Prevalence of prediabetes and risk factors in the general adult population of Croatia - EH-UH 2 study

Introduction: Prediabetes is a state of elevated blood glucose, but not high enough to be classified as diabetes. The prevalence depends on the criteria used in the definition of prediabetes and on the observed populations. Known risk factors are obesity, age ≥ 45 years, positive family history of type 2 diabetes, insufficient physical activity, arterial hypertension, dyslipidaemia, and positive smoking status. The aim of our study was to determine the prevalence of prediabetes in a randomized, repre- sentative sample of the adult population of the Republic of Croatia and to determine the association and predictability of risk factors. Materials and methods: Out of 1219 adult participants who were involved in the scientific research project EHUH-2, 687 met the final criteria. All participants underwent clinical examination. Personal and family history were obtained from the collected data in the questionnaire. The participants were instructed to fast for 12 hours before the blood draw and were given detailed instructions on collecting a 24-hour urine sample. According to the ADA criteria, prediabetes is defined as a fasting glucose value between 5.6, and 6.9 mmol/L. Results: The prevalence of prediabetes in our sample was 11.1%. Predictive factors for prediabetes were older age, male gender, higher body weight, higher body mass index, larger waist circumference, higher systolic and diastolic blood pressure, larger body surface area, a higher percentage of visceral fat, decreased glomerular filtration rate, higher serum uric acid levels, and greater albuminuria (ACR). The final hierarchical regression model, which included body mass index, systolic and diastolic blood pres- sure, waist circumference, age, gender, eGFR, information on smoking, albuminuria, and urate, was statistically significant (p < ; 0.001; Nagelkerke R2=0,272). Conclusion: Our study is the first in which the prevalence of prediabetes and its association with risk factors were determined in a representative randomized sample of the general adult population of Croatia. While further research is needed, our results shows that in the presence of multiple risk fac- tors for prediabetes, the focus should be on age, systolic blood pressure, and albuminuria as the main predictive factors of prediabetes, especially in individuals with visceral obesity

Prevalence of prediabetes and risk factors in the general adult population of Croatia - EH-UH 2 study

Introduction: Prediabetes is a state of elevated blood glucose, but not high enough to be classified as diabetes. The prevalence depends on the criteria used in the definition of prediabetes and on the observed populations. Known risk factors are obesity, age ≥ 45 years, positive family history of type 2 diabetes, insufficient physical activity, arterial hypertension, dyslipidaemia, and positive smoking status. The aim of our study was to determine the prevalence of prediabetes in a randomized, repre- sentative sample of the adult population of the Republic of Croatia and to determine the association and predictability of risk factors. Materials and methods: Out of 1219 adult participants who were involved in the scientific research project EHUH-2, 687 met the final criteria. All participants underwent clinical examination. Personal and family history were obtained from the collected data in the questionnaire. The participants were instructed to fast for 12 hours before the blood draw and were given detailed instructions on collecting a 24-hour urine sample. According to the ADA criteria, prediabetes is defined as a fasting glucose value between 5.6, and 6.9 mmol/L. Results: The prevalence of prediabetes in our sample was 11.1%. Predictive factors for prediabetes were older age, male gender, higher body weight, higher body mass index, larger waist circumference, higher systolic and diastolic blood pressure, larger body surface area, a higher percentage of visceral fat, decreased glomerular filtration rate, higher serum uric acid levels, and greater albuminuria (ACR). The final hierarchical regression model, which included body mass index, systolic and diastolic blood pres- sure, waist circumference, age, gender, eGFR, information on smoking, albuminuria, and urate, was statistically significant (p < ; 0.001; Nagelkerke R2=0,272). Conclusion: Our study is the first in which the prevalence of prediabetes and its association with risk factors were determined in a representative randomized sample of the general adult population of Croatia. While further research is needed, our results shows that in the presence of multiple risk fac- tors for prediabetes, the focus should be on age, systolic blood pressure, and albuminuria as the main predictive factors of prediabetes, especially in individuals with visceral obesity

Estimated arterial stiffness and cardiovascular risk in chronic kidney disease – a study protocol

Introduction The prevalence of chronic kidney disease (CKD) in the general population is 9.1%. Cur- rent guidelines recommend a cut-off GFR value of 60 mL/min/1.73 m2 for diagnosis of CKD, without considering the physiological decline of GFR with aging, or the association with cardiovascular (CV), cerebrovascular or renal outcomes. There is also an increase in arterial stiffness with aging, which is es- timated by pulse wave velocity (PWV). Aim The aim of this study is to show how the ePWV predicts CV incidents independently of SCORE chart and traditional risk factors. Materials and Methods This prospective observational study will include 2058 subjects from the Endemic nephropathy in Croatia – epidemiology, diagnosis and etiopathogenesis scientific research project. Conclusion This will be the first study that could show how the estimated arterial stiffness, independently of CKD contributes to overall CV, cerebrovascular and renal risk. We could also, based on the results, propose an age-independent definition of CKD based on the association with CV disease and mortality

Prevalence of incidental chronic kidney disease and patient characteristics - results of the EH-UH 2 study and the ENAH project

Introduction: Chronic kidney disease (CKD) is an independent risk factor for cardiovascular (CV) disease and premature deaths. The worldwide prevalence of CKD in 2017 in the general population is 9.1%. In this paper our primary aim was to present preliminary data on incidental, i.e., newly discov- ered CKD and the overall prevalence of CKD in the adult population in Croatia. Secondary aim was to compare these data with the data of the CKD prevalence of the adult population from the rural part of Croatia (results of the ENAH study). Materials and Methods: This cross-sectional observational study included random, representative sample of general adults in Croatia, 781 subjects who were part of the large cohort from the EH-UH 2 study. The eGFR was calculated by creatinine-based CKD EPI equation. Albuminuria was determined from the albumin to creatinine ratio in urine (ACR) in 691 subjects. Results: The overall prevalence of CKD in Croatia was 12.7%, of which 9.5% were newly discovered CKD, and only 3.2% were subjects with previously known CKD. According to the albuminuria level, 30.7% of the adult population belonged to the group with a moderate risk of CKD progression, and 7% had a high risk, while 2.5% of the study subjects had a very high risk. Predictors for newly discov- ered CKD are older age, higher urate and potassium, antihypertensive therapy, angina pectoris, atrial fibrillation, lower hemoglobin level. Conclusions: These results continue in a pilot project of the Croatian Kidney Society and the Croatian Hypertension League on the implementation of an action plan to detect new kidney disease in the general population in real life, in a collaboration of primary care physicians and nephrologists

Prevalence of incidental chronic kidney disease and patient characteristics - results of the EH-UH 2 study and the ENAH project

Introduction: Chronic kidney disease (CKD) is an independent risk factor for cardiovascular (CV) disease and premature deaths. The worldwide prevalence of CKD in 2017 in the general population is 9.1%. In this paper our primary aim was to present preliminary data on incidental, i.e., newly discov- ered CKD and the overall prevalence of CKD in the adult population in Croatia. Secondary aim was to compare these data with the data of the CKD prevalence of the adult population from the