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Mark J Sarnak - One of the best experts on this subject based on the ideXlab platform.
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Original Investigation Urine Potassium Excretion, Kidney Failure, and Mortality in CKD
2017Co-Authors: Amanda K. Leonberg-yoo, Hocine Tighiouart, Andrew S Levey, Gerald J Beck, Mark J SarnakAbstract:Background: Low urine potassium excretion, as a surrogate for dietary potassium intake, is associated with higher risk for hypertension and cardiovascular disease in a general population. Few studies have investigated the relationship of urine potassium with clinical outcomes in chronic Kidney disease (CKD). Study Design: Longitudinal cohort study. Setting & Participants: The MDRD (Modification of Diet in Renal Disease) Study was a randomized controlled trial (N 5 840) conducted in 1989 to 1993 to examine the effects of blood pressure control and dietary protein restriction on Kidney disease progression in adults aged 18 to 70 years with CKD stages 2 to 4. This post hoc analysis included 812 participants. Predictor: The primary predictor variable was 24-hour urine potassium excretion, measured at baseline and at multiple time points (presented as time-updated average urine potassium excretion). Outcomes: Kidney Failure, defined as initiation of dialysis therapy or transplantation, was determined from US Renal Data System data. All-cause mortality was assessed using the National Death Index. Results: Median follow-up for Kidney Failure was 6.1 (IQR, 3.5-11.7) years, with 9 events/100 patient-years. Median all-cause mortality follow-up was 19.2 (IQR, 10.8-20.6) years, with 3 deaths/100 patient-years. Baseline mean urine potassium excretion was 2.39 6 0.89 (SD) g/d. Each 1-SD higher baseline urine potassium level was associated with an adjusted HR of 0.95 (95% CI, 0.87-1.04) for Kidney Failure and 0.83 (95% CI, 0.74-0.94) for all-cause mortality. Results were consistent using time-updated average urine potassium measurements. Limitations: Analyses were performed using urine potassium excretion as a surrogate for dietary potassium intake. Results are obtained from a primarily young, nondiabetic, and advanced CKD population and may not be generalizable to the general CKD population. Conclusions: Higher urine potassium excretion was associated with lower risk for all-cause mortality, but not Kidney Failure. Am J Kidney Dis. 69(3):341-349. a 2016 by the National Kidney Foundation, Inc.
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Urine Potassium Excretion, Kidney Failure, and Mortality in CKD
American journal of kidney diseases : the official journal of the National Kidney Foundation, 2016Co-Authors: Amanda K. Leonberg-yoo, Hocine Tighiouart, Andrew S Levey, Gerald J Beck, Mark J SarnakAbstract:Background Low urine potassium excretion, as a surrogate for dietary potassium intake, is associated with higher risk for hypertension and cardiovascular disease in a general population. Few studies have investigated the relationship of urine potassium with clinical outcomes in chronic Kidney disease (CKD). Study Design Longitudinal cohort study. Setting & Participants The MDRD (Modification of Diet in Renal Disease) Study was a randomized controlled trial (N = 840) conducted in 1989 to 1993 to examine the effects of blood pressure control and dietary protein restriction on Kidney disease progression in adults aged 18 to 70 years with CKD stages 2 to 4. This post hoc analysis included 812 participants. Predictor The primary predictor variable was 24-hour urine potassium excretion, measured at baseline and at multiple time points (presented as time-updated average urine potassium excretion). Outcomes Kidney Failure, defined as initiation of dialysis therapy or transplantation, was determined from US Renal Data System data. All-cause mortality was assessed using the National Death Index. Results Median follow-up for Kidney Failure was 6.1 (IQR, 3.5-11.7) years, with 9 events/100 patient-years. Median all-cause mortality follow-up was 19.2 (IQR, 10.8-20.6) years, with 3 deaths/100 patient-years. Baseline mean urine potassium excretion was 2.39±0.89 (SD) g/d. Each 1-SD higher baseline urine potassium level was associated with an adjusted HR of 0.95 (95% CI, 0.87-1.04) for Kidney Failure and 0.83 (95% CI, 0.74-0.94) for all-cause mortality. Results were consistent using time-updated average urine potassium measurements. Limitations Analyses were performed using urine potassium excretion as a surrogate for dietary potassium intake. Results are obtained from a primarily young, nondiabetic, and advanced CKD population and may not be generalizable to the general CKD population. Conclusions Higher urine potassium excretion was associated with lower risk for all-cause mortality, but not Kidney Failure.
