Regression Analysis of Additive Hazards Model With Latent Variables

There is an increasing burden of chronic kidney disease among youths in most developing countries like Nigeria where healthcare financing is poor. Therefore, there is a need to assess the level of awareness of the risk factors for chronic kidney disease. The study employed the cross-sectional study design. Random selection of 271 respondents was done and data was collected from them using questionnaire. The analysis of the data was done using the statistical package for social sciences (SPSS) to generate descriptive statistics in form of frequency tables and charts. The result showed that 49.8% of the respondents were between the ages of 13 and 15 years, with a mean age of 13.51±1.385. Most of the respondents (56.8%) were females and of the Christians denomination (64.9%). Nearly all the respondents (90.4%) were from the Yoruba ethnic group. Some 60.9% of the respondents claimed to be aware of chronic kidney disease while only 44.6% had heard about the risk factors of chronic kidney disease. The mean value for the computed construct for level of awareness of risk factors of chronic kidney disease was 14.40±2.59 which is approximately 60% (not very strong) of the maximum point (using a 24-point scale). There is therefore a need for more awareness on risk factors for chronic kidney disease among adolescents in Nigeria and this can be done through the different mediums for passing health messages to the general public.

Radical nephrectomy is a significant risk factor for chronic kidney disease (CKD). There are few reports on the renal outcome of acute kidney injury (AKI) after radical nephrectomy. The aim of this study was to determine the incidence of AKI and whether post-operative AKI is associated with new-onset CKD after radical nephrectomy for renal cell cancer (RCC). We conducted a retrospective study of 519 adult patients (>40 years old) with normal renal function who underwent unilateral radical nephrectomy for a solitary renal cortical tumour and were pathologically diagnosed with RCC between January 2000 and February 2007. Post-operative AKI was classed using risk, injury, failure, loss and end-stage kidney disease (RIFLE) criteria. CKD was defined as a decrease in estimated glomerular filtration rate (GFR) to <60 mL/min/1.73 m(2). According to the RIFLE criteria, 165 of 175 patients fell into the AKI risk category, 8 patients fell into the AKI injury category and 2 patients fell into the AKI failure category. Multivariate analysis revealed that older age [odds ratio (OR) 1.02, 95% confidence interval (CI) 1.00-1.05], male gender (OR 3.13, 95% CI 1.91-5.12), higher body mass index (OR 1.08, 95% CI 1.01-1.15), smaller RCC size (OR 0.87, 95% CI 0.81-0.93) and higher preoperative GFR (OR 1.04, 95% CI 1.03-1.06) were independent risk factors for post-operative AKI. CKD was more prevalent in the AKI risk group than in patients without AKI 1 year after surgery (54.7% versus 43.9%, respectively; P = 0.006) and 3 years after surgery (50% versus 32%, respectively; P = 0.003). Patients who experienced post-operative AKI had a 4.24-fold higher risk of new-onset CKD after multiple adjustments were made to the data (95% CI 2.28-7.89, P < 0.001). AKI after radical nephrectomy in patients with RCC is a potent risk factor for new-onset CKD. Prevention of post-operative AKI is essential for reducing the incidence of CKD after nephrectomy.

CKD of Unknown Origin in Central America: The Case for a Mesoamerican Nephropathy

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.

To examine knowledge of chronic kidney disease in the general public. Cross-sectional telephone survey. Hong Kong. Community-dwelling adults who spoke Chinese in Hong Kong. The response rate was 47.3% (516/1091) out of all subjects who were eligible to participate. The final survey population included 516 adults (55.6% female), of whom over 80% had received a secondary level of education or higher. Close to 20% of the participants self-reported a diagnosis of hypertension. Few (17.8%) realised the asymptomatic nature of chronic kidney disease. Less than half of these individuals identified hypertension (43.8%) or diabetes (44.0%) as risk factors of kidney disease. Awareness of high dietary sodium as a risk factor for chronic kidney disease was high (79.5%). The public in Hong Kong is poorly informed about chronic kidney disease, with major knowledge gaps regarding the influence of hypertension on kidney disease. We are concerned about the public's unawareness of hypertension being a risk factor for kidney disease. Future health education should target areas of knowledge deficits.

