Long-term, flexible therapy strategies are needed for chronic diseases like cardiovascular ailments, diabetes, and chronic kidney disease and they have to deal with patient heterogeneity, changing physiological states and privacy constraints. This research suggests a framework for privacy-preserving and personalized artificial intelligence that combines Federated Learning (FL), a Res-HyperTransformerNet deep prediction model, Personalized Multi-Agent Reinforcement Learning (PMARL) and Explainable Artificial Intelligence (XAI) for adaptive chronic disease management. The framework is structured with two main aims: (i) to create an accurate and privacy-aware predictive model for chronic disease risk using diverse data sources, and (ii) to permit adaptive, individual therapy optimization through multi-agent reinforcement learning. Federated learning is utilized to conduct the training of Res-HyperTransformerNet over distributed Internet of Medical Things (IoMT) nodes without the requirement of transferring raw patient data. The embeddings that are created from patient data are then passed on to a PMARL module, where several agents optimize therapy dimensions like medications, diet, physical activity, and mental health interventions independently. To make the clinical support more understandable, the SHAP-based explainability method is used for both predictive and decision-making parts. The framework is tested using two public datasets—the CDC Chronic Disease dataset and the UCI Chronic Kidney Disease Risk Factor dataset. The performance is measured by employing classification metrics (accuracy, precision, recall, F1-score, MCC) as well as reinforcement learning metrics (reward score, convergence steps, episode return) and federated system metrics (communication overhead, convergence rounds, and training time). The experiments indicate that the proposed framework demonstrated improved performance in terms of predictive accuracy and policy convergence speed compared to the baseline deep learning and reinforcement learning models, and at the same time it is more cost-effective when it comes to communication in a federated setting. This means that the proposed method suggests the potential of being a reproducible and open AI framework for adaptive chronic disease therapy management. The combination of ResNet and Transformer blocks, i.e., Federated Res-HyperTransformerNet, achieved strong performance in both datasets, namely CDC Chronic Disease (Dataset 1) and UCI CKD Risk Factor (Dataset 2). The obtained accuracy for Dataset 1 was 98.61% and for Dataset 2, it was 97.75%, under the conducted experimental settings.
96A Risk Score for Chronic Kidney Disease in the General Population
A Risk Score for Chronic Kidney Disease in the General Population
1Nutrition and Kidney Health: Processing Emerging Evidence About Foods
Nutrition and Kidney Health: Processing Emerging Evidence About Foods
20Awareness and Discussions About Chronic Kidney Disease Among African-Americans with Chronic Kidney Disease and Hypertension: a Mixed Methods Study.
Routine primary care visits provide an educational opportunity for African-Americans with chronic kidney disease (CKD) and CKD risk factors such as hypertension. The nature of patient-physician discussions about CKD and their impact on CKD awareness in this population have not been well explored. To characterize patient CKD awareness and discussions about CKD between patients and primary care physicians (PCPs). Mixed methods study. African-American patients with uncontrolled hypertension (≥ 140/90 mmHg) and CKD (albuminuria or eGFR < 60 ml/min/1.73 m2) recruited from an urban primary care clinic. We assessed patient CKD awareness with questionnaires and audio-recorded patients-PCP discussions during a routine visit. We characterized discussions and used multivariate regression analysis to identify independent patient and visit predictors of CKD awareness or CKD discussions. Among 48 African-American patients with uncontrolled hypertension and CKD, 29% were aware of their CKD. After adjustment, CKD awareness was associated with moderate-severe CKD (stages 3-4) (vs. mild CKD [stages 1-2]) (prevalence ratio [PR] 2.82; 95% CI 1.18-6.78) and inversely associated with diabetes (vs. without diabetes) (PR 0.28; 95% CI 0.10-0.75). CKD discussions occurred in 30 (63%) visits; most focused on laboratory assessment (n = 23, 77%) or risk factor management to delay CKD progression (n = 19, 63%). CKD discussions were associated with moderate-severe CKD (vs. mild CKD) (PR 1.57; 95% CI 1.04-2.36) and diabetes (vs. without diabetes) (PR 1.42; 95% CI 1.09-1.85), and inversely associated with uncontrolled hypertension (vs. controlled) (PR 0.58; 95% CI 0.92-0.89). In subgroup analysis, follow-up CKD awareness did not change by presence or absence of CKD discussion (10.5% vs. 7.7%, p = 0.8). In patients at risk of CKD progression, few were aware of CKD, and CKD discussions were not associated with CKD awareness. More resources may be needed to enhance the clarity of clinical messages regarding CKD and its significance for patients' health. ClinicalTrials.gov Identifier: NCT01902719.