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urinary sodium excretion and Kidney Failure in nondiabetic chronic Kidney disease
Kidney International, 2014Co-Authors: Hocine Tighiouart, Andrew S Levey, Gerald J Beck, Mark J SarnakAbstract:Current guidelines recommend under 2g/day sodium intake in chronic Kidney disease, but there are a few studies relating sodium intake to long-term outcomes. Here we evaluated the association of mean baseline 24-h urinary sodium excretion with Kidney Failure and a composite outcome of Kidney Failure or all-cause mortality using Cox regression in 840 participants enrolled in the Modification of Diet in Renal Disease Study. Mean 24-h urinary sodium excretion was 3.46g/day. Kidney Failure developed in 617 participants, and the composite outcome was reached in 723. In the primary analyses, there was no association between 24-h urine sodium and Kidney Failure (HR 0.99 (95% CI 0.91–1.08)) nor on the composite outcome (HR 1.01 (95% CI 0.93–1.09)), each per 1g/day higher urine sodium. In exploratory analyses, there was a significant interaction of baseline proteinuria and sodium excretion with Kidney Failure. Using a two-slope model, when urine sodium was under 3g/day, higher urine sodium was associated with increased risk of Kidney Failure in those with baseline proteinuria under 1g/day and with lower risk of Kidney Failure in those with baseline proteinuria of ⩾1g/day. There was no association between urine sodium and Kidney Failure when urine sodium was⩾3g/day. Results were consistent using first baseline and time-dependent urinary sodium excretion. Thus, we noted no association of urine sodium with Kidney Failure. Results of the exploratory analyses need to be verified in additional studies and the mechanism explored.
Brenda R. Hemmelgarn - One of the best experts on this subject based on the ideXlab platform.
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Association of Age With Risk of Kidney Failure in Adults With Stage IV Chronic Kidney Disease in Canada.
JAMA network open, 2020Co-Authors: Pietro Ravani, Brenda R. Hemmelgarn, Matthew T. James, Braden J. Manns, Marta Fiocco, Ping Liu, Ngan N. Lam, Rob R. Quinn, Huda Al-wahsh, Yves JoanetteAbstract:Importance With population aging, the burden of many age-related chronic conditions, including Kidney Failure, is increasing globally. Objective To investigate the risks of Kidney Failure and death in adults with incident stage IV chronic Kidney disease (CKD). Design, Setting, and Participants This population-based cohort study obtained data recorded between July 30, 2002, and March 31, 2014, from the linked laboratory and administrative data set of Alberta Health in Alberta, Canada. All adults of the province of Alberta with stage IV CKD (estimated glomerular filtration rate [eGFR] of 15-30 mL/min/1.73 m2) were eligible for inclusion. Included individuals were followed up from study entry until the date of Kidney Failure, death, or censoring, whichever occurred first. Observations were censored at the date of emigration from the province, the study end date (March 31, 2017), or at 10 years after study entry. Data analyses were performed from January 2020 to June 2020. Main Outcomes and Measures The primary outcome was Kidney Failure, defined as the earlier of either renal replacement (dialysis or Kidney transplant) initiation or severe Kidney impairment (eGFR Results The study included 30 801 adults (mean [SD] age, 76.8 [13.3] years; 17 294 women [56.1%]) with stage IV CKD. Of these, 5511 developed Kidney Failure (17.9%) and 16 285 died (52.9%). The incidence rate of stage IV CKD increased sharply with advancing age; the absolute risk of Kidney Failure decreased with advancing age, and the risk of death increased, especially in those aged 85 years or older. Compared with the 5-year risk of death, the 5-year risk of Kidney Failure was higher in people younger than 65 years, similar in people aged 65 to 74 years, and lower for older age groups. For those aged 75 years or older, the risk of death was much higher than the risk of Kidney Failure: 6-fold higher among those aged 75 to 84 years (0.51 [95% CI, 0.5-0.52] vs 0.09 [95% CI, 0.08-0.09]) and 25-fold higher among those aged 85 years or older (0.75 [95% CI, 0.74-0.76] vs 0.03 [95% CI, 0.02-0.03]). The risk of death was higher than the risk of Kidney Failure by 24-fold among those aged 85 to 94 years (0.73 [95% CI, 0.72-0.74] vs 0.03 [95% CI, 0.02-0.03]) and by 149-fold among those aged 95 years or older (0.89 [95% CI, 0.87-0.92] vs Conclusions and Relevance This study found that, although the incidence rate of stage IV CKD increased with advancing age, the absolute risk of Kidney Failure decreased. Unlike other age-related conditions, the expected increase in the burden of Kidney Failure in the older adults may be less dramatic than expected.
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Influence of Mortality on Estimating the Risk of Kidney Failure in People with Stage 4 CKD.