The aim of this study was to estimate the prevalence and risk factors of chronic kidney disease (CKD) in first-degree relatives (FDRs) of CKD patients. A cross-section study of first-degree relatives of CKD patients was conducted between November 2007 and March 2009 in southern China. A total of 1187 first-degree relatives (494 male and 693 female; mean age 41.26 years) of 419 CKD patients (194 male and 225 female; mean age 32.10 years) were reviewed and tested for haematuria, albuminuria and reduced glomerular filtration rate. CKD risk factors, including age, gender, body mass index, hypertension and the causes of index case were also investigated. CKD was diagnosed according to the criteria of the National Kidney Foundation-Kidney Disease Outcomes Quality Initiative. The prevalence of CKD in first-degree relatives of CKD patients was 29.7% (95% confidence interval [CI]: 27.1%-32.2%). After adjusting for all the potential confounders, older age, female gender, hypertension, hyperglycaemia, hyperuricaemia, hypertriglyceridemic, low level of high density lipoproteins, increased body mass index and nephrotoxic medications were independently associated with increased risk of CKD. Furthermore, relatives of index cases with chronic glomerulonephritis were at higher risk haematuria (ORs = 2.12, 95% CI: 1.45-3.10) compared with relatives of index cases with other kinds of renal diseases. The first-degree relatives of CKD patients are at high risk of CKD, especially those relatives of CKD patients with chronic glomerulonephritis. Screening in this high risk population might help to identify early CKD patients and make a proper intervention strategy to prevent the disease from quick progression.

To examine long-term effects of antiretroviral therapy (ART) on kidney function, we evaluated the incidence and risk factors for chronic kidney disease (CKD) among ART-naive, HIV-infected adults and compared changes in estimated glomerular filtration rates (eGFR) before and after starting ART. Multicenter observational cohort study of patients with at least one serum creatinine measurement before and after initiating ART. Cox proportional hazard models, and marginal structure models examined CKD risk factors; mixed-effects linear models examined eGFR slopes. Three thousand, three hundred and twenty-nine patients met entry criteria, contributing 10 099 person-years of observation on ART. ART was associated with a significantly slower rate of eGFR decline (from -2.18 to -1.37 ml/min per 1.73 m per year; P = 0.02). The incidence of CKD defined by eGFR thresholds of 60, 45 and 30 ml/min per 1.73 m was 10.5, 3.4 and 1.6 per 1000 person-years, respectively. In adjusted analyses black race, hepatitis C coinfection, lower time-varying CD4 cell count and higher time-varying viral load on ART were associated with higher CKD risk, and the magnitude of these risks increased with more severe CKD. Tenofovir and a ritonavir-boosted protease inhibitor (rPI) was also associated with higher CKD risk [hazard odds ratio for an eGFR threshold <60 ml/min per 1.73 m: 3.35 (95% confidence interval (CI) = 1.40-8.02)], which developed in 5.7% of patients after 4 years of exposure to this regimen-type. ART was associated with reduced CKD risk in association with CD4 cell restoration and plasma viral load suppression, despite an increased CKD risk that was associated with initial regimens that included tenofovir and rPI.

Background: Chronic kidney disease is a progressive loss in renal function that is more accepted as global public health importance and its magnitude is overgrowing in the least developed countries like Ethiopia. No data was found in Debre Birhan Central Ethiopia on the magnitude of chronic kidney disease among type 2 diabetes patients. Methods: Institution-based cross-sectional study was conducted among 327 at Debre Berhan Referral Hospital from March to June 2019 in Adult (≥ 18 years) type 2 diabetes follow-up patients who volunteered to give informed written consent were included in the study. Systematic random sampling was used. Data were collected by interviews using structured and pre-tested questionnaires. Descriptive statistics of the continuous and categorical variables were done. The bi-variable and multivariable logistic regression was done to show the net effect of explanatory variables on chronic renal disease. Results: A total of 327 study participants were involved in the final analysis. The Prevalence of CKD among type 2 diabetic patients was 15.9%. A significant association was found with age &gt; 60 years [AOR 3.5 (95% CI 1.8-6.8)], alcoholic patients [AOR 2.4 (95% CI 1.2-5.1)], glycated hemoglobin levels above 7% [AOR 2.5 (95 CI 1.5-4.1)], higher level of LDL greater than 100 g/dl [AOR 2.7 (95% CI 1.9-4)] and lower level of HDL [AOR 2.9 (95% CI 1.4-6)]. Conclusion: The magnitude of chronic kidney disease among type 2 diabetic follow-up patients was 15.9%. Estimated GFR should be determined for diabetic patients at regular intervals of time for earlier diagnosis of chronic kidney disease.

