Diabetic Cardiovascular Disease Predicts Chronic Kidney Disease Awareness in the Kidney Early Evaluation Program

Whaley‐Connell, Adam; Bomback, Andrew S.; McFarlane, Samy I.; Li, Suying; Roberts, Tricia; Chen, Shu‐Cheng; Collins, Allan J.; Norris, Keith C.; Bakris, George L.; Sowers, James R.; McCullough, Peter A.

doi:10.1159/000322862

Cited by 19 publications

(17 citation statements)

References 25 publications

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“…6 However, hypertension and diabetes have a longer history of understanding by primary care healthcare providers and public health awareness campaigning. Previous studies have reported that more men than women were aware of their diagnosis of CKD, 6,7 and the present study has found similarly that 64% of those who were not aware of their diagnosis were female. When analysing variables associated with awareness, risk factors for CKD and cardiovascular disease surprisingly did not show a significant association in the present study cohort.…”

Section: Comparison With Existing Literaturesupporting

confidence: 73%

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Treatment needs and diagnosis awareness in primary care patients with chronic kidney disease

et al. 2012

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BackgroundGPs in England are required to keep a register of patients with chronic kidney disease (CKD). National Institute for Health and Clinical Excellence (NICE) guidelines recommend regular follow-up, but patients are perceived to be low risk and not requiring active management. AimTo assess treatment needs of CKD stage 3 patients in primary care, as well as their awareness of CKD. Design and settingA cross-sectional analysis from a longitudinal prospective study in 32 general practices. MethodA total of 1741 participants underwent clinical assessment including urine and blood tests. Participants were asked about awareness of their CKD. Results were reviewed and a letter recommending treatment in line with NICE guidelines was sent to their GP. ResultsThe mean age of participants was 73 ± 9 years; 60% (n = 1052) were female and diabetes was present in 17%; 67% of participants required further intervention. Most required improved control of hypertension (n = 1576; 33.1% of cohort). Other recommendations included advice to investigate anaemia (n = 1142; 8.2%) or stop nephrotoxic drugs (n = 1120; 7.5%). Less than 6% of participants met NICE criteria for referral to nephrology services and 41% were unaware of their CKD diagnosis. Multivariable analysis identified subjects with formal educational qualifications, age <75 years, estimated glomerular filtration rate (eGFR) 30-44 ml/min/1.73 m 2 , and significant albuminuria as more likely to be aware of their diagnosis. ConclusionThe study data show that the majority of patients required at least one intervention to improve the management of their CKD. Most interventions could be delivered in primary care and only a minority required nephrology referral. Many patients were unaware of their CKD diagnosis, and efforts should be made to improve this to facilitate involvement in their care. Keywordsawareness; kidney disease, chronic; primary care; treatment.e227 British Journal of General Practice, April 2012 who had previously had a solid organ transplant or were terminally ill (expected survival <1 year) were excluded. Data collectionThe first study visits were conducted from August 2008 to March 2010. Participants were sent a medical questionnaire and urine specimen bottles and were asked not to eat cooked meat for at least 12 hours prior to the assessment. 5Anthropomorphic and blood pressure measurements were taken. Blood and urine specimens were submitted for analysis. Diabetes was defined in line with World Health Organization (WHO) criteria.10 A previous cardiovascular event (CVE) was defined as subject-reported myocardial infarction, stroke, transient ischaemic attack, revascularisation, amputation due to peripheral vascular disease, or aortic aneurysm. Blood pressure was measured after a minimum of 5 minutes' rest in the sitting position, and calculated as the mean of three readings that were within 10% of each other. Hypertension was defined as systolic blood pressure ≥140 mmHg, diastolic blood pressure ≥90 mmHg, or current antihypertensive medication....