Journal of the American Society of Nephrology : JASN, 2019Co-Authors: Pietro Ravani, Brenda R. Hemmelgarn, Matthew T. James, Braden J. Manns, Robert R. Quinn, Marta Fiocco, Ping Liu, Ngan N. Lam, Matthew J. Oliver, Giovanni F.m. StrippoliAbstract:Background Most Kidney Failure risk calculators are based on methods that censor for death. Because mortality is high in people with severe, nondialysis-dependent CKD, censoring for death may overestimate their risk of Kidney Failure. Methods Using 2002-2014 population-based laboratory and administrative data for adults with stage 4 CKD in Alberta, Canada, we analyzed the time to the earliest of Kidney Failure, death, or censoring, using methods that censor for death and methods that treat death as a competing event factoring in age, sex, diabetes, cardiovascular disease, eGFR, and albuminuria. Stage 4 CKD was defined as a sustained eGFR of 15-30 ml/min per 1.73 m2. Results Of the 30,801 participants (106,447 patient-years at risk; mean age 77 years), 18% developed Kidney Failure and 53% died. The observed risk of the combined end point of death or Kidney Failure was 64% at 5 years and 87% at 10 years. By comparison, standard risk calculators that censored for death estimated these risks to be 76% at 5 years and >100% at 7.5 years. Censoring for death increasingly overestimated the risk of Kidney Failure over time from 7% at 5 years to 19% at 10 years, especially in people at higher risk of death. For example, the overestimation of 5-year absolute risk ranged from 1% in a woman without diabetes, cardiovascular disease, or albuminuria and with an eGFR of 25 ml/min per 1.73 m2 (9% versus 8%), to 27% in a man with diabetes, cardiovascular disease, albuminuria >300 mg/d, and an eGFR of 20 ml/min per 1.73 m2 (78% versus 51%). Conclusions Kidney Failure risk calculators should account for death as a competing risk to increase their accuracy and utility for patients and providers.
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association between first nations ethnicity and progression to Kidney Failure by presence and severity of albuminuria
Canadian Medical Association Journal, 2014Co-Authors: Susan Samuel, Braden J. Manns, Marcello Tonelli, Luz Palaciosderflingher, Lynden Crowshoe, Sofia B Ahmed, Min Jun, Nathalie Saad, Brenda R. HemmelgarnAbstract:Background: Despite a low prevalence of chronic Kidney disease (estimated glomerular filtration rate [GFR] 2 ), First Nations people have high rates of Kidney Failure requiring chronic dialysis or Kidney transplantation. We sought to examine whether the presence and severity of albuminuria contributes to the progression of chronic Kidney disease to Kidney Failure among First Nations people. Methods: We identified all adult residents of Alberta (age ≥ 18 yr) for whom an outpatient serum creatinine measurement was available from May 1, 2002, to Mar. 31, 2008. We determined albuminuria using urine dipsticks and categorized results as normal (i.e., no albuminuria), mild, heavy or unmeasured. Our primary outcome was progression to Kidney Failure (defined as the need for chronic dialysis or Kidney transplantation, or a sustained doubling of serum creatinine levels). We calculated rates of progression to Kidney Failure by First Nations status, by estimated GFR and by albuminuria category. We determined the relative hazard of progression to Kidney Failure for First Nations compared with non–First Nations participants by level of albuminuria and estimated GFR. Results: Of the 1 816 824 participants we identified, 48 669 (2.7%) were First Nations. First Nations people were less likely to have normal albuminuria compared with non–First Nations people (38.7% v. 56.4%). Rates of progression to Kidney Failure were consistently 2- to 3-fold higher among First Nations people than among non–First Nations people, across all levels of albuminuria and estimated GFRs. Compared with non–First Nations people, First Nations people with an estimated GFR of 15.0–29.9 mL/min per 1.73 m 2 had the highest risk of progression to Kidney Failure, with similar hazard ratios for those with normal and heavy albuminuria. Interpretation: Albuminuria confers a similar risk of progression to Kidney Failure for First Nations and non–First Nations people.
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Age and treatment of Kidney Failure.
Current opinion in nephrology and hypertension, 2013Co-Authors: Meghan J. Elliott, Helen Tam-tham, Brenda R. HemmelgarnAbstract:Purpose of reviewThis review discusses issues related to treatment of chronic Kidney disease, and Kidney Failure in particular, among older adults.Recent findingsA substantial proportion of older adults have chronic Kidney disease and progress to Kidney Failure. There is considerable variability in
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Rates of treated and untreated Kidney Failure in older vs younger adults.