The main aim of this study was determining the risk factors of chronic kidney disease (CKD) in HIV-1-infected patients. Patients were followed from seven large HIV reference centers in France that maintain prospective databases on HIV-1-infected patients. The main outcome was the time to CKD defined as two consecutive measures of estimated GFR ≤60 ml/min per 1.73 m² over ≥3 months. A Cox's model with delayed entry was used to search predictive factors of time to CKD. From 1993 to 2006, 349 out of 7378 patients were found to have CKD. Of these, 166 had hypertension, 33 had diabetes, and 26 were antiretroviral therapy-naïve. Occurrence of acute kidney injury (hazard ratio [HR] = 2.40) and hypertension (HR = 2.39) were strongly associated with an increased risk of CKD. Patients with a durable level of CD4 count >200 cells/mm³ had a lower risk of CKD (HR = 0.63). Recent exposure to indinavir (HR = 2.03), totenofovir (HR = 1.55), and abacavir (HR = 1.37) were associated with an increased risk of CKD. Past exposure to tenofovir was also associated with an increased risk of CKD (HR = 2.23), and a trend toward significance was observed for past exposure to indinavir (HR = 1.28). CKD was not rare in HIV-infected patients and occurs preferentially in HIV-infected patients exposed to certain ARVs, specifically abacavir, indinavir and tenofovir. This requires closer monitoring of renal function in patients exposed to one of these drugs.

Serum 25-Hydroxyvitamin D Deficiency; A Risk Factor for Chronic Kidney Disease in Ambulatory Indigent Patients

Background: Chronic kidney disease (CKD) is a long-term health condition that in many cases is preventable. Many people do not know they have kidney disease, because up to 90% of kidney function can be lost before symptoms are evident. Fortunately, simple tests performed by a general practitioner can identify most cases of CKD when the disease is in its early stages, enabling treatment to prevent or slow progress. Objective: To evaluate the risk factors for the development of CKD. Methods: A case-control study conducted to 300 persons (150 cases and 150 controls) selected from Medical Wards, Dialysis Kidney Unit and in Outpatient Clinic at Ibn Sina Teaching Hospital in Mosul City. Results: Diabetes mellitus (DM) had 12.9 folds risk for developing of CKD and both type 1 and type 2 D.M. had significant role for developing CKD. Diabetic patients for (&gt; 15 years) had 29.8 times risk for development of CKD. Hypertension (HT) had 3.5 folds risk for CKD and those having HT more than 15 years had 12.9 times risk for CKD. Cardiovascular disease (CVD) had 13.6 folds risk for CKD and having more than one type of CVD had 37 times risk for CKD than heart failure, ischemic heart disease. Family history of renal diseases had 7.1 times risk for CKD and there was statistically significant role of having family history of CKD that had more than 22 times risk for CKD. Statistically significant role of having proteinuria with 383 times risk for CKD. Conclusion: There are many risk factors significantly contributing to the development of CKD in Mosul especially DM, HT, CVD, family history of renal disease, family history of chronic diseases, and from this study it has been concluded that proteinuria plays a major role for the development and progress of CKD. Keywords: Chronic kidney disease, risk factors Citation: Khaleel FF, Hussain SS, Hmood AH. Risk factors of chronic kidney disease among patients attending Ibn Sina Teaching Hospital in Mosul City. Iraqi JMS. 2019; 17(1): 24-31. doi: 10.22578/IJMS.17.1.5

A retrospective study conducted in 2023 on risk factors for chronic kidney disease (CKD), in patients from Southern Libya (Wadi Ataba). The present study was focused on the relationship between a few disorders that have been linked to chronic kidney disease (CKD) and other diseases. The goal of the current study is to investigate the risk factors for chronic renal disease in the city of Wadi Ataba in southern Libya. The 27-questions questionnaire was used to gather the data, which were included categories such as personal information, health conditions, family history of diabetes, hypertension, and renal failure, questions regarding the abuse of analgesics and herbs, questions about energy drinks and their origins, and questions about lifestyle habits such as drinking water and source of them. 379 participants were interviewed. Response rate was 98 %. Among the patients in our samples, which found that the highest risk factors for CKD were hypertension (HT) at 28.5%, followed by diabetes mellitus (DM) and hypertension combined at 16.1%, and diabetes at 36.1%..One important finding of the current study is the increased association between diadetes and CDK. They represent about one third (29.1%).

Risk factors for chronic kidney disease include diabetes mellitus, hypertension, autoimmune diseases, urinary tract infections, urolithiasis, urinary tract obstruction, toxic effects of drugs, cardiovascular diseases, etc. In order to study the effect of several risk factors on the development of chronic kidney disease and the role of each factor in comparison with the proportion of their effect on the final result, a dispersion analysis was carried out. It was revealed that the development of chronic kidney disease in men is influenced by diabetes mellitus (H/h=+0.69), diabetic nephropathy (H/h=+0.71), obesity (H/h=+0.36), arterial hypertension (H/h=+0.70), coronary heart disease (H/h=+0.62), renal stone disease (H/h =+0.37), urolithiasis (H/h=+0.41), chronic pyelonephritis (H/h=+0.39), chronic glomerulonephritis (H/h=+0.81), polycystic kidney disease (H/h=+0.68), autoimmune diseases (H/h=+0.67). In women, diabetes mellitus (H/h=+0.70), diabetic nephropathy (H/h=+0.73), obesity (H/h=+0.45), arterial hypertension (H/h=+0.71), ischemic heart disease (H/h=+0.52), urinary tract infections (H/h=+0.63), renal stone disease (H/h=+0.35), urolithiasis (H/h=+0.36), chronic pyelonephritis (H/h=+0.47), chronic glomerulonephritis (H/h=+0.79), polycystic kidney disease (H/h=+0.59), iron deficiency anemia (H/h=+0.37), autoimmune diseases (H/h=+0.66). Variance analysis revealed direct strong and average correlation relationships of risk factors according to the validity of their negative influence in men, with the exception of urinary tract infection and iron deficiency anemia, where weak correlation relationships were revealed. In women, direct strong and average correlations of all risk factors in the validity of their negative effects were identified. Increasing the wariness of doctors at the primary level in identifying risk factors and its timely correction will reduce the incidence of chronic kidney disease.

