Unlocking the Value of Variation in CKD Prevalence

Black, Corri; Veer, Sabine N van der

doi:10.1681/asn.2015111280

Cited by 7 publications

(3 citation statements)

References 15 publications

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“…Black and van der Veer 38 draw on the Darwinian philosophy and note that describing and studying variation will unlock a better understanding of disease, and mechanisms of change. In the era of precision medicine—largely enabled by significant advances in biotechnology—where much attention is being devoted to individual-level characteristics that drive health outcomes, it is important to remain cognizant that ecologic conditions including social, economic, and environmental health of communities matters to health of individuals.…”

Section: Discussionmentioning

confidence: 99%

Geographic Variation and US County Characteristics Associated With Rapid Kidney Function Decline

Bowe

Xie

Xian

et al. 2017

Kidney International Reports

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IntroductionGeographic variation in the prevalence of chronic kidney disease and incidence of end-stage renal disease has been previously reported. However, the geographic epidemiology of rapid estimated glomerular filtration rate (eGFR) decline has not been examined.MethodsWe built a longitudinal cohort of 2,107,570 US veterans to characterize the spatial epidemiology of and examine the associations between US county characteristics and rapid eGFR decline.ResultsThere were 169,029 (8.02%) with rapid eGFR decline (defined as eGFR slope < –5 ml/min per 1.73 m2/year). The prevalence of rapid eGFR decline adjusted for age, race, gender, diabetes, and hypertension varied by county from 4.10%–6.72% in the lowest prevalence quintile to 8.41%–22.04% in the highest prevalence quintile (P for heterogeneity < 0.001). Examination of adjusted prevalence showed substantial geographic variation in those with and without diabetes and those with and without hypertension (P for heterogeneity < 0.001). Cohort participants had higher odds of rapid eGFR decline when living in counties with unfavorable characteristics in domains including health outcomes (odds ratio [OR] = 1.15; confidence interval [CI] = 1.09–1.22), health behaviors (OR = 1.08; CI = 1.03–1.13), clinical care (OR = 1.11; CI = 1.06–1.16), socioeconomic conditions (OR = 1.15; CI = 1.09–1.22), and physical environment (OR = 1.15; CI = 1.01–1.20); living in counties with high percentage of minorities and immigrants was associated with rapid eGFR decline (OR = 1.25; CI = 1.20–1.31). Spatial analyses suggest the presence of cluster of counties with high prevalence of rapid eGFR decline.DiscussionOur findings show substantial geographic variation in rapid eGFR decline among US veterans; the variation persists in analyses stratified by diabetes and hypertension status; results show associations between US county characteristics in domains capturing health, socioeconomic, environmental, and diversity conditions, and rapid eGFR decline.

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Section: Discussionmentioning

confidence: 99%

Geographic Variation and US County Characteristics Associated With Rapid Kidney Function Decline

Bowe

Xie

Xian

et al. 2017

Kidney International Reports

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“…Furthermore, angiotensin II is one of the main players in the pathogenesis of hypertensive nephropathy and subsequent chronic and end-stage renal damage [23] and has been used as an experimental model in rodents, which exhibit upregulation of osteopontin in inflammation, oxidation, and fibrosis in the course of angiotensin II-induced renal injury [24]. Moreover, osteopontin has been shown to be constitutively expressed in human kidney and locally upregulated during inflammation and fibrosis, strengthening the inflammatory function and expression of osteopontin in the renal compartments [17].…”

Section: Discussionmentioning

confidence: 99%

Urinary Osteopontin Predicts Incident Chronic Kidney Disease, while Plasma Osteopontin Predicts Cardiovascular Death in Elderly Men