JAMA, 2012Co-Authors: Brenda R. Hemmelgarn, Matthew T. James, Braden J. Manns, Ann M. O’hare, Paul Muntner, Pietro Ravani, Robert R. Quinn, Tanvir Chowdhury Turin, Zhi Tan, Marcello TonelliAbstract:Context Studies of Kidney Failure in older adults have focused on receipt of dialysis, which may underestimate the burden of disease if older people are less likely to receive treatment. Objective To determine the extent to which age is associated with the likelihood of treatment of Kidney Failure. Design, Setting, and Participants Community-based cohort study of 1 816 824 adults in Alberta, Canada, who had outpatient estimated glomerular filtration rate (eGFR) measured between May 1, 2002, and March 31, 2008, with a baseline eGFR of 15 mL/min/1.73 m 2 or higher and who did not require renal replacement therapy at baseline. Age was categorized as 18 to 44, 45 to 54, 55 to 64, 65 to 74, 75 to 84, and 85 or more years and eGFR as 90 or higher, 60 to 89, 45 to 59, 30 to 44, and 15 to 29 mL/min/1.73 m 2 . Main Outcome Measures Adjusted rates of treated Kidney Failure (receipt of dialysis or Kidney transplantation), untreated Kidney Failure (progression to eGFR 2 without renal replacement therapy), and death. Results During a median follow-up of 4.4 years, 97 451 (5.36%) died, 3295 (0.18%) developed Kidney Failure that was treated and 3116 (0.17%) developed Kidney Failure that went untreated. Within each eGFR stratum the rate of treated Kidney Failure was higher in younger compared with older people. For example, in the lowest eGFR stratum (15-29 mL/min/1.73 m 2 ), adjusted rates of treated Kidney Failure were more than 10-fold higher among the youngest (18-44 years) compared with the oldest (≥85 years) groups (adjusted rate, 24.00 [95% CI, 14.78-38.97] vs 1.53 [95% CI, 0.59-3.99] per 1000 person-years, respectively; P 2 , adjusted rates of untreated Kidney Failure were more than 5-fold higher among the oldest (≥85 years), compared with the youngest (18-44 years) groups (adjusted rate, 19.95 [95% CI, 15.79-25.19] vs 3.53 [95% CI, 1.56-8.01] per 1000 person-years, respectively; P 2 was 36.45 (95% CI, 24.46-54.32) among participants aged 18 to 44 years and 20.19 (95% CI, 15.27-26.69) among those aged 85 years or older (P = .01). Conclusion In Alberta, Canada, rates of untreated Kidney Failure are significantly higher in older compared with younger individuals.
Braden J. Manns - One of the best experts on this subject based on the ideXlab platform.
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Association of Age With Risk of Kidney Failure in Adults With Stage IV Chronic Kidney Disease in Canada.
JAMA network open, 2020Co-Authors: Pietro Ravani, Brenda R. Hemmelgarn, Matthew T. James, Braden J. Manns, Marta Fiocco, Ping Liu, Ngan N. Lam, Rob R. Quinn, Huda Al-wahsh, Yves JoanetteAbstract:Importance With population aging, the burden of many age-related chronic conditions, including Kidney Failure, is increasing globally. Objective To investigate the risks of Kidney Failure and death in adults with incident stage IV chronic Kidney disease (CKD). Design, Setting, and Participants This population-based cohort study obtained data recorded between July 30, 2002, and March 31, 2014, from the linked laboratory and administrative data set of Alberta Health in Alberta, Canada. All adults of the province of Alberta with stage IV CKD (estimated glomerular filtration rate [eGFR] of 15-30 mL/min/1.73 m2) were eligible for inclusion. Included individuals were followed up from study entry until the date of Kidney Failure, death, or censoring, whichever occurred first. Observations were censored at the date of emigration from the province, the study end date (March 31, 2017), or at 10 years after study entry. Data analyses were performed from January 2020 to June 2020. Main Outcomes and Measures The primary outcome was Kidney Failure, defined as the earlier of either renal replacement (dialysis or Kidney transplant) initiation or severe Kidney impairment (eGFR Results The study included 30 801 adults (mean [SD] age, 76.8 [13.3] years; 17 294 women [56.1%]) with stage IV CKD. Of these, 5511 developed Kidney Failure (17.9%) and 16 285 died (52.9%). The incidence rate of stage IV CKD increased sharply with advancing age; the absolute risk of Kidney Failure decreased with advancing age, and the risk of death increased, especially in those aged 85 years or older. Compared with the 5-year risk of death, the 5-year risk of Kidney Failure was higher in people younger than 65 years, similar in people aged 65 to 74 years, and lower for older age groups. For those aged 75 years or older, the risk of death was much higher than the risk of Kidney Failure: 6-fold higher among those aged 75 to 84 years (0.51 [95% CI, 0.5-0.52] vs 0.09 [95% CI, 0.08-0.09]) and 25-fold higher among those aged 85 years or older (0.75 [95% CI, 0.74-0.76] vs 0.03 [95% CI, 0.02-0.03]). The risk of death was higher than the risk of Kidney Failure by 24-fold among those aged 85 to 94 years (0.73 [95% CI, 0.72-0.74] vs 0.03 [95% CI, 0.02-0.03]) and by 149-fold among those aged 95 years or older (0.89 [95% CI, 0.87-0.92] vs Conclusions and Relevance This study found that, although the incidence rate of stage IV CKD increased with advancing age, the absolute risk of Kidney Failure decreased. Unlike other age-related conditions, the expected increase in the burden of Kidney Failure in the older adults may be less dramatic than expected.
