High unawareness of chronic kidney disease in Germany

Chronic kidney disease (CKD) is associated with an increased risk for cardiovascular events, hospitalizations, end stage renal disease and mortality. Main risk factors for CKD are diabetes, hypertension, and older age. Although CKD prevalence is about 10%, awareness for CKD is generally low in patients and physicians, hindering early diagnosis and treatment. We analyzed baseline data of 3305 participants with CKD Stages 1–4 from German cohorts and registries collected in 2010. Prevalence of CKD unawareness and prevalence ratios (PR) (each with 95%-confidence intervals) were estimated in categories of age, sex, CKD stages, BMI, hypertension, diabetes and other relevant comorbidities. We used a log-binomial regression model to estimate the PR for CKD unawareness for females compared to males adjusting for CKD stage and CKD risk factors. CKD unawareness was high, reaching 71% (68–73%) in CKD 3a, 49% (45–54%) in CKD 3b and still 30% (24–36%) in CKD4. Prevalence of hypertension, diabetes or cardiovascular comorbidities was not associated with lower CKD unawareness. Independent of CKD stage and other risk factors unawareness was higher in female patients (PR = 1.06 (1.01; 1.10)). Even in patients with CKD related comorbidities, CKD unawareness was high. Female sex was strongly associated with CKD unawareness. Guideline oriented treatment of patients at higher risk for CKD could increase CKD awareness. Patient–physician communication about CKD might be amendable. © 2021 by the authors. Licensee MDPI, Basel, Switzerland

Outcome after intracranial hemorrhage under dabigatran and reversal with idarucizumab versus under vitamin-K-antagonists – the RIC-ICH study

BackgroundIntracranial hemorrhage (ICH) is a rare but serious side effect associated with the use of oral anticoagulants, such as dabigatran. The specific reversal agent for dabigatran, idarucizumab, is available for the management of individuals with ICH. The aim of this study was to provide real-world evidence on patients with ICH and effective treatment with dabigatran and reversal with idarucizumab in clinical routine compared to those under effective treatment with vitamin-K-antagonist (VKA).MethodsRegistration of Idarucizumab for Patients with IntraCranial Hemorrhage (RIC-ICH) is a non-interventional study conducted in 22 German stroke units that prospectively enrolled dabigatran patients treated with idarucizumab. Retrospective data from VKA patients served as reference population. Main objective was in-hospital mortality. Further objectives included change in bleeding volume, stroke severity, and functional status.ResultIn-hospital mortality was 26.7% in 15 dabigatran and 27.3% in 88 VKA patients (hazard ratio 1.00, 95% CI 0.29–2.60). In patients with bleeding volume > 60 ml, mortality was lower in the dabigatran group (N = 6, 33%) compared to the VKA group (N = 15, 67%; HR 0.24, 95% CI 0.04–0.96). No differences were observed in secondary endpoints between dabigatran and VKA patients.ConclusionThese results, based on data from routine clinical practice, suggest that in-hospital mortality after idarucizumab treatment is comparable to that in patients pretreated with VKA. Due to the low precision of estimates, the results must be interpreted with caution

Eine chronische Niereninsuffizienz, auch in höherem Stadium, ist Patienten häufig unbekannt-aber warum wissen Frauen noch seltener von ihrer Erkrankung als Männer?

Introduction: Chronic kidney failure (CKD) is as common as diabetes or coronary heart disease in a population aged 40 years and older. Although CKD increases the risk of secondary diseases or premature death, patients with CKD are often unaware of their disease. In a recent analysis of German data, unawareness CKD was higher in women than in men. Methods: Baseline data from 2010 of 3,305 CKD patients from German cohort studies and registries were analyzed. Stage 1-4 CKD was defined by eGFR (estimated glomerular filtration rate) and albumin-creatinine ratio according to the KDIGO-guideline. Patient knowledge of CKD was coded according to self-report. The proportion of patients without knowledge of CKD and the sex-specific proportion difference (each with 95 % confidence interval) were calculated according to CKD stages and additional comorbidities (diabetes, hypertension, anemia, and cardiovascular disease). In addition, the prevalence ratio (PR) for not knowing about CKD was estimated for women compared to men crude and adjusted for age and other risk factors. Results: Women were less likely than men to know about their CKD in all subgroups studied by age, CKD stage, and comorbidities. The proportion difference for CKD awareness increased with higher CKD stage and was 21 percentage points (7.6; 34.6) at the expense of women in CKD stage 4. Among patients with CKD stage 3b and concomitant grade 2 hypertension, 61 % of women versus 45 % of men were unaware of their disease. The PR for CKD unawareness in women compared with men in the fully adjusted model increased from 1.08 (1.00; 1.16) in CKD stage 3a to 1.75 (1.14; 2.68) in CKD stage 4. Conclusion: Despite the presence risk factors that necessitate monitoring of renal function, less than half of patients know they have CKD stage 3b or 4. Women are less likely to be aware of their CKD in all subgroups. Possible causes are gender-related differences in primary health care (gender bias) or in patient-doctor communication. © 2022 The Author(s).Hintergrund: Chronische Niereninsuffizienz (CKD) ist in der Bevölkerung ab einem Alter von 40 Jahren genauso verbreitet wie Diabetes oder koronare Herzkrankheit. Obwohl eine CKD das Risiko für Folgeerkrankungen oder vorzeitigen Tod erhöht, wissen Patienten oft nichts von ihrer Erkrankung. In einer Auswertung deutscher Daten war die Unkenntnis über eine CKD bei Frauen größer als bei Männern. Methode: Es wurden Baseline-Daten aus dem Jahr 2010 von 3305 CKD-Patienten aus deutschen Kohortenstudien und Registern ausgewertet. Eine CKD der Stadien 1–4 war nach veröffentlichten Leitlinien definiert. Das Patientenwissen über eine CKD wurde über Selbstauskunft kodiert. Der Anteil von Patienten ohne Wissen über eine CKD sowie die geschlechtsspezifische Anteilsdifferenz (jeweils mit 95 %-Konfidenzintervall) wurde nach CKD-Stadien und weiteren Komorbiditäten berechnet. Darüber hinaus wurde die Prävalenz-Ratio (PR) für die Nichtkenntnis einer CKD für Frauen im Vergleich zu Männern grob und nach Alter und weiteren Risikofaktoren adjustiert geschätzt. Ergebnisse: In den Subgruppen nach Alter, CKD-Stadium und Komorbiditäten wussten Frauen seltener von ihrer CKD als Männer. Der Anteilsunterschied im Wissen um eine CKD stieg mit höherem CKD-Stadium an und betrug im Stadium 4 21 Prozentpunkte (7,6; 34,6) zuungunsten der Frauen. Bei Patienten mit einer CKD im Stadium 3b und Bluthochdruck Grad 2 wussten 61 % der Frauen nichts von ihrer Erkrankung, verglichen mit 45 % der Männer. Das PR für die Unkenntnis einer CKD für Frauen im Vergleich zu Männern im voll-adjustierten Modell stieg von 1,08 (1,00; 1,16) bei einer CKD 3a auf 1,75 (1,14; 2,68) bei einer CKD im Stadium 4. Folgerung: Frauen wissen in allen untersuchten Subgruppen seltener von ihrer CKD als Männer. Der Geschlechtsunterschied besteht unabhängig von allen untersuchten Einflussfaktoren. Mögliche Ursachen sind unbewusste geschlechtsbezogene Unterschiede in der Versorgung (gender bias) oder in der Patient-Arzt-Kommunikation

