You might be interested in…Nephrology

Kidney diseases are now recognized as a global public health priority. On a world scale, about 861 million individuals are affected by kidney diseases, and the vast majority of these present with chronic kidney disease (CKD). CKD conveys a high risk for coronary artery disease, heart failure, arrhythmias, and sudden cardiac death.

This topic was the subject of a review article¹. The relative risk of death from cardiovascular (CV) disease is related to the patient’s CKD stage. The risk varies from normal in those with no CKD to 8.1 in those with stage G4 disease.1

Indeed, CV complications are the most common causes of death in patients with kidney failure who are maintained on regular dialysis treatment. Because of the high death rate attributable to CV disease, most patients with progressive CKD die before reaching kidney failure.

Diabetes is a major public health challenge and diabetic kidney disease (DKD), a broader diagnostic term than diabetic nephropathy, is the leading cause of chronic kidney disease and end-stage kidney disease in the United States and worldwide. A review article on this topic2 concluded that a better understanding of the underlying pathophysiological mechanisms of DKD, and recent clinical trials testing new therapeutic interventions, have shown promising results to curb this epidemic. Given the global health burden of DKD, it is extremely important to prioritize prevention, early recognition, referral, and aggressive management of DKD in the primary care setting.

Hypertension is also a major cause of end-stage renal disease. This study3 assessed temporal trends in the prevalence of CKD in patients with hypertension in the USA from 1999 to 2018. It was found that the prevalence of CKD remained relatively stable. However, the age-standardized prevalence of stage 1 CKD in hypertension increased from 4.9 per cent in 2003 to 2006 to 7.0 per cent in 2015 to 2018. At the same time the age-standardized prevalence of stages 3 to 5 CKD in hypertension declined from 10.9 per cent in 2011 to 2014 to 8.9 per cent in 2015 to 2018.

To support shared decision making, guidelines recommend that people with CKD are provided with individualised risk predictions of outcomes important to them. Existing prediction tools focus on the outcome of kidney failure. The authors of this study4developed what they called a ‘super learner algorithm’ (called KDPredict) which selected the best performing regression models or machine learning algorithms, based on their ability to predict kidney failure and mortality. The authors of the study claimed that their model outperformed the current benchmark model for kidney failure risk prediction in Denmark and Scotland and provided also accurate risk predictions for mortality.

Sarcopenia is a risk factor for adverse clinical outcomes in CKD patients, including mortality. The authors of this paper conducted a systematic review and meta-analysis to investigate the global prevalence of sarcopenia and its traits across the wide spectrum of CKD.5 A total of 140 studies (42,041 patients) across 25 countries were included. Global prevalence of sarcopenia was 24.5 per cent and did not differ among CKD stages.

Prevalence of sarcopenia varied according to the consensus definition from 11 per cent to 30 per cent. Prevalence of severe sarcopenia was 21.0 per cent, with higher rates for patients on dialysis (26.2 per cent) compared to non-dialysis (3.0 per cent). Sarcopenic obesity was observed in 10.8 per cent. Low muscle strength, the primary sarcopenia trait, was found in almost half of the overall population with CKD. Patients on dialysis were more likely to have low muscle strength and severe sarcopenia. Nephrology professionals should be aware of regularly assessing sarcopenia and its traits in patients with CKD, especially those on dialysis.

References

1. Zoccali C et al. Cardiovascular complications in chronic kidney disease: a review from the European Renal and Cardiovascular Medicine Working Group of the European Renal Association. Cardiovasc Res. 2023 Aug; 119(11): 2017–2032. Published online 2023. doi: 10.1093/cvr/cvad083 PMCID: PMC10478756 PMID: 37249051
2. Gupta S et al. Diabetic Kidney Disease: An Update. Med Clin North Am 2023 Jul;107(4):689-705. doi: 10.1016/j.mcna.2023.03.004
3. Zeng X et al. Prevalence of Chronic Kidney Disease Among US Adults With Hypertension, 1999 to 2018. Hypertension 2023 Oct;80(10):2149-2158. doi: 10.1161/HYPERTENSIONAHA.123.21482
4. Liu P et al. Predicting the risks of kidney failure and death in adults with moderate to severe chronic kidney disease: multinational, longitudinal, population based, cohort study. BMJ 2024;385:e078063 http://dx.doi.org/10.1136/ bmj‑2023‑078063
5. Duarte M et al. Prevalence of sarcopenia in patients with chronic kidney disease: a global systematic review and meta-analysis. Journal of Cachexia, Sarcopenia and Muscle 2024; 15: 501–512 Published online 24 January 2024 in Wiley Online Library (wileyonlinelibrary.com) doi: 10.1002/jcsm.13425