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Influence of Mortality on Estimating the Risk of Kidney Failure in People with Stage 4 CKD.
Journal of the American Society of Nephrology : JASN, 2019Co-Authors: Pietro Ravani, Brenda R. Hemmelgarn, Matthew T. James, Braden J. Manns, Robert R. Quinn, Marta Fiocco, Ping Liu, Ngan N. Lam, Matthew J. Oliver, Giovanni F.m. StrippoliAbstract:Background Most Kidney Failure risk calculators are based on methods that censor for death. Because mortality is high in people with severe, nondialysis-dependent CKD, censoring for death may overestimate their risk of Kidney Failure. Methods Using 2002-2014 population-based laboratory and administrative data for adults with stage 4 CKD in Alberta, Canada, we analyzed the time to the earliest of Kidney Failure, death, or censoring, using methods that censor for death and methods that treat death as a competing event factoring in age, sex, diabetes, cardiovascular disease, eGFR, and albuminuria. Stage 4 CKD was defined as a sustained eGFR of 15-30 ml/min per 1.73 m2. Results Of the 30,801 participants (106,447 patient-years at risk; mean age 77 years), 18% developed Kidney Failure and 53% died. The observed risk of the combined end point of death or Kidney Failure was 64% at 5 years and 87% at 10 years. By comparison, standard risk calculators that censored for death estimated these risks to be 76% at 5 years and >100% at 7.5 years. Censoring for death increasingly overestimated the risk of Kidney Failure over time from 7% at 5 years to 19% at 10 years, especially in people at higher risk of death. For example, the overestimation of 5-year absolute risk ranged from 1% in a woman without diabetes, cardiovascular disease, or albuminuria and with an eGFR of 25 ml/min per 1.73 m2 (9% versus 8%), to 27% in a man with diabetes, cardiovascular disease, albuminuria >300 mg/d, and an eGFR of 20 ml/min per 1.73 m2 (78% versus 51%). Conclusions Kidney Failure risk calculators should account for death as a competing risk to increase their accuracy and utility for patients and providers.
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association between first nations ethnicity and progression to Kidney Failure by presence and severity of albuminuria
Canadian Medical Association Journal, 2014Co-Authors: Susan Samuel, Braden J. Manns, Marcello Tonelli, Luz Palaciosderflingher, Lynden Crowshoe, Sofia B Ahmed, Min Jun, Nathalie Saad, Brenda R. HemmelgarnAbstract:Background: Despite a low prevalence of chronic Kidney disease (estimated glomerular filtration rate [GFR] 2 ), First Nations people have high rates of Kidney Failure requiring chronic dialysis or Kidney transplantation. We sought to examine whether the presence and severity of albuminuria contributes to the progression of chronic Kidney disease to Kidney Failure among First Nations people. Methods: We identified all adult residents of Alberta (age ≥ 18 yr) for whom an outpatient serum creatinine measurement was available from May 1, 2002, to Mar. 31, 2008. We determined albuminuria using urine dipsticks and categorized results as normal (i.e., no albuminuria), mild, heavy or unmeasured. Our primary outcome was progression to Kidney Failure (defined as the need for chronic dialysis or Kidney transplantation, or a sustained doubling of serum creatinine levels). We calculated rates of progression to Kidney Failure by First Nations status, by estimated GFR and by albuminuria category. We determined the relative hazard of progression to Kidney Failure for First Nations compared with non–First Nations participants by level of albuminuria and estimated GFR. Results: Of the 1 816 824 participants we identified, 48 669 (2.7%) were First Nations. First Nations people were less likely to have normal albuminuria compared with non–First Nations people (38.7% v. 56.4%). Rates of progression to Kidney Failure were consistently 2- to 3-fold higher among First Nations people than among non–First Nations people, across all levels of albuminuria and estimated GFRs. Compared with non–First Nations people, First Nations people with an estimated GFR of 15.0–29.9 mL/min per 1.73 m 2 had the highest risk of progression to Kidney Failure, with similar hazard ratios for those with normal and heavy albuminuria. Interpretation: Albuminuria confers a similar risk of progression to Kidney Failure for First Nations and non–First Nations people.
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Rates of treated and untreated Kidney Failure in older vs younger adults.