High Depressive Symptoms in Previously Undetected Diabetes : 10-Year Follow-Up Results of the Heinz Nixdorf Recall Study

Aim: To determine the 10-year cumulative incidence of high depressive symptoms in people with diagnosed and, in particular, previously undetected diabetes compared to those without diabetes in a population-based cohort study in Germany. Materials and Methods: We included 2813 participants (52.9% men, mean age (SD) 58.9 (7.7) years, 7.1% diagnosed diabetes, 5.6% previously undetected diabetes) from the Heinz Nixdorf Recall study. We calculated the odds ratios (OR) with 95% confidence intervals (CI) using multiple logistic regression analyses for diagnosed and undetected diabetes. Results: Cumulative 10-year incidences (95%-CI) of high depressive symptoms in participants with diagnosed diabetes, previously undetected diabetes, and without diabetes were 15.4% (10.7– 21.2), 10.1% (5.9– 15.9), and 12.4% (11.1– 13.8), respectively. Age-sex-adjusted ORs were 1.51 (1.01– 2.28) in participants with diagnosed diabetes compared to those without, 1.40 (0.92– 2.12) after adjustment for BMI, physical activity, education, and smoking, and 1.33 (0.87– 2.02) after further adjustment for stroke and myocardial infarction. ORs in participants with previously undetected diabetes were 0.96 (0.56– 1.65), 0.85 (0.49– 1.47), and 0.85 (0.49– 1.48), respectively, and lower in men than in women. Conclusion: As expected, we found an increased odds of developing high depressive symptoms in participants with diagnosed diabetes. However, the odds ratios decreased when we considered comorbidities and other covariates. Interestingly, in participants with previously undetected diabetes, the odds was not increased, even 10 years after detection of diabetes. These results support the hypothesis that high depressive symptoms develop due to diabetes-related burdens and comorbidities and not due to hyperglycemia or hyperinsulinemia

Validation of a common data model for active safety surveillance research

Systematic analysis of observational medical databases for active safety surveillance is hindered by the variation in data models and coding systems. Data analysts often find robust clinical data models difficult to understand and ill suited to support their analytic approaches. Further, some models do not facilitate the computations required for systematic analysis across many interventions and outcomes for large datasets. Translating the data from these idiosyncratic data models to a common data model (CDM) could facilitate both the analysts' understanding and the suitability for large-scale systematic analysis. In addition to facilitating analysis, a suitable CDM has to faithfully represent the source observational database. Before beginning to use the Observational Medical Outcomes Partnership (OMOP) CDM and a related dictionary of standardized terminologies for a study of large-scale systematic active safety surveillance, the authors validated the model's suitability for this use by example

The Mere Exposure Effect in the Domain of Haptics

Background: Zajonc showed that the attitude towards stimuli that one had been previously exposed to is more positive than towards novel stimuli. This mere exposure effect (MEE) has been tested extensively using various visual stimuli. Research on the MEE is sparse, however, for other sensory modalities. Methodology/Principal Findings: We used objects of two material categories (stone and wood) and two complexity levels (simple and complex) to test the influence of exposure frequency (F0 = novel stimuli, F2 = stimuli exposed twice, F10 = stimuli exposed ten times) under two sensory modalities (haptics only and haptics & vision). Effects of exposure frequency were found for high complex stimuli with significantly increasing liking from F0 to F2 and F10, but only for the stone category. Analysis of ‘‘Need for Touch’ ’ data showed the MEE in participants with high need for touch, which suggests different sensitivity or saturation levels of MEE. Conclusions/Significance: This different sensitivity or saturation levels might also reflect the effects of expertise on the haptic evaluation of objects. It seems that haptic and cross-modal MEEs are influenced by factors similar to those in the visual domain indicating a common cognitive basis