Read more89Risk Factors for Chronic Kidney Disease in Adults with Cystic Fibrosis
Adults with cystic fibrosis (CF) possess multiple potential risk factors for chronic kidney disease, including CF-related diabetes (CFRD) and lifetime nephrotoxic drug exposure. To determine whether cumulative intravenous (IV) aminoglycoside exposure and CFRD increase the risk of chronic kidney disease in adults with CF. This was a cohort study using adults (≥ 18 yr) in the CF Foundation registry from 2001-2008. Chronic kidney disease (stage 3 or greater) was defined by an estimated glomerular filtration rate of less than 60 ml/min/1.73 m(2). Time-dependent multivariable Cox proportional hazards models were used to determine whether cumulative number of acute pulmonary exacerbations (surrogate for IV aminoglycoside exposure) and CFRD requiring insulin increase the risk of chronic kidney disease, adjusting for confounders. The study cohort included 11,912 adults with a median follow-up of 4 years. During the study period, 204 subjects had chronic kidney disease, with an annual disease prevalence of 2.3%. Disease prevalence doubled with every 10-year increase in age. CFRD requiring insulin therapy substantially increased the risk of chronic kidney disease (1-4 yr of CFRD requiring insulin vs. no CFRD, hazard ratio [HR] = 2.40, 95% confidence interval [CI] 1.74-3.32; ≥ 5 yr, HR = 4.56, 95% CI 2.84-7.31). Pulmonary exacerbations did not significantly increase the risk of chronic kidney disease (one to five exacerbations vs. none, HR = 0.79, 95% CI 0.56-1.11; six to nine exacerbations, HR = 0.92, 95% CI 0.58-1.46; ≥ 10 exacerbations, HR = 1.16, 95% CI 0.75-1.81). CF-related diabetes is a significant risk factor for chronic kidney disease in adults with CF, but additional studies examining IV aminoglycoside exposure directly are required.
Read more10Reply to: Correspondence on “EASL Clinical Practice Guidelines on non-invasive tests for evaluation of liver disease severity and prognosis – 2021 update”
Reply to: Correspondence on “EASL Clinical Practice Guidelines on non-invasive tests for evaluation of liver disease severity and prognosis – 2021 update”
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98Epidemiology of chronic kidney disease in adults of Salvadoran agricultural communities.
In El Salvador, chronic kidney disease is a serious and growing public health problem. Chronic renal failure was the first cause of hospital deaths in men and the fifth in women in 2011. Determine prevalence of CKD, CKD risk factors (traditional and nontraditional) and renal damage markers in the adult population of specific rural areas in El Salvador; measure population distribution of renal function; and identify associated risk factors in CKD patients detected. A cross-sectional analytical epidemiological study was conducted based on active screening for chronic kidney disease and risk factors in persons aged ≥18 years during 2009-2011. Epidemiological and clinical data were gathered through personal history, as well as urinalysis for renal and vascular damage markers, determinations of serum creatinine and glucose, and estimation of glomerular filtration rates. Chronic kidney disease cases were confirmed at three months. Multiple logistical regression was used for statistical analysis. Prevalence of chronic kidney disease was 18% (23.9% for men and 13.9% for women) in 2388 persons: 976 men and 1412 women from 1306 families studied. Chronic kidney disease with neither diabetes nor hypertension nor proteinuria ≥1 g/L (51.9%) predominated. Prevalence of chronic renal failure was 11% (17.1% in men and 6.8% in women). Prevalence of renal damage markers was 12.5% (higher in men): microalbuminuria, 6.9%; proteinuria (0.3 g/L), 1.7%; proteinuria (1g/L), 0.6%; proteinuria (2 g/L), 0.4 %; and hematuria, 1.5%. Prevalence of chronic kidney disease risk factors was: diabetes mellitus, 9%; hypertension, 20.9%; family history of chronic kidney disease, 16.5%; family history of diabetes mellitus, 18.5%; family history of hypertension, 30.6%; obesity, 21%; central obesity, 24.9%; NSAID use, 84.2%; smoking, 9.9%; alcohol use, 15%; agricultural occupation, 31.2%; and contact with agrochemicals, 46.7%. Chronic kidney disease was significantly associated with male sex, older age, hypertension, agricultural occupation, family history of chronic kidney disease and contact with the agrochemical methyl parathion. The results of this study support suggestions from other research that we are facing a new form of kidney disease that could be called agricultural nephropathy.