JAMA, 2012Co-Authors: Brenda R. Hemmelgarn, Matthew T. James, Braden J. Manns, Ann M. O’hare, Paul Muntner, Pietro Ravani, Robert R. Quinn, Tanvir Chowdhury Turin, Zhi Tan, Marcello TonelliAbstract:Context Studies of Kidney Failure in older adults have focused on receipt of dialysis, which may underestimate the burden of disease if older people are less likely to receive treatment. Objective To determine the extent to which age is associated with the likelihood of treatment of Kidney Failure. Design, Setting, and Participants Community-based cohort study of 1 816 824 adults in Alberta, Canada, who had outpatient estimated glomerular filtration rate (eGFR) measured between May 1, 2002, and March 31, 2008, with a baseline eGFR of 15 mL/min/1.73 m 2 or higher and who did not require renal replacement therapy at baseline. Age was categorized as 18 to 44, 45 to 54, 55 to 64, 65 to 74, 75 to 84, and 85 or more years and eGFR as 90 or higher, 60 to 89, 45 to 59, 30 to 44, and 15 to 29 mL/min/1.73 m 2 . Main Outcome Measures Adjusted rates of treated Kidney Failure (receipt of dialysis or Kidney transplantation), untreated Kidney Failure (progression to eGFR 2 without renal replacement therapy), and death. Results During a median follow-up of 4.4 years, 97 451 (5.36%) died, 3295 (0.18%) developed Kidney Failure that was treated and 3116 (0.17%) developed Kidney Failure that went untreated. Within each eGFR stratum the rate of treated Kidney Failure was higher in younger compared with older people. For example, in the lowest eGFR stratum (15-29 mL/min/1.73 m 2 ), adjusted rates of treated Kidney Failure were more than 10-fold higher among the youngest (18-44 years) compared with the oldest (≥85 years) groups (adjusted rate, 24.00 [95% CI, 14.78-38.97] vs 1.53 [95% CI, 0.59-3.99] per 1000 person-years, respectively; P 2 , adjusted rates of untreated Kidney Failure were more than 5-fold higher among the oldest (≥85 years), compared with the youngest (18-44 years) groups (adjusted rate, 19.95 [95% CI, 15.79-25.19] vs 3.53 [95% CI, 1.56-8.01] per 1000 person-years, respectively; P 2 was 36.45 (95% CI, 24.46-54.32) among participants aged 18 to 44 years and 20.19 (95% CI, 15.27-26.69) among those aged 85 years or older (P = .01). Conclusion In Alberta, Canada, rates of untreated Kidney Failure are significantly higher in older compared with younger individuals.
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oral phosphate binders in patients with Kidney Failure
The New England Journal of Medicine, 2010Co-Authors: Marcello Tonelli, Neesh Pannu, Braden J. MannsAbstract:Hyperphosphatemia, which is nearly universal in Kidney Failure, is accompanied by low serum levels of vitamin D and hypocalcemia. Without treatment, severe secondary hyperparathyroidism occurs, which may result in painful fractures, brown tumors, and generalized osteopenia. This article reviews the rationale for treatment with oral phosphate binders, discusses evidence supporting the use of available agents, and suggests an approach for clinical practice.
Bénédicte Stengel - One of the best experts on this subject based on the ideXlab platform.
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Trends and Outcomes with Kidney Failure from Antineoplastic Treatments and Urinary Tract Cancer in France
Clinical Journal of the American Society of Nephrology, 2020Co-Authors: Imène Mansouri, Natalia Alencar De Pinho, Renaud Snanoudj, Christian Jacquelinet, Mathilde Lassalle, Clémence Béchade, Cécile Vigneau, Florent De Vathaire, Nadia Haddy, Bénédicte StengelAbstract:Background and objectives - Cancer survival is improving along with an increase in the potential for adverse Kidney effects from antineoplastic treatments or nephrectomy. We sought to describe recent trends in the incidence of Kidney Failure related to antineoplastic treatments and urinary tract cancers and evaluate patient survival and Kidney transplantation access. Design, setting, participants, & measurements - We used the French Renal Epidemiology and Information Network registry to identify patients with Kidney Failure related to antineoplastic treatments or urinary tract cancer from 2003 to 2015. We identified 287 and 1157 cases with nephrotoxin- and urinary tract cancer-related Kidney Failure, respectively. The main study outcomes were death and Kidney transplantation. After matching cases to two to ten controls (=11,678) with other Kidney Failure causes for age, sex, year of dialysis initiation, and diabetes status, we estimated subdistribution hazard ratios (SHR) of each outcome separately for patients with and without active malignancy. Results - The mean age- and sex-adjusted incidence of nephrotoxin-related Kidney Failure was 0.43 (95% CI, 0.38 to 0.49) per million inhabitants and 1.80 (95% CI, 1.68 to 1.90) for urinary tract cancer-related Kidney Failure; they increased significantly by 5% and 2% annually, respectively, during 2006-2015. Compared with matched controls, age-, sex-, and comorbidity-adjusted SHRs for mortality in patients with nephrotoxin-related Kidney Failure were 4.2 (95% CI, 3.2 to 5.5) and 1.4 (95% CI, 1.0 to 2.0) for those with and without active malignancy, respectively; for those with urinary tract cancer, SHRs were 2.0 (95% CI, 1.7 to 2.2) and 1.1 (95% CI, 0.9 to 1.2). The corresponding SHRs for transplant wait-listing were 0.19 (95% CI, 0.11 to 0.32) and 0.62 (95% CI, 0.43 to 0.88) for nephrotoxin-related Kidney Failure cases and 0.28 (95% CI, 0.21 to 0.37) and 0.47 (95% CI, 0.36 to 0.60) for urinary tract cancer cases. Once on the waiting list, access to transplantation did not differ significantly between cases and controls. Conclusions - Cancer-related Kidney Failure is slowly but steadily increasing. Mortality does not appear to be increased among patients without active malignancy at dialysis start, but their access to Kidney transplant remains limited.
