Early detection of chronic kidney disease

Feehally, John; Griffith, K.; Lamb, Edmund J.; O’Donoghue, Dónal; Tomson, Charles

doi:10.1136/bmj.a1618

Cited by 13 publications

(7 citation statements)

References 16 publications

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“…While patients may have had multiple clinic visits during this period, only the latest data point within the study period was used for analysis. Variables for analysis included renal function as the estimated glomerular filtration rate (eGFR) expressed by the 4 variable MDRD equation [19], systolic and diastolic blood pressure, total cholesterol, smoking status, diagnosis of ischaemic heart disease, and prescription data for the use of antihypertensive medications (angiotensin converting enzyme inhibitor (ACE-I), angiotensin receptor blocker (ARB), thiazide diuretics, calcium channel blockers, beta blockers and alpha blockers). Blood pressure was measured using both manual and automated devices during routine clinical consultations.…”

Section: Methodsmentioning

confidence: 99%

“…Renal function is expressed as stage of chronic kidney disease defined by current UK guidelines [19] based on the eGFR value: stage 3a CKD (eGFR 45-59 ml/min/1.73 m 2 ), stage 3b CKD (eGFR 30-44 ml/min/1.73 m 2 ), stage 4 CKD (eGFR 15-29 ml/min/1.73 m 2 ) and stage 5 CKD (eGFR < 15 ml/min/1.73 m 2 ). All eGFR measures have been corrected for Black ethnicity (multiply eGFR by 1.21).…”

Section: Methodsmentioning

confidence: 99%

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The relationship of ethnicity to the prevalence and management of hypertension and associated chronic kidney disease

et al. 2011

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BackgroundThe effect of ethnicity on the prevalence and management of hypertension and associated chronic kidney (CKD) disease in the UK is unknown.MethodsWe performed a cross sectional study of 49,203 adults with hypertension to establish the prevalence and management of hypertension and associated CKD by ethnicity. Routinely collected data from general practice hypertension registers in 148 practices in London between 1/1/07 and 31/3/08 were analysed.ResultsThe crude prevalence of hypertension was 9.5%, and by ethnicity was 8.2% for White, 11.3% for South Asian and 11.1% for Black groups. The prevalence of CKD stages 3-5 among those with hypertension was 22%. Stage 3 CKD was less prevalent in South Asian groups (OR 0.77, 95% CI 0.67 - 0.88) compared to Whites (reference population) with Black groups having similar rates to Whites. The prevalence of severe CKD (stages 4-5) was higher in the South Asian group (OR 1.53, 95% CI 1.17 - 2.0) compared to Whites, but did not differ between Black and White groups. In the whole hypertension cohort, achievement of target blood pressure (< 140/90 mmHg) was better in South Asian (OR 1.43, 95% CI 1.28 - 1.60) and worse in Black groups (OR 0.79, 95% CI 0.74 - 0.84) compared to White patients. Hypertensive medication was prescribed unequally among ethnic groups for any degree of blood pressure control.ConclusionsSignificant variations exist in the prevalence of hypertension and associated CKD and its management between the major ethnic groups. Among those with CKD less than 50% were treated to a target BP of ≤ 130/80 mmHg. Rates of ACE-I/ARB prescribing for those with CKD were less than optimal, with the lowest rates (58.5%) among Black groups.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

The relationship of ethnicity to the prevalence and management of hypertension and associated chronic kidney disease

et al. 2011

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“…Primary care teams in the UK have recently assumed greater responsibility for the management of chronic kidney disease in recognition of the need to identify the condition at an early stage and then intervene to slow renal disease progression and reduce cardiovascular morbidity and mortality 1 2. A number of recent policy initiatives have helped to facilitate this transition 3–6.…”

Section: Contextmentioning

confidence: 99%

Electronic consultation as an alternative to hospital referral for patients with chronic kidney disease: a novel application for networked electronic health records to improve the accessibility and efficiency of healthcare

Stoves

Connolly

Cheung

et al. 2010

BMJ Quality & Safety

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“…Patients with chronic kidney disease (CKD) are far more likely to die of cardiovascular disease (CVD) than progress to end stage kidney disease (ESKD) [1]. Traditional risk factors including age, hypertension, smoking and diabetes mellitus do not entirely account for the excess of CVD mortality in patients with CKD.…”

Section: Introductionmentioning

confidence: 99%

Ergocalciferol and Microcirculatory Function in Chronic Kidney Disease and Concomitant Vitamin D Deficiency: An Exploratory, Double Blind, Randomised Controlled Trial

et al. 2014

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Background and ObjectivesVitamin D deficiency and endothelial dysfunction are non-traditional risk factors for cardiovascular events in chronic kidney disease. Previous studies in chronic kidney disease have failed to demonstrate a beneficial effect of vitamin D on arterial stiffness, left ventricular mass and inflammation but none have assessed the effect of vitamin D on microcirculatory endothelial function.Study DesignWe conducted a randomised controlled trial of 38 patients with non diabetic chronic kidney disease stage 3–4 and concomitant vitamin D deficiency (<16 ng/dl) who received oral ergocalciferol (50,000 IU weekly for one month followed by 50,000 IU monthly) or placebo over 6 months. The primary outcome was change in microcirculatory function measured by laser Doppler flowmetry after iontophoresis of acetylcholine. Secondary endpoints were tissue advanced glycation end products, sublingual functional capillary density and flow index as well as macrovascular parameters. Parallel in vitro experiments were conducted to determine the effect of ergocalciferol on cultured human endothelial cells.ResultsTwenty patients received ergocalciferol and 18 patients received placebo. After 6 months, there was a significant improvement in the ergocalciferol group in both endothelium dependent microcirculatory vasodilatation after iontophoresis of acetylcholine (p = 0.03) and a reduction in tissue advanced glycation end products (p = 0.03). There were no changes in sublingual microcirculatory parameters. Pulse pressure (p = 0.01) but not aortic pulse wave velocity was reduced. There were no significant changes in bone mineral parameters, blood pressure or left ventricular mass index suggesting that ergocalciferol improved endothelial function independently of these parameters. In parallel experiments, expression of endothelial nitric oxide synthase and activity were increased in human endothelial cells in a dose dependent manner.ConclusionsErgocalciferol improved microcirculatory endothelial function in patients with chronic kidney disease and concomitant vitamin D deficiency. This process may be mediated through enhanced expression and activity of endothelial nitric oxide synthase.Trial RegistrationClinical trials.gov NCT00882401

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Early detection of chronic kidney disease

Abstract: J Feehally and colleagues explain the value of reporting estimated glomerular filtration rate

Cited by 13 publications

References 16 publications

The relationship of ethnicity to the prevalence and management of hypertension and associated chronic kidney disease

The relationship of ethnicity to the prevalence and management of hypertension and associated chronic kidney disease

Electronic consultation as an alternative to hospital referral for patients with chronic kidney disease: a novel application for networked electronic health records to improve the accessibility and efficiency of healthcare

Ergocalciferol and Microcirculatory Function in Chronic Kidney Disease and Concomitant Vitamin D Deficiency: An Exploratory, Double Blind, Randomised Controlled Trial

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