Read more1Perfil nutricional de adultos e idosos atendidos na rede municipal de saúde de Manaus e sua associação a doenças crônico-degenerativas
Introduction: The increasing incidence of overweight raises the question about the risks of chronic degenerative diseases. Objective: This study aimed to investigate the nutritional profile of adults and elderly and their association with chronic degenerative diseases in patients seen at polyclinics in different zones Polyclinic A (North Zone) and Polyclinic B (South Zone) in Manaus-Am in January-March period of 2009. Patients and Methods: We studied 129 individuals of both sexes aged from 19 years. Results: Body Mass Index - BMI average was 19.14 ± 4.11 in the Polyclinic A and 18.2 ± 4.58 in the Polyclinic B. Association were found in obese women, high waist circumference with risk for development of cardiovascular diseases (p> 0.05). In relation to food consumption, was not seen high levels of dietary misconceptions by analyzed, however, was found in two polyclinics studied a high rate of individuals at risk for cardiovascular disease. Conclusion: The results regarding the prevalence of some risk factors for chronic diseases showed that both the adults and the elderly are at risk for cardiovascular diseases, mainly due to high values of waist circumference, although not proven with the dietary habits.
Read more13Milestones in DRI Development: What Does the Future Hold?
Milestones in DRI Development: What Does the Future Hold?
13Association of intraabdominal fat with the risk of incident chronic kidney disease according to body mass index among Korean adults.
The association between abdominal visceral adipose tissue and the risk of incident chronic kidney disease according to body mass index in the Asian population, remains unclear. We evaluated the impact of abdominal adiposity stratified by body mass index on the risk of incident chronic kidney disease. A cohort study included 11,050 adult participants who underwent health check-ups and re-evaluated the follow-up medical examination at a single university-affiliated healthcare center. Cross-sectional abdominal adipose tissue areas were measured using computed tomography. The primary outcome was progression to chronic kidney disease (estimated glomerular filtration rate <60 ml/min/1.73m2). The highest quartile of visceral adipose tissue was used for the cut-off of central obesity. During the mean of 5.6 follow-up years, 104 incident chronic kidney disease cases were identified. The risk for chronic kidney disease incidence was significantly increased in the 3rd and 4th quartile ranges of visceral adipose tissue [hazard ratio (95% confidence interval)]: 4.59 (1.48-14.30) and 7.50 (2.33-24.20), respectively. In the analysis stratified by body mass index, the chronic kidney disease incidence risk was increased in the highest quartile range of visceral adipose tissue in the normal weight group: 7.06 (1.35-37.04). However, there was no significant relationship between visceral adipose tissue and chronic kidney disease in the obese group. Compared to the subjects with normal weight and absent central obesity, the hazard ratio for chronic kidney disease incidence was 2.32 (1.26-4.27) among subjects with normal weight and central obesity and 1.81 (1.03-3.15) among subjects with obesity and central obesity. Visceral adipose tissue was a significant risk factor for subsequent chronic kidney disease progression, and the association was identified only in the normal weight group. Normal-weight central obesity was associated with excess risk of chronic kidney disease, similar to the risk in the group with obesity and central obesity.
Read more1Bitter Taste Sensitivity, Food Cravings, and Risk of Chronic Disease: A Cross-Sectional Study.
Variation in common taste receptor type 2 member 38 (TAS2R38) haplotypes is associated with bitter taste sensitivity, but there is not much or inconsistent evidence on association with food cravings and with chronic disease risk factors. We have conducted a cross-sectional study to assess whether genetically defined taster groups would differ in their sensitivity to bitter-tasting compounds, cravings for various food groups, and risk of chronic disease risk factors. Methodology: A total of 116 non-diabetic individuals were recruited from the Loma Linda University (LLU) campus. Various measures were carried out to examine genetic variations, bitter sensitivity, anthropometrics, food cravings, and participant demographics. Taster status was determined based on TAS2R38 haplotypes, classifying participants as super-tasters, tasters, or non-tasters. Analysis of Covariance (ANCOVA) models were used to examine differences among the three TAS2R38 genetic groups in bitter taste sensitivity, food cravings, body mass index (BMI), non-fasting blood glucose, and family history of type 2 diabetes (T2D). A significant difference in sensitivity to the bitter taste compounds thiourea and phenylthiocarbamide (PTC) was observed among the three TAS2R38 genetic groups (P < 0.01). The sensitivity scores of the bitter taste compounds thiourea and PTC werelowest for super-tasters and highest for non-tasters (-41.283 and -0.233 for thiourea; -32.983and 3.380 for PTC, respectively). Moreover, super-tasters had a significantly higher cravings score than non-tasters for starchy foods (2.641 vs. 2.183, respectively). Tasters had a significantly higher cravings score than non-tasters for bitter foods (2.306 vs. 1.740, respectively). No significant differences were observed across the TAS2R38 genetic-based taste groups for the chronic disease risk factors, BMI non-fasting blood glucose, and family history of T2D. Super-tasters had the lowest taste sensitivity for bitter compounds and the highest cravings for bitter foods, which suggests that they might be more likely to consume bitter foods. Examining the genetic differences in taste preferences and sensitivities may pave the way for effective and individualized dietary plans and intervention strategies targeting chronic disease prevention, treatment, and management.