Hocine Tighiouart - One of the best experts on this subject based on the ideXlab platform.
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Original Investigation Urine Potassium Excretion, Kidney Failure, and Mortality in CKD
2017Co-Authors: Amanda K. Leonberg-yoo, Hocine Tighiouart, Andrew S Levey, Gerald J Beck, Mark J SarnakAbstract:Background: Low urine potassium excretion, as a surrogate for dietary potassium intake, is associated with higher risk for hypertension and cardiovascular disease in a general population. Few studies have investigated the relationship of urine potassium with clinical outcomes in chronic Kidney disease (CKD). Study Design: Longitudinal cohort study. Setting & Participants: The MDRD (Modification of Diet in Renal Disease) Study was a randomized controlled trial (N 5 840) conducted in 1989 to 1993 to examine the effects of blood pressure control and dietary protein restriction on Kidney disease progression in adults aged 18 to 70 years with CKD stages 2 to 4. This post hoc analysis included 812 participants. Predictor: The primary predictor variable was 24-hour urine potassium excretion, measured at baseline and at multiple time points (presented as time-updated average urine potassium excretion). Outcomes: Kidney Failure, defined as initiation of dialysis therapy or transplantation, was determined from US Renal Data System data. All-cause mortality was assessed using the National Death Index. Results: Median follow-up for Kidney Failure was 6.1 (IQR, 3.5-11.7) years, with 9 events/100 patient-years. Median all-cause mortality follow-up was 19.2 (IQR, 10.8-20.6) years, with 3 deaths/100 patient-years. Baseline mean urine potassium excretion was 2.39 6 0.89 (SD) g/d. Each 1-SD higher baseline urine potassium level was associated with an adjusted HR of 0.95 (95% CI, 0.87-1.04) for Kidney Failure and 0.83 (95% CI, 0.74-0.94) for all-cause mortality. Results were consistent using time-updated average urine potassium measurements. Limitations: Analyses were performed using urine potassium excretion as a surrogate for dietary potassium intake. Results are obtained from a primarily young, nondiabetic, and advanced CKD population and may not be generalizable to the general CKD population. Conclusions: Higher urine potassium excretion was associated with lower risk for all-cause mortality, but not Kidney Failure. Am J Kidney Dis. 69(3):341-349. a 2016 by the National Kidney Foundation, Inc.
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Urine Potassium Excretion, Kidney Failure, and Mortality in CKD
American journal of kidney diseases : the official journal of the National Kidney Foundation, 2016Co-Authors: Amanda K. Leonberg-yoo, Hocine Tighiouart, Andrew S Levey, Gerald J Beck, Mark J SarnakAbstract:Background Low urine potassium excretion, as a surrogate for dietary potassium intake, is associated with higher risk for hypertension and cardiovascular disease in a general population. Few studies have investigated the relationship of urine potassium with clinical outcomes in chronic Kidney disease (CKD). Study Design Longitudinal cohort study. Setting & Participants The MDRD (Modification of Diet in Renal Disease) Study was a randomized controlled trial (N = 840) conducted in 1989 to 1993 to examine the effects of blood pressure control and dietary protein restriction on Kidney disease progression in adults aged 18 to 70 years with CKD stages 2 to 4. This post hoc analysis included 812 participants. Predictor The primary predictor variable was 24-hour urine potassium excretion, measured at baseline and at multiple time points (presented as time-updated average urine potassium excretion). Outcomes Kidney Failure, defined as initiation of dialysis therapy or transplantation, was determined from US Renal Data System data. All-cause mortality was assessed using the National Death Index. Results Median follow-up for Kidney Failure was 6.1 (IQR, 3.5-11.7) years, with 9 events/100 patient-years. Median all-cause mortality follow-up was 19.2 (IQR, 10.8-20.6) years, with 3 deaths/100 patient-years. Baseline mean urine potassium excretion was 2.39±0.89 (SD) g/d. Each 1-SD higher baseline urine potassium level was associated with an adjusted HR of 0.95 (95% CI, 0.87-1.04) for Kidney Failure and 0.83 (95% CI, 0.74-0.94) for all-cause mortality. Results were consistent using time-updated average urine potassium measurements. Limitations Analyses were performed using urine potassium excretion as a surrogate for dietary potassium intake. Results are obtained from a primarily young, nondiabetic, and advanced CKD population and may not be generalizable to the general CKD population. Conclusions Higher urine potassium excretion was associated with lower risk for all-cause mortality, but not Kidney Failure.
