the Stockholm Sodium Cohort: A laboratorial and pharmacoepidemiologic database covering 1.6 million individuals in the Stockholm County. Ann Epidemiol 2024; 91:1-7. [PMID: 38219968 DOI: 10.1016/j.annepidem.2024.01.005] [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: 08/10/2023] [Revised: 12/20/2023] [Accepted: 01/11/2024] [Indexed: 01/16/2024]
Abstract
OBJECTIVE Hyponatremia is associated with considerable morbidity and mortality, but causal links have been difficult to establish. Here, we describe the establishment and representativeness of the Stockholm Sodium Cohort (SSC), designed to study etiologies and outcomes of hyponatremia. STUDY DESIGN AND SETTING All residents of Stockholm County undertaking at least one serum sodium test between 2005-2018 were included in the SSC. Individual-level test results from over 100 laboratory parameters relevant to hyponatremia were collected and linked to data on demographics, socioeconomic status, healthcare contacts, diagnoses and dispensed prescription medications using national registers. RESULTS A total of 1,632,249 individuals, corresponding to 64% of the population of Stockholm County, were included in the SSC. Coverage increased with advancing age, ranging from 32% in children and adolescents (≤18 years) to 97% among the oldest (≥80 years). The coverage of SSC included the vast majority of patients in Stockholm County diagnosed with diabetes mellitus (93%), myocardial infarction (98%), ischemic stroke (97%), cancer (85%), pneumonias requiring inpatient care (95%) and deaths (88%). CONCLUSION SSC is the first cohort specifically designed to investigate sodium levels in a large, population-based setting. It includes a wide range of administrative health data and laboratory analyses. The coverage is high, particularly among elderly and individuals with comorbidities. Consequently, the cohort has a large potential for exploration of various aspects of hyponatremia.
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Affiliation(s)
- Issa Issa
- Department of Clinical Science and Education at Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
| | - Jakob Skov
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Medicine, Karlstad Central Hospital, Karlstad, Sweden
| | - Henrik Falhammar
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Endocrinology, Karolinska University Hospital, Stockholm, Sweden
| | - Mikael Andersson Franko
- Department of Clinical Science and Education at Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Jonatan D Lindh
- Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska University Hospital Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Buster Mannheimer
- Department of Clinical Science and Education at Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
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Plantener E, Nanthan KR, Deding U, Damkjær M, Marmolin ES, Hansen LH, Petersen JJH, Pinilla R, Coia JE, Wolff DL, Song Z, Chen M. Impact of COVID-19 Restrictions on Acute Gastroenteritis in Children: A Regional, Danish, Register-Based Study. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10050816. [PMID: 37238364 DOI: 10.3390/children10050816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 04/13/2023] [Accepted: 04/27/2023] [Indexed: 05/28/2023]
Abstract
This study aimed to evaluate the impact of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) restrictions such as social distancing on the occurrence of acute gastroenteritis (AGE) among children. This study is a register-based study, including every child seen in the departments of paediatrics with the initial diagnosis of AGE in three neighbouring hospitals in Denmark, from March 2018 through February 2021. The study also included every positive stool sample for AGE-causing pathogens analysed in these three hospitals from children during the same period. The Wilcoxon rank-sum test was used to determine differences between the period during the SARS-CoV-2 restrictions and before. In all, 222,157 children were seen in the three paediatric departments during this period. Of these, 3917 children were diagnosed with AGE. We found a decrease of 46.6% in AGE-related visits per month after the SARS-CoV-2 restrictions were introduced compared to before (p-value < 0.001). Positive stool samples decreased by 38.2% (p-value = 0.008) during the restrictions. This study found that cases of paediatric AGE decreased significantly the during COVID-19 restrictions, suggesting that studies should be conducted to determine whether this reduction was a result of good hand hygiene and social distancing or just a result of altered health-seeking behaviour among children.