Background: Currently we face a significant increase in the new cases of end-stage renal disease in developing countries. Hence it seems vital to work on strategies and reduce its development and progression. Determining the related risk factors can provide insight into achieving these policy-making goals. Therefore, this study was conducted in order to identify risk factors associated with chronic kidney disease in Iranian adult population. Material and Methods: This cross-sectional study was performed in Shiraz, through a random cluster sampling in 819 including 340 male and 479 female adult participants. Body mass indexes, waist circumference, blood pressure and biochemical profile were assessed. We evaluated the prevalence of CKD according to glomerular filtration rate (GFR) as well as possible risk factors. GFR was calculated based on “Chronic Kidney Disease Epidemiology Collaboration” creatinine equation. Result: Mean age of our participants were 43.0± 14.0 years, and 58.5% were female. Our results showed 16.6% of patients with GFR less than 60 mL/min per 1.73. The proportion of participants having hypertension, obesity, high waist circumference, diabetes mellitus and history of cardiovascular disease were 17.3%,19.3%, 35%,9.4% and 5.3 %, respectively. Multiple regression analysis indicated an independent correlation between age, sex, dyslipidemia, and hypertension with CKD. Conclusion: This study indicates that CKD is a substantial health burden in Iranian adult population. Additionally, the results of this study addressed the importance of integrated strategies that aimed to identify, prevent, and treat non-communicable diseases fueling the development of CKD. [GMJ. 2019;8:e935]

Background. In the article, a clinical case of managing a comorbid 74-year-old patient with a history ofischemic heart disease, who was hospitalized in a vascular center due to myocardial infarction, with subsequently developed acute kidney injury against the background of chronic kidney disease is presented. Objective. The purpose of describing this clinical case is to demonstrate the importance of assessing and considering the significance and modifiability of risk factors for the development of chronic kidney disease, as well as their timely correction. The clinical example illustrates the connection between impaired kidney function and the progression of cardiovascular pathology. Results. The patient described in the clinical case, despite a long history of hypertension, did not receive ambulatory combined antihypertensive therapy in accordance with actual clinical recommendations, but received a monopreparation from the class of angiotensin-converting enzyme inhibitors without achieving the target blood pressure. In 2012, the patient underwent coronary artery stenting due to unstable angina, after which she received only angiotensin-converting enzyme inhibitors and beta-blockers from the drugs recommended by clinicalguidelines and did not receive antithrombotic and lipid-lowering therapy. The patient was diagnosed with type 2 diabetes mellitus 20 years ago without subsequent control of glucose levels and choice of hypoglycemic therapy. In addition, the patient had modifiable risk factors of cardiovascular diseases and chronic kidney disease: long smoking history, obesity. Upon admission to the hospital, coronary angiography was performed with intravenous administration of iodine-containing contrast medium, according to the results of which stenosis of the right coronary artery was detected, and its stenting was performed with drug-coated stents. During the hospitalization period, there was an increase in the level of creatinine and urea in the blood serum with maximum values of 570.7 μmol/L and 37.1 mmol/L respectively. When these changes were detected, the patient was consulted twice by a nephrologist, and a decision was made to conduct sessions of replacement kidney therapy due to severe azotemia with persistent restoration of kidney function. Upon stabilization of the patient’s condition, she was discharged from the hospital with recommendations to continue the program hemodialysis. However, even upon admission to the hospital, the patient’s creatinine level was 260 μmol/L, which may indicate that chronic kidney disease had been developing for a long time before myocardial infarction and before the administration of X-ray contrast medium during coronary angiography. Conclusion. Thus, due to the management of the patient at the outpatient stage without compliance with clinical recommendations, lack of correction of modifiable risk factors for chronic kidney disease and cardiovascular pathology, it was not possible to prevent acute kidney injury against the background of chronic kidney disease and myocardial infarction due to late diagnosis of chronic kidney disease.