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urinary sodium excretion and Kidney Failure in nondiabetic chronic Kidney disease
Kidney International, 2014Co-Authors: Hocine Tighiouart, Andrew S Levey, Gerald J Beck, Mark J SarnakAbstract:Current guidelines recommend under 2g/day sodium intake in chronic Kidney disease, but there are a few studies relating sodium intake to long-term outcomes. Here we evaluated the association of mean baseline 24-h urinary sodium excretion with Kidney Failure and a composite outcome of Kidney Failure or all-cause mortality using Cox regression in 840 participants enrolled in the Modification of Diet in Renal Disease Study. Mean 24-h urinary sodium excretion was 3.46g/day. Kidney Failure developed in 617 participants, and the composite outcome was reached in 723. In the primary analyses, there was no association between 24-h urine sodium and Kidney Failure (HR 0.99 (95% CI 0.91–1.08)) nor on the composite outcome (HR 1.01 (95% CI 0.93–1.09)), each per 1g/day higher urine sodium. In exploratory analyses, there was a significant interaction of baseline proteinuria and sodium excretion with Kidney Failure. Using a two-slope model, when urine sodium was under 3g/day, higher urine sodium was associated with increased risk of Kidney Failure in those with baseline proteinuria under 1g/day and with lower risk of Kidney Failure in those with baseline proteinuria of ⩾1g/day. There was no association between urine sodium and Kidney Failure when urine sodium was⩾3g/day. Results were consistent using first baseline and time-dependent urinary sodium excretion. Thus, we noted no association of urine sodium with Kidney Failure. Results of the exploratory analyses need to be verified in additional studies and the mechanism explored.
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a predictive model for progression of chronic Kidney disease to Kidney Failure
JAMA, 2011Co-Authors: Navdeep Tangri, Hocine Tighiouart, Adeera Levin, Lesley A Stevens, John L Griffith, Ognjenka Djurdjev, David Naimark, Andrew S LeveyAbstract:Context Chronic Kidney disease (CKD) is common. Kidney disease severity can be classified by estimated glomerular filtration rate (GFR) and albuminuria, but more accurate information regarding risk for progression to Kidney Failure is required for clinical decisions about testing, treatment, and referral. Objective To develop and validate predictive models for progression of CKD. Design, Setting, and Participants Development and validation of prediction models using demographic, clinical, and laboratory data from 2 independent Canadian cohorts of patients with CKD stages 3 to 5 (estimated GFR, 10-59 mL/min/1.73 m 2 ) who were referred to nephrologists between April 1, 2001, and December 31, 2008. Models were developed using Cox proportional hazards regression methods and evaluated using C statistics and integrated discrimination improvement for discrimination, calibration plots and Akaike Information Criterion for goodness of fit, and net reclassification improvement (NRI) at 1, 3, and 5 years. Main Outcome Measure Kidney Failure, defined as need for dialysis or preemptive Kidney transplantation. Results The development and validation cohorts included 3449 patients (386 with Kidney Failure [11%]) and 4942 patients (1177 with Kidney Failure [24%]), respectively. The most accurate model included age, sex, estimated GFR, albuminuria, serum calcium, serum phosphate, serum bicarbonate, and serum albumin (C statistic, 0.917; 95% confidence interval [CI], 0.901-0.933 in the development cohort and 0.841; 95% CI, 0.825-0.857 in the validation cohort). In the validation cohort, this model was more accurate than a simpler model that included age, sex, estimated GFR, and albuminuria (integrated discrimination improvement, 3.2%; 95% CI, 2.4%-4.2%; calibration [Nam and D’Agostino χ 2 statistic, 19 vs 32]; and reclassification for CKD stage 3 [NRI, 8.0%; 95% CI, 2.1%-13.9%] and for CKD stage 4 [NRI, 4.1%; 95% CI, −0.5% to 8.8%]). Conclusion A model using routinely obtained laboratory tests can accurately predict progression to Kidney Failure in patients with CKD stages 3 to 5.