Feldreich

Carlsson

Helmersson‐Karlqvist³

et al. 2017

Cardiorenal Med

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Background and Objectives: The matricellular protein osteopontin is involved in the pathogenesis of both kidney and cardiovascular disease. However, whether circulating and urinary osteopontin levels are associated with the risk of these diseases is less studied. Design, Setting, Participants, and Measurements: A community-based cohort of elderly men (Uppsala Longitudinal Study of Adult Men [ULSAM]; n = 741; mean age: 77 years) was used to study the associations between plasma and urinary osteopontin, incident chronic kidney disease, and the risk of cardiovascular death during a median of 8 years of follow-up. Results: There was no significant cross-sectional correlation between plasma and urinary osteopontin (Spearman ρ = 0.07, p = 0.13). Higher urinary osteopontin, but not plasma osteopontin, was associated with incident chronic kidney disease in multivariable models adjusted for age, cardiovascular risk factors, baseline glomerular filtration rate, urinary albumin/creatinine ratio, and the inflammatory markers interleukin 6 and high-sensitivity C-reactive protein (odds ratio for 1 standard deviation [SD] of urinary osteopontin, 1.42, 95% CI 1.00-2.02, p = 0.048). Conversely, plasma osteopontin, but not urinary osteopontin, was independently associated with cardiovascular death (multivariable hazard ratio per SD increase, 1.35, 95% CI 1.14-1.58, p < 0.001, and 1.00, 95% CI 0.79-1.26, p = 0.99, respectively). The addition of plasma osteopontin to a model with established cardiovascular risk factors significantly increased the C-statistics for the prediction of cardiovascular death (p < 0.002). Conclusions: Higher urinary osteopontin specifically predicts incident chronic kidney disease, while plasma osteopontin specifically predicts cardiovascular death. Our data put forward osteopontin as an important factor in the detrimental interplay between the kidney and the cardiovascular system. The clinical implications, and why plasma and urinary osteopontin mirror different pathologies, remain to be established.

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“…Several studies described substantial geographic variation in the burden of chronic kidney disease (CKD) that cannot be explained by traditional drivers including diabetes and hypertension 1–4. It was suggested that other risk factors including environmental pollution may explain these geographic variations 5. We recently characterised fine particulate matter of <2.5 µm in aerodynamic diameter (PM 2.5 ) as a novel risk factor for development and progression of kidney disease and described a linear relationship between exposure to levels of PM 2.5 and risk of incident CKD, kidney disease progression and end-stage renal disease 6…”

Section: Introductionmentioning

confidence: 99%

Estimates of the 2016 global burden of kidney disease attributable to ambient fine particulate matter air pollution

Bowe

Xie

Li³

et al. 2019

BMJ Open

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ObjectiveTo quantitate the 2016 global and national burden of chronic kidney disease (CKD) attributable to ambient fine particulate matter air pollution ≤ 2.5 μm in aerodynamic diameter (PM2.5).DesignWe used the Global Burden of Disease (GBD) study data and methodologies to estimate the 2016 burden of CKD attributable to PM2.5in 194 countries and territories. Population-weighted PM2.5levels and incident rates of CKD for each country were curated from the GBD study publicly available data sources.SettingGBD global and national data on PM2.5and CKD.Participants194 countries and territories.Main outcome measuresWe estimated the attributable burden of disease (ABD), years living with disability (YLD), years of life lost (YLL) and disability-adjusted life-years (DALYs).ResultsThe 2016 global burden of incident CKD attributable to PM2.5was 6 950 514 (95% uncertainty interval: 5 061 533–8 914 745). Global YLD, YLL and DALYs of CKD attributable to PM2.5were 2 849 311 (1 875 219–3 983 941), 8 587 735 (6 355 784–10 772 239) and 11 445 397 (8 380 246–14 554 091), respectively. Age-standardised ABD, YLL, YLD and DALY rates varied substantially among geographies. Populations in Mesoamerica, Northern Africa, several countries in the Eastern Mediterranean region, Afghanistan, Pakistan, India and several countries in Southeast Asia were among those with highest age-standardised DALY rates. For example, age-standardised DALYs per 100 000 were 543.35 (391.16–707.96) in El Salvador, 455.29 (332.51–577.97) in Mexico, 408.41 (283.82–551.84) in Guatemala, 238.25 (173.90–303.98) in India and 178.26 (125.31–238.47) in Sri Lanka, compared with 5.52 (0.82–11.48) in Sweden, 6.46 (0.00–14.49) in Australia and 12.13 (4.95–21.82) in Canada. Frontier analyses showed that Mesoamerican countries had significantly higher CKD DALY rates relative to other countries with comparable sociodemographic development.ConclusionsOur results demonstrate that the global toll of CKD attributable to ambient air pollution is significant and identify several endemic geographies where air pollution may be a significant driver of CKD burden. Air pollution may need to be considered in the discussion of the global epidemiology of CKD.

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Unlocking the Value of Variation in CKD Prevalence

Cited by 7 publications

References 15 publications

Geographic Variation and US County Characteristics Associated With Rapid Kidney Function Decline

Geographic Variation and US County Characteristics Associated With Rapid Kidney Function Decline

Urinary Osteopontin Predicts Incident Chronic Kidney Disease, while Plasma Osteopontin Predicts Cardiovascular Death in Elderly Men

Estimates of the 2016 global burden of kidney disease attributable to ambient fine particulate matter air pollution

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