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Section: Comparison With Existing Literaturesupporting

confidence: 73%

“…Nevertheless, studies from the US suggest that patient awareness of CKD is poor. 6,7 A second aim of this study was to assess awareness of the diagnosis in the study cohort of patients with CKD stage 3.…”

Section: Introductionmentioning

confidence: 99%

Treatment needs and diagnosis awareness in primary care patients with chronic kidney disease

et al. 2012

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“…In the absence of CKD, normal serum levels of phosphorus and calcium are maintained through integrative actions of two hormones: parathyroid hormone (PTH) and 1,25-dihydroxyvitamin D 3 (calcitriol), the principal metabolite that activates the vitamin D receptor [20][21][22][23][24][25][26][27][28][29] . There is also increasing evidence to support the existence of various factors (historically known as phosphatonins) that directly control the renal excretion of phosphorus, and elucidation of their precise role in the regulation of phosphorus metabolism is an area of active research [20,29,30] .…”

Section: Normal Phosphate Homeostasis and Alterations In Ckdmentioning

confidence: 99%

“…The prevalence of CKD is approaching epidemic proportions worldwide [1,2] . More than 26 million Americans, or 13% of the total population, have CKD [3] . Most patients with CKD die prematurely, not from kidney failure, but from early onset of common diseases, such as cardiovascular disease (CVD), cancer, and infection [3][4][5][6][7][8][9][10] .…”

Section: Introductionmentioning

confidence: 99%

“…More than 26 million Americans, or 13% of the total population, have CKD [3] . Most patients with CKD die prematurely, not from kidney failure, but from early onset of common diseases, such as cardiovascular disease (CVD), cancer, and infection [3][4][5][6][7][8][9][10] . There is increasing evidence suggesting that abnormalities in mineral metabolism in CKD play a major role in accelerating CVD and metabolic abnormalities associated with CKD [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] .…”

Section: Introductionmentioning

confidence: 99%

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Phosphate Metabolism in Cardiorenal Metabolic Disease

Gupta

Brietzke²,

Hayden³

et al. 2011

Cardiorenal Med

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Hyperphosphatemia is a major risk factor for cardiovascular disease, abnormalities of mineral metabolism and bone disease, and the progression of renal insufficiency in patients with chronic renal disease. In early renal disease, serum phosphate levels are maintained within the 'normal laboratory range' by compensatory increases in phosphaturic hormones such as fibroblast growth factor-23 (FGF-23). An important co-factor for FGF-23 is Klotho; a deficiency in Klotho plays an important role in the pathogenesis of hyperphosphatemia, renal tubulointerstitial disease, and parathyroid and bone abnormalities. Clinical hyperphosphatemia occurs when these phosphaturic mechanisms cannot counterbalance nephron loss. Hyperphosphatemia is associated with calcific uremic arteriolopathy and uremic cardiomyopathy, which may explain, in part, the epidemiologic connections between phosphate excess and cardiovascular disease. However, no clinical trials have been conducted to establish a causal relationship, and large, randomized trials with hard endpoints are urgently needed to prove or disprove the benefits and risks of therapy. In summary, hyperphosphatemia accelerates renal tubulointerstitial disease, renal osteodystrophy, as well as cardiovascular disease, and it is an important mortality risk factor in patients with chronic kidney disease.

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The Landscape of Diabetic Kidney Disease in the United States

et al. 2018

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Purpose of ReviewThe purposes of this review are to identify population characteristics of important risk factors for the development and progression of diabetic kidney disease (DKD) in the United States and to discuss barriers and opportunities to improve awareness, management, and outcomes in patients with DKD.Recent FindingsThe major risk factors for the development and progression of DKD include hyperglycemia, hypertension, and albuminuria. DKD disproportionately affects minorities and individuals with low educational and socioeconomic status. Barriers to effective management of DKD include the following: (a) limited patient and healthcare provider awareness of DKD, (b) lack of timely referrals of patients to a nephrologist, (c) low patient healthcare literacy, and (d) insufficient access to healthcare and health insurance.SummaryIncreased patient and physician awareness of DKD has been shown to enhance patient outcomes. Multifactorial and multidisciplinary interventions targeting multiple risk factors and patient/physician education may provide better outcomes in patients with DKD.Electronic supplementary materialThe online version of this article (10.1007/s11892-018-0980-x) contains supplementary material, which is available to authorized users.

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Diabetic Cardiovascular Disease Predicts Chronic Kidney Disease Awareness in the Kidney Early Evaluation Program

Cited by 19 publications

References 25 publications

Treatment needs and diagnosis awareness in primary care patients with chronic kidney disease

Treatment needs and diagnosis awareness in primary care patients with chronic kidney disease

Phosphate Metabolism in Cardiorenal Metabolic Disease

The Landscape of Diabetic Kidney Disease in the United States

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