Disproportionately high incidence of diabetes-related end-stage renal disease in the Canary Islands. An analysis based on estimated population at risk

Lorenzo, V.; Boronat, Mauro; Saavedra, Pedro; Rufino, Margarita; Maceira, B.; Nóvoa, Francisco J.; Torres, Armando

doi:10.1093/ndt/gfp761

Cited by 25 publications

(18 citation statements)

References 12 publications

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“…First, it is a single centre study with a small sample size. In addition, it has been conducted in the Canary Islands, a particular geographical area where a disproportionate proportion of cases of advanced CKD are related to diabetes [40] . As a consequence, these findings should be confirmed on other populations.…”

Section: Discussionmentioning

confidence: 99%

Relationship between Anemia and Serum Concentrations of Calcium and Phosphorus in Advanced Non-Dialysis-Dependent Chronic Kidney Disease

Boronat¹,

Santana²,

Bosch³

et al. 2016

Nephron

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Background/Aims: Different biochemical abnormalities of metabolic bone disease have been associated with anemia of chronic kidney disease (CKD), mainly in hemodialysis patients. However, all of these abnormalities are closely inter-related and their individual effect on the development of anemia is uncertain. This study was aimed to assess the relationship between anemia and a set of metabolic bone disease biomarkers in a cohort of adult patients with advanced non-dialysis-dependent CKD. Methods: The sample consisted of 382 patients submitted to a Nephrology Unit for evaluation of advanced CKD in a tertiary hospital from Gran Canaria during 3 years. Associations between anemia and serum levels of calcium (albumin-corrected), phosphorus, PTH, 25-hydroxivitamin D (25(OH)D₃) and alkaline phosphatase were analyzed by using logistic regression models with adjustment for other demographic, clinical and biochemical covariates potentially related to anemia and to bone mineral metabolism. Results: Serum levels of calcium and 25(OH)D₃ (negatively) and phosphorus (positively) were significantly associated with anemia in an unadjusted logistic regression model. In a fully adjusted multivariable model, the OR for anemia was 0.29 (95% CI 0.16-0.49; p < 0.0001) for every 1 mg/dl increase in serum calcium and 2.19 (95% CI 1.55-3.15; p < 0.001) for every 1 mg/dl increase in serum phosphorus. Female sex and lower serum albumin levels were also independently associated with anemia. The inclusion of albumin in the adjusted model displaced the significance of 25(OH)D₃. Conclusions: Circulating levels of calcium and phosphorus are strongly linked to anemia in patients with advanced non-dialysis CKD.

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Section: Discussionmentioning

confidence: 99%

Relationship between Anemia and Serum Concentrations of Calcium and Phosphorus in Advanced Non-Dialysis-Dependent Chronic Kidney Disease

Boronat¹,

Santana²,

Bosch³

et al. 2016

Nephron

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“…Microvascular complications, including retinopathy, neuropathy, and kidney disease also account for a highly significant morbidity, mortality, and economic burden [ 54 ] among patients with T2DM. The incidence of these complications and their healthcare and social and economic consequences is higher in the Canary Islands than in the rest of Spain and most western countries [ 2 - 4 ].…”

Section: Discussionmentioning

confidence: 99%

“…In the Canary Islands, Spain, the prevalence of T2DM in the population over 15 years is 7.74%, slightly higher than the Spanish average (6.99%) [ 1 ]. However, the Canary Islands have an increased prevalence of diabetes-related end-stage renal disease [ 2 - 4 ] and diabetes-related mortality [ 5 ], when compared to the rest of Spain, with 65 vs 20–30 cases/million population and 7.8% vs 2.5%, respectively. This happens despite the fact that patients with diabetes mellitus (DM) have a mean number of ten visits/year to their primary care physician/nurse in the Canary Islands [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Effectiveness and cost-effectiveness of knowledge transfer and behavior modification interventions in type 2 diabetes mellitus patients—the INDICA study: a cluster randomized controlled trial

et al. 2015

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BackgroundType 2 diabetes mellitus is a chronic disease whose health outcomes are related to patients and healthcare professionals’ decision-making. The Diabetes Intervention study in the Canary Islands (INDICA study) aims to evaluate the effectiveness and cost-effectiveness of educational interventions supported by new technology decision tools for type 2 diabetes patients and primary care professionals in the Canary Islands.Methods/designThe INDICA study is an open, community-based, multicenter, clinical controlled trial with random allocation by clusters to one of three interventions or to usual care. The setting is primary care where physicians and nurses are invited to participate. Patients with diabetes diagnosis, 18–65 years of age, and regular users of mobile phone were randomly selected. Patients with severe comorbidities were excluded. The clusters are primary healthcare practices with enough professionals and available places to provide the intervention. The calculated sample size was 2,300 patients.Patients in group 1 are receiving an educational group program of eight sessions every 3 months led by trained nurses and monitored by means of logs and a web-based platform and tailored semi-automated SMS for continuous support. Primary care professionals in group 2 are receiving a short educational program to update their diabetes knowledge, which includes a decision support tool embedded into the electronic clinical record and a monthly feedback report of patients’ results. Group 3 is receiving a combination of the interventions for patients and professionals.The primary endpoint is the change in HbA1c in 2 years. Secondary endpoints are cardiovascular risk factors, macrovascular and microvascular diabetes complications, quality of life, psychological outcomes, diabetes knowledge, and healthcare utilization. Data is being collected from interviews, questionnaires, clinical examinations, and records. Generalized linear mixed models with repeated time measurements will be used to analyze changes in outcomes.The cost-effectiveness analysis, from the healthcare services perspective, involves direct medical costs per quality-adjusted life year gained and two periods, a ‘within-trial’ period and a lifetime Markov model. Deterministic and probabilistic sensitivity analyses are planned.DiscussionThis ongoing trial aims to set up the implementation of evidence-based programs in the clinical setting for chronic patients.Trial registrationClinical Trial.gov NCT01657227

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“…This finding is compatible with the high prevalence of the metabolic syndrome among general Canarian population, 14 but it could also be somehow related to the fact that the Canary Islands are characterized by a disproportionately high incidence of end-stage diabetes-related CKD. 23 In this regard, an increased prevalence of the metabolic syndrome has been observed among relatives of patients with endstage renal disease (ESRD). 24 In our study, apart from age, family history of diabetes was the variable most strongly associated with the metabolic syndrome.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and determinants of the metabolic syndrome among subjects with advanced nondiabetes-related chronic kidney disease in Gran Canaria, Spain

et al. 2015

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Disproportionately high incidence of diabetes-related end-stage renal disease in the Canary Islands. An analysis based on estimated population at risk

Abstract: Individuals with diabetes in the Canary Islands present a disproportionately high incidence of ESRD. Diabetic Canary inhabitants are exposed to the disease for a longer time and therefore, may be more vulnerable to the development of chronic diabetes complications, including ESRD.

Cited by 25 publications

References 12 publications

Relationship between Anemia and Serum Concentrations of Calcium and Phosphorus in Advanced Non-Dialysis-Dependent Chronic Kidney Disease

Relationship between Anemia and Serum Concentrations of Calcium and Phosphorus in Advanced Non-Dialysis-Dependent Chronic Kidney Disease

Effectiveness and cost-effectiveness of knowledge transfer and behavior modification interventions in type 2 diabetes mellitus patients—the INDICA study: a cluster randomized controlled trial

Prevalence and determinants of the metabolic syndrome among subjects with advanced nondiabetes-related chronic kidney disease in Gran Canaria, Spain

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