The Future Burden of CKD in the United States: A Simulation Model for the CDC CKD Initiative

Hoerger, Thomas J.; Simpson, Sean A.; Yarnoff, Benjamin; Pavkov, Meda E.; Burrows, Nilka Ríos; Saydah, Sharon; Williams, Desmond E.; Zhuo, Xiaohui

doi:10.1053/j.ajkd.2014.09.023

Cited by 250 publications

(177 citation statements)

References 28 publications

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“…Alternatively in mild to moderate renal impairment in myeloma, sFLCs may only be a small contributing factor and more likely triggered by myeloma related co-morbidities (dehydration, hypercalcaemia and use of non-steroidal anti-inflammatory drugs) [12]. Unrelated co-morbidities may also play a role: in the age population from which myeloma arises approximately 25% of individuals have mild to moderate renal impairment linked to age-related morbidities, such as hypertension, cardiovascular disease and diabetes [26][27][28]. The relationship between sFLC levels assessed by Seralite® and different degrees of renal impairment in myeloma requires exploration in separate studies.…”

Section: Discussionmentioning

confidence: 99%

Multiple Myeloma Can Be Accurately Diagnosed in Acute Kidney Injury Patients Using a Rapid Serum Free Light Chain Test

Drayson

Heaney

Campbell

et al. 2017

Clinical Lymphoma Myeloma and Leukemia

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Background: Acute kidney injury (AKI) is common in patients with multiple myeloma (MM). Whether serum free light chain (sFLC) measurements can distinguish between myeloma and other causes of AKI requires confirmation to guide early treatment. A rapid and portable sFLC test (Seralite®) is newly available and could reduce delays in obtaining sFLC results and accelerate diagnosis in patients with unexplained AKI. This study evaluated the accuracy of Seralite® to identify MM as the cause of AKI. Method: sFLCs were retrospectively analysed in patients with AKI stage 3 as per KDIGO criteria (i.e. serum creatinine ≥354 μmol/L or those on dialysis treatment) (n = 99); 45/99 patients had a confirmed MM diagnosis. Results: The Seralite® κ:λ FLC ratio accurately diagnosed all MM patients in the presence of AKI: a range of 0.14-2.02 returned 100% sensitivity and specificity for identifying all non-myeloma related AKI patients. The sFLC difference (dFLC) also demonstrated high sensitivity (91%) and specificity (100%): an optimal cut-off of 399 mg/L distinguished between myeloma and non-myeloma AKI patients. We propose a pathway of patient screening and stratification in unexplained AKI for use of Seralite® in clinical practice, with a κ:λ ratio range of 0.14-2.02 and dFLC 400 mg/L as decision points. Conclusions: Seralite® accurately differentiates between AKI due to MM and AKI due to other causes in patients considered at risk of myeloma. This rapid test can sensitively screen for MM in patients with AKI and help inform early treatment intervention.

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Section: Discussionmentioning

confidence: 99%

Multiple Myeloma Can Be Accurately Diagnosed in Acute Kidney Injury Patients Using a Rapid Serum Free Light Chain Test

Drayson

Heaney

Campbell

et al. 2017

Clinical Lymphoma Myeloma and Leukemia

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“…[1][2][3] Chronic kidney disease (CKD) has often been indicated as a major contributing factor to this burden, especially in low-and middle-income countries. [4] Initial figures stated that CKD was present in 10% of the world's population. Recently, this figure has risen to 14% in the USA, and by 2030, 27% of North Americans >30 years of age are predicted to have CKD.…”

Section: Cmementioning

confidence: 99%

“…Recently, this figure has risen to 14% in the USA, and by 2030, 27% of North Americans >30 years of age are predicted to have CKD. [4] An added burden to the recent number of people with CKD >45 years old will be markedly increased, taking into consideration that the estimated glomerular filtration rate (eGFR) decreases by 0.75 -1.00 mL/min and, for example, 50% of UK children born in 2007 will live to the age of 103 years. [5] Although no figures for CKD are available in South Africa (SA), it is highly likely that these will be higher in the majority of the SA public, given that end-stage renal failure (ESRF) (CKD stage 5) is 3 -4 times more prevalent in Afro-Americans.…”

Section: Cmementioning

confidence: 99%

Recent important strategies in the management of chronic kidney disease

Meyers

Davies

2017

S Afr Med J

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The burden of chronic kidney disease (CKD) is considerably higher in low-and middle-income countries, which are less able than the developed world to cope with treating advanced renal failure owing to financial constraints. Prevention, early diagnosis and implementation of existing knowledge can improve outcomes. This review presents several recent advances to assist with avoiding and slowing down CKD progression and reducing common comorbid complications. The following are discussed: the possible use of metformin in patients with type 2 diabetes-related CKD; recent inexpensive important developments in the treatment of autosomal-dominant polycystic kidney disease; prevention of acidosis and the early dietary reduction of red meat consumption; and the therapeutic lowering of uric acid in persistent hyperuricaemia. Finally, an active and monitored exercise programme should be undertaken whenever possible. All of these recommendations have been shown to significantly slow the progression of CKD and increase cardiovascular protection. CME 731September 2017, Vol. 107, No. 9 CME addition to the multiple cardiovascular and renal complications of DM, renal dysfunction in the elderly is further compounded by the slow but progressive fall in glomerular filtration rate (GFR) in persons >45 years of age (i.e. ±1 mL/min/year) and also because people live longer. For many years the US Food and Drug Administration (FDA), the Regulatory Cooperation Council (RCC) in Canada and other regulatory bodies have indicated that the use of MF is contraindicated in patients with mild and moderate CKD (stages 3a and 3b) owing to the rarely reported but life-threatening complication of lactic acidosis (LA) (serum lactate levels ≥15 mmol/L).That LA does not occur in patients who receive MF, with an estimated GFR (eGFR) of 50 -30 mL/min., has been indicated in studies conducted by Inzucchi et al. [13] They showed that MF can be safely used in these patients, provided that certain guidelines are always followed. A Coch rane meta-analysis conducted on 47 096 patients with a follow-up of 86 067 patient-years compared the incidence of LA in patients who received MF with those who did not, irrespective of the eGFR.[14] They found that for the upper limit of 95% confidence the true incidence of LA was 6.3/100 000 patient-years for the MF group and 7.8/100 000 patient-years for the non-MF group.It is important to remember that before prescribing MF for any degree of renal function, certain rules are essential and must be fully adhered to. As many practitioners are either unaware or uncertain of the predisposing conditions, these are set out in Table 4.Mechanisms of MF-associated LA are not well elucidated, but include conversion of glucose to lactate in the splanchnic bed and inhibition of hepatic gluconeogenesis (i.e. from lactate, pyruvate and adenine). [15,16] It is essential that any patient with the abovementioned precipi ta ting disorders is instructed to immediately but temporarily withdraw the use of MF and present to a doctor. Patients h...

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“…These results need to be contrasted with other studies that examined lifetime risk of CKD, including retrospective, simulation models in which CKD was defined by only one value of eGFR (7,8). In their longitudinal analysis, Inker et al clearly demonstrated that eGFR decreased progressively with aging; unsurprisingly, the diagnosis of CKD, using a single threshold, increased with aging (6).…”

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confidence: 92%