The case for early identification and intervention of chronic kidney disease: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference

Shlipak, Michael G.; Tummalapalli, Sri Lekha; Boulware, L. Ebony; Grams, Morgan E.; Ix, Joachim H.; Jha, Vivekanand; Kengne, André Pascal; Madero, Magdalena; Mihaylova, Borislava; Tangri, Navdeep; Cheung, Michael; Jadoul, Michel; Winkelmayer, Wolfgang C.; Zoungas, Sophia; Abraham, Georgi; Ademi, Zanfina; Alicic, Radica Z.; Boer, Ian de; Deo, Raj; Ding, Xiaoqiang; Ebert, Natalie; Fowler, Kevin; Fried, Linda F.; Gansevoort, Ron T.; García-García, Guillermo; Hemmelgarn, Brenda R.; Harding, Jessica L.; Hudson, Joanna Q.; Iseki, Kunitoshi; Jotwani, Vasantha; Karliner, Leah; Levey, Andrew S.; Liew, Adrian; Lin, Peter; Luk, Andrea O. Y.; Martínez, V. Rodríguez; Moran, Andrew E.; Nguyễn, Mai Ánh; Obrador, Gregorio T.; O’Donoghue, Dónal; Pavkov, Meda E.; Pavlinac, Jessie M.; Powe, Neil R.; Seegmiller, Jesse C.; Shen, Jenny I.; Shroff, Rukshana; Solá, Laura; Taal, Maarten W.; Tattersall, James; Vassalotti, Joseph A.; Weir, Matthew R.; Zomer, Ella

doi:10.1016/j.kint.2020.10.012

Cited by 320 publications

(285 citation statements)

References 106 publications

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“…CKD is generally underdiagnosed and represents a growing public health problem worldwide 20 . Because its diagnosis relies almost entirely on blood and urine tests, CKD is ideal for developing a computable EHR-based definition.…”

Section: Discussionmentioning

confidence: 99%

“…Our electronic phenotyping approach provides pragmatic means to enhance broad and proactive CKD screening, risk stratification, and timely initiation of treatment to reduce the global burden of kidney disease, as recommended by the 2019 consensus statement of the KDIGO Conference on "Early Identification and Intervention in CKD" 20 . To assure transferability across different EHR systems, our algorithm was developed using training and validation datasets across several institutions, including Columbia University (CU), University of Minnesota (UMN), Vanderbilt University (VU), and Mayo Clinic (MC).…”

Section: Introductionmentioning

confidence: 99%

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Medical records-based chronic kidney disease phenotype for clinical care and “big data” observational and genetic studies

et al. 2021

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Chronic Kidney Disease (CKD) represents a slowly progressive disorder that is typically silent until late stages, but early intervention can significantly delay its progression. We designed a portable and scalable electronic CKD phenotype to facilitate early disease recognition and empower large-scale observational and genetic studies of kidney traits. The algorithm uses a combination of rule-based and machine-learning methods to automatically place patients on the staging grid of albuminuria by glomerular filtration rate (“A-by-G” grid). We manually validated the algorithm by 451 chart reviews across three medical systems, demonstrating overall positive predictive value of 95% for CKD cases and 97% for healthy controls. Independent case-control validation using 2350 patient records demonstrated diagnostic specificity of 97% and sensitivity of 87%. Application of the phenotype to 1.3 million patients demonstrated that over 80% of CKD cases are undetected using ICD codes alone. We also demonstrated several large-scale applications of the phenotype, including identifying stage-specific kidney disease comorbidities, in silico estimation of kidney trait heritability in thousands of pedigrees reconstructed from medical records, and biobank-based multicenter genome-wide and phenome-wide association studies.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Medical records-based chronic kidney disease phenotype for clinical care and “big data” observational and genetic studies

et al. 2021

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“…Chronic kidney disease (CKD) is defined as an abnormality in the kidney structure or function present for >3 months ( 1 ), and has been a public health concern worldwide in recent years ( 1 – 3 ). From 1990 to 2017, the global all-age prevalence of CKD increased by 29.3% [95% uncertainty interval (UI), 26.4 to 32·6%] to 697.5 million (95% UI, 649.2 million to 752.0 million), and all-age mortality increased by 41.5% (95% UI, 35·2 to 46·5%) to 1.2 million (95% UI, 1.2 to 1.3 million) ( 4 ).…”

Section: Introductionmentioning

confidence: 99%

Disease Burden of Chronic Kidney Disease Due to Hypertension From 1990 to 2019: A Global Analysis

et al. 2021

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Background: Although it is widely known that hypertension is an important cause of chronic kidney disease (CKD), little detailed quantitative research exists on the burden of CKD due to hypertension.Objective: The objective of the study is to estimate the global disease burden of CKD due to hypertension and to evaluate the association between the socioeconomic factors and country-level disease burden of CKD due to hypertension.Methods: We extracted the disability-adjusted life-year (DALY) numbers, rates, and age-standardized rates of CKD due to hypertension from the Global Burden of Disease Study 2019 database to investigate the time trends of the burden of CKD due to hypertension from 1990 to 2019. Stepwise multiple linear regression analysis was performed to evaluate the correlations between the age-standardized DALY rate and socioeconomic factors and other related factors obtained from open databases.Results: Globally, from 1990 to 2019, DALY numbers caused by CKD due to hypertension increased by 125.2% [95% confidential interval (CI), 124.6 to 125.7%]. The DALY rate increased by 55.7% (55.3 to 56.0%) to 128.8 (110.9 to 149.2) per 100,000 population, while the age-standardized DALYs per 100,000 population increased by 10.9% (10.3 to 11.5%). In general, males and elderly people tended to have a higher disease burden. The distribution disparity in the burden of CKD due to hypertension varies greatly among countries. In the stepwise multiple linear regression model, inequality-adjusted human development index (IHDI) [β = −161.1 (95% CI −238.1 to −84.2), P < 0.001] and number of physicians per 10,000 people [β = −2.91 (95% CI −4.02 to −1.80), P < 0.001] were significantly negatively correlated with age-standardized DALY rate when adjusted for IHDI, health access and quality (HAQ), number of physicians per 10,000 people, and population with at least some secondary education.Conclusion: Improving the average achievements and equality of distribution in health, education, and income, as well as increasing the number of physicians per 10,000 people could help to reduce the burden of CKD due to hypertension. These findings may provide relevant information toward efforts to optimize health policies aimed at reducing the burden of CKD due to hypertension.

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“…Consequently, a patient with an overestimated eGFR may suffer an accelerated progression to ESKD and premature mortality from cardiovascular disease. 23 In advanced CKD stages, eGFR overestimation may result in delayed referral to a nephrologist (recommended at eGFR < 30mL/min/1.73 m 2 ), nutrition counseling, renal replacement therapy education, timely referral for renal replacement therapy access placement, and transplant evaluation (can be listed when eGFR < 20 mL/min/1.73 m 2 ). 16,24,25 In the Clinical Vignette, it is clear from the information presented that Mr. C' s concerns are well-founded.…”

Section: Clinical Consequences Of Race Coefficient Usementioning

confidence: 99%

A Step Toward Health Equity for Veterans: Evidence Supports Removing Race From Kidney Function Calculations

Conner¹,

Jain

Khan

et al. 2021

Federal Practitioner

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Background: The practice of race-based medicine fails to recognize that race cannot be used as a proxy for genetic ancestry and that racial and ethnic categories are complex sociopolitical constructs without biological basis. Clinical algorithms and equations that incorporate race modifiers and are currently considered standard for diagnosis and management of disease are appropriately being scrutinized for lack of biological plausibility and their role in exacerbating health inequities. In this paper, we review the history, evidence, and implications of using a Black race coefficient when calculating estimated glomerular filtration rate (eGFR) in the diagnosis and management of kidney disease. Observations: Currently, the US Department of Veterans Affairs (VA) uses the Modification of Diet in Renal Disease (MDRD) equation for eGFR. This equation includes a Black race coefficient that results in an eGFR that is 21% higher for a Black patient when compared with a patient of any other race. The rationale for the inclusion of this coefficient is based on racist science that incorrectly assumes race as a proxy for genetic ancestry. Multiple studies across diverse Black populations demonstrate that the application of a race coefficient in kidney function estimation equations is inferior when compared with the race-neutral option. Furthermore, the most utilized eGFR equations are biased and imprecise. Because eGFR is the primary diagnostic method for detecting and managing kidney disease, preventing its progression, planning for dialysis, and evaluating for transplantation, it is vital that eGFR be as accurate, precise, and equitable as possible. Conclusions: The incorporation of a race coefficient in kidney estimation equations lacks biological plausibility and its use exacerbates kidney health disparities. Until a better method to estimate kidney function becomes available, a race-neutral option for current estimation equations should be applied for all patients.

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The case for early identification and intervention of chronic kidney disease: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference

Cited by 320 publications

References 106 publications

Medical records-based chronic kidney disease phenotype for clinical care and “big data” observational and genetic studies

Medical records-based chronic kidney disease phenotype for clinical care and “big data” observational and genetic studies

Disease Burden of Chronic Kidney Disease Due to Hypertension From 1990 to 2019: A Global Analysis

A Step Toward Health Equity for Veterans: Evidence Supports Removing Race From Kidney Function Calculations

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