Read more1Relationship between Abdominal Obesity and Prevalence of Other Chronic Diseases in Korean Adults: Based on the Korea National Health and Nutrition Examination Survey 2016 to 2020
Background: The burden of disease caused by obesity is high worldwide, and the rate of obesity among adult men in Korea is increasing rapidly. Previous studies have shown that people with abdominal obesity have a higher risk of chronic diseases, including cardiovascular disease. Therefore, in this study, we analyzed the association between abdominal obesity and the risk of chronic diseases among Korean adults.Methods: Using raw data from the Korea National Health and Nutrition Examination Survey 2016-2020, adults over 19 years of age were selected as research subjects. A chi square independence test was conducted to investigate the basic demographic characteristics of patients with abdominal obesity and the prevalence of chronic diseases. The relationship between abdominal obesity and each chronic disease was verified using multiple logistic regression analysis that adjusted for multiple chronic diseases.Results: The risk of all chronic diseases was higher in the abdominal obesity group than in the non-abdominal obese group. When multiple logistic regression analysis was performed with adjustments for age, gender, education level, income level, smoking, alcohol use and multiple chronic disease, the risk of hypertension, dyslipidemia, diabetes, and arthritis was higher in the abdominal obesity group.Conclusions: Abdominal obesity is related to chronic diseases. The management and prevention of abdominal obesity should be emphasized to reduce the risk of chronic diseases.
Read more60Epidemic of Childhood Obesity: Implications for Kidney Disease
Epidemic of Childhood Obesity: Implications for Kidney Disease
13Long-term impact of PM2.5 exposure on frailty, chronic diseases, and multimorbidity among middle-aged and older adults: insights from a national population-based longitudinal study.
Particulate Matter 2.5 (PM2.5) is a significant risk factor for frailty and chronic diseases. Studies on the associations between PM2.5 and frailty, chronic diseases, and multimorbidity are scarce, especially from large cohort studies. We aimed to explore the potential association between PM2.5 exposure and the risk of frailty, chronic diseases, and multimorbidity. We collected data from a national cohort (CHARLS) with a follow-up period of 11-18years, totaling 13,366 participants. We obtained PM2.5 concentration data from the Atmospheric Composition Analysis Group at Dalhousie University. PM2.5 exposure is based on the average annual concentration in the prefecture-level city where residents live. We define frailty as the comprehensive manifestation of declining various body functions, characterized by a frailty index of 0.25 or greater, and multimorbidity as the presence of at least two or more chronic conditions. Cox proportional hazards regression was used to estimate the hazard ratio (HR) with its 95% confidence interval (95%CI). A 10-μg/m3 increase for PM2.5 was significantly associated with an increased risk of frailty (HR = 1.289, 95%CI = 1.257-1.322, P < 0.001). A 10-μg/m3 increase for PM2.5 was significantly associated with the elevated risk for most chronic diseases. Compared to those with no morbidity or only single morbidity, a 10-μg/m3 increase for PM2.5 was significantly associated with the elevated risk for multimorbidity (HR = 1.220, 95%CI = 1.181-1.260, P < 0.001). Ambient PM2.5 exposure is a significant risk factor for frailty, chronic diseases, and multimorbidity, and some measures need to be taken to reduce PM2.5 concentration and prevent frailty and chronic diseases.
Read more55Surveillance for Certain Health Behaviors, Chronic Diseases, and Conditions, Access to Health Care, and Use of Preventive Health Services Among States and Selected Local Areas - Behavioral Risk Factor Surveillance System, United States, 2012.
State and local health departments and agencies can continue to use BRFSS data to identify populations at high risk for unhealthy behaviors and chronic diseases or conditions, lack of health care access, and inadequate use of preventive care services. Additionally, states can use the data to design, implement, monitor, and evaluate public health programs and policies at state and local levels.
Read more155Nonalcoholic steatohepatitis and increased risk of chronic kidney disease
Nonalcoholic steatohepatitis and increased risk of chronic kidney disease
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