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Affiliation(s)
- Eva Plantener
- Department of Clinical Microbiology, University Hospital of Southern Denmark, 6200 Aabenraa, Denmark
| | - Kumanan Rune Nanthan
- Department of Clinical Microbiology, University Hospital of Southern Denmark, 6200 Aabenraa, Denmark
| | - Ulrik Deding
- Department of Clinical Research, University of Southern Denmark, 5000 Odense, Denmark
- Department of Surgery, Odense University Hospital, 5700 Svendborg, Denmark
| | - Mads Damkjær
- Department of Pediatrics, Lillebaelt Hospital, 6000 Kolding, Denmark
- Institute of Regional Health Research, University of Southern Denmark, 5000 Odense, Denmark
| | - Ea Sofie Marmolin
- Department of Clinical Microbiology, University Hospital of Southern Denmark, 6000 Kolding, Denmark
| | - Lotte Høeg Hansen
- Department of Pediatrics, University Hospital of Southern Denmark, 6200 Aabenraa, Denmark
| | - Jens J H Petersen
- Department of Pediatrics, University Hospital of Southern Denmark, 6700 Esbjerg, Denmark
| | - Roberto Pinilla
- Department of Pediatrics, University Hospital of Southern Denmark, 6700 Esbjerg, Denmark
| | - John E Coia
- Department of Clinical Microbiology, University Hospital of Southern Denmark, 6700 Esbjerg, Denmark
| | - Donna Lykke Wolff
- Institute of Regional Health Research, University of Southern Denmark, 5000 Odense, Denmark
- Department of Clinical Research, University Hospital of Southern Denmark, 6200 Aabenraa, Denmark
| | - Zhijun Song
- Department of Clinical Microbiology, University Hospital of Southern Denmark, 6700 Esbjerg, Denmark
| | - Ming Chen
- Department of Clinical Microbiology, University Hospital of Southern Denmark, 6200 Aabenraa, Denmark
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Kampmann JD, Heaf JG, Mogensen CB, Mickley H, Wolff DL, Brandt F. Prevalence and incidence of chronic kidney disease stage 3-5 - results from KidDiCo. BMC Nephrol 2023; 24:17. [PMID: 36658506 PMCID: PMC9849831 DOI: 10.1186/s12882-023-03056-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 01/02/2023] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) is a global challenge. CKD prevalence estimation is central to management strategies and prevention. It is necessary to predict end stage kidney disease (ESKD) and, subsequently, the burden for healthcare systems. In this study we characterize CKD stage 3-5 prevalence and incidence in a cohort covering the majority of the Region of Southern Denmark and investigate individuals' demographic, socioeconomic, and comorbidity status. METHODS We used data from the Kidney Disease Cohort (KidDiCo) combining laboratory data from Southern Denmark with Danish national databases. Chronic kidney disease was defined according to the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. RESULTS The prevalence varied between 4.83 and 4.98% and incidence rate of CKD was 0.49%/year. The median age was 76.4 years. The proportion of individuals with CKD stage 3-5 in the entire population increased consistently with age. The percentage of women in the CKD 3-5 group was higher than in the background population. Diabetes mellitus, hypertension and cardiovascular disease were more prominent in patients with CKD. CKD stage 5 and ESKD were more frequent as incident CKD stages in the 18-49 year olds when compared to older individuals. CKD patients tended to have a lower socioeconomic status. CONCLUSION Chronic kidney disease stage 3-5 is common, especially in the elderly. Patients with CKD stage 3-5 are predominantly female. The KidDiCo data suggests an association between lower socioeconomic status and prevalence of CKD.
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Affiliation(s)
- Jan Dominik Kampmann
- grid.7143.10000 0004 0512 5013Department of Internal Medicine, University Hospital of Southern Denmark, Sydvang 1, Sonderborg, 6400 Denmark ,grid.10825.3e0000 0001 0728 0170Institute of Regional Health Research, University of Southern Denmark, Campusvej 55, Odense, 5230 Denmark
| | - James Goya Heaf
- grid.476266.7Department of Medicine, Zealand University Hospital, Roskilde, Sygehusvej 10, Roskilde, 4000 Denmark
| | - Christian Backer Mogensen
- grid.10825.3e0000 0001 0728 0170Institute of Regional Health Research, University of Southern Denmark, Campusvej 55, Odense, 5230 Denmark ,grid.7143.10000 0004 0512 5013Department of Emergency Medicine, University Hospital of Southern Denmark, Kresten Philipsens Vej 15, Aabenraa, 6200 Denmark
| | - Hans Mickley
- grid.7143.10000 0004 0512 5013Department of Cardiology, Odense University Hospital, J. B. Winsløws Vej 4, Odense, 5000 Denmark
| | - Donna Lykke Wolff
- grid.7143.10000 0004 0512 5013Department of Internal Medicine, University Hospital of Southern Denmark, Sydvang 1, Sonderborg, 6400 Denmark ,grid.10825.3e0000 0001 0728 0170Institute of Regional Health Research, University of Southern Denmark, Campusvej 55, Odense, 5230 Denmark
| | - Frans Brandt
- grid.7143.10000 0004 0512 5013Department of Internal Medicine, University Hospital of Southern Denmark, Sydvang 1, Sonderborg, 6400 Denmark ,grid.10825.3e0000 0001 0728 0170Institute of Regional Health Research, University of Southern Denmark, Campusvej 55, Odense, 5230 Denmark
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Jensen SK, Heide-Jørgensen U, Vestergaard SV, Sørensen HT, Christiansen CF. Routine Clinical Care Creatinine Data in Denmark - An Epidemiological Resource for Nationwide Population-Based Studies of Kidney Disease. Clin Epidemiol 2022; 14:1415-1426. [PMID: 36444292 PMCID: PMC9700471 DOI: 10.2147/clep.s380840] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 11/04/2022] [Indexed: 11/22/2023] Open
Abstract
PURPOSE Creatinine data are key in identifying acute and chronic kidney disease. In Denmark, routine clinical care creatinine data have been collected regionally in the Clinical Laboratory Information System Research Database (LABKA) since the 1990s and nationwide in the Register of Laboratory Results for Research (RLRR) since 2013. Here we describe the geographical coverage of the databases and characteristics of Danish individuals with creatinine tests. This information is pivotal for the design and interpretation of studies using these data to examine kidney disease epidemiology. PATIENTS AND METHODS We included all creatinine tests in LABKA and RLRR from 1990 through 2018. The daily number of creatinine tests by municipality and region of residence were plotted and geographical coverage was ascertained. In addition, we characterized a contemporary cohort of creatinine-tested individuals in 2016-2018. RESULTS During 1990-2018, 61,011,941 creatinine tests were available for 4,647,966 unique Danish residents. The North Denmark Region was the first region to achieve complete reporting in November 2004, and nationwide reporting was complete starting in October 2015. In each year from 2016 to 2018, more than a third of Danish residents had a recorded creatinine measurement, with the highest proportion of tested individuals aged 77-87 years and the lowest proportion aged 3-5 years. During 2016-2018, the creatinine-tested cohort had a median age of 53 years (IQR, 35-67 years) and included 54.3% women. The most common comorbidity was a hospital-based diagnosis of hypertension (12.0%), and the most common prescription drug was angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers (15.8%). CONCLUSION In combination, the population-based LABKA and RLRR databases provide regional creatinine data with long follow-up and nationwide data for the Danish population. There was considerable variation in the time of complete geographical coverage by region, which needs to be considered when using these data for studies on kidney disease epidemiology.
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Affiliation(s)
- Simon Kok Jensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Uffe Heide-Jørgensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Søren Viborg Vestergaard
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Christian Fynbo Christiansen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Rate and Risk Factors of Acute Myocardial Infarction after Debut of Chronic Kidney Disease-Results from the KidDiCo. J Cardiovasc Dev Dis 2022; 9:jcdd9110387. [PMID: 36354786 PMCID: PMC9696870 DOI: 10.3390/jcdd9110387] [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: 10/23/2022] [Revised: 11/05/2022] [Accepted: 11/07/2022] [Indexed: 11/11/2022] Open
Abstract
Chronic kidney disease (CKD) is a known risk factor for cardiovascular disease, including acute myocardial infarction. However, whether this risk is only associated with severe kidney disease or is also related to mildly impaired kidney function is still under debate. The incidence rate and risk factors of incident acute myocardial infarction (AMI) in patients with CKD are sparse. Potential differences in risk factor profiles between CKD patients with incident AMI and CKD patients with a prior AMI have not been sufficiently investigated. Furthermore, important factors such as albuminuria and socio-economic factors are often not included. The primary aim of this study was to establish the incidence rate of AMI after CKD debut. Secondly, to evaluate the importance of different CKD stages and the risk of having an AMI. Finally, to identify individuals at risk for AMI after CKD debut adjusted for prevalent AMI. Based on data from the kidney disease cohort of Southern Denmark (KidDiCo), including 66,486 CKD patients, we established incidence rates and characteristics of incident AMI among patients within a 5-year follow-up period after CKD debut. A Cox regression was performed to compute the cause-specific hazard ratios for the different risk factors. The incidence rate for CKD stage G3−5 patients suffering acute myocardial infarction is 2.5 cases/1000 people/year. In patients without a previous myocardial infarction, the risk of suffering a myocardial infarction after CKD debut was only significant in CKD stage G4 (HR = 1.402; (95% CI: 1.08−1.81); p-value = 0.010) and stage G5 (HR = 1.491; (95% CI: 1.01−2.19); p-value = 0.042). This was not the case in patients who had suffered an acute myocardial infarction prior to their CKD debut. In this group, a previous myocardial infarction was the most critical risk factor for an additional myocardial infarction after CKD debut (HR = 2.615; (95% CI: 2.241−3.05); p-value < 0.001). Irrespective of a previous myocardial infarction, age, male sex, hypertension, and a low educational level were significant risk factors associated with an acute myocardial infarction after CKD debut. The incidence rate of AMI in patients with CKD stage G3−5 was 2.5 cases/1000 people/year. Risk factors associated with incident AMI in CKD stage G3−5 patients were CKD stage, age, and hypertension. Female sex and higher educational levels were associated with a lower risk for AMI. Prior AMI was the most significant risk factor in patients with and without previous AMI before fulfilling CKD stage G3−5 criteria. Only age, sex, and a medium-long educational level were significant risk factors in this group.
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Kampmann JD, Heaf JG, Mogensen CB, Mickley H, Wolff DL, Kristensen FB. Referral rate of chronic kidney disease patients to a nephrologist in the region of Southern Denmark: results from KidDiCo. Clin Kidney J 2022; 15:2116-2123. [DOI: 10.1093/ckj/sfac165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Data on the referral rate of chronic kidney disease (CKD) patients to specialists are sparse. Investigating referral rates and characterising patients with kidney disease not followed by a nephrologist is relevant for future measures in order to optimize public health and guideline implementation.
Methods
Data were extracted from the Kidney Disease Cohort of Southern Denmark (KidDiCo). Referral rates for all incident CKD patients below 60ml/min/1.73m² and referral rates according to the KDIGO guidelines based glomerular filtration rates below 30 ml/min/1.73m² were calculated. Information on contact with one of the nephrologist outpatient clinics in the Region of Southern Denmark was collected from the Danish National Patient Registry. The individual follow up time for nephrology contact was 12 months. Additional data was accessed via the respective national databases. CKD patients on dialysis and kidney transplanted patients were excluded.
Result
Three % of patients with an eGFR < 60 ml/min/1.73m² sixteen % of patients with an eGFR < 30 ml/min/1.73m² and thirty-five % of patients with an eGFR < 15 ml/min/1.73m² were in contact with a nephrologist in the outpatient settings. Younger age, male sex, diabetes, hypertension, higher education and proximity to a nephrology outpatient clinic increased the chance of nephrology follow up.
Conclusion
Only a small fraction of CKD patients are followed by a nephrologist. More studies should be performed in order to find out which patients will profit the most from renal referral and how to optimize the collaboration between nephrologists and general practitioners.
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Affiliation(s)
- Jan Dominik Kampmann
- Department of Internal Medicine, Hospital of Southern Jutland, Sønderborg, Sonderborg , Denmark
- Institute of Regional Health Research, University of Southern Denmark , Odense , Denmark
| | - James Goya Heaf
- Department of Medicine, Zealand University Hospital, Roskilde , Roskilde , Denmark
| | - Christian Backer Mogensen
- Department of Emergency Medicine, Hospital of Southern Jutland , Aabenraa , Denmark
- Institute of Regional Health Research, University of Southern Denmark , Odense , Denmark
| | - Hans Mickley
- Department of Cardiology, Odense University Hospital , Odense , Denmark
| | - Donna Lykke Wolff
- Department of Internal Medicine, Hospital of Southern Jutland, Sønderborg, Sonderborg , Denmark
- Institute of Regional Health Research, University of Southern Denmark , Odense , Denmark
| | - Frans Brandt Kristensen
- Department of Internal Medicine, Hospital of Southern Jutland, Sønderborg, Sonderborg , Denmark
- Institute of Regional Health Research, University of Southern Denmark , Odense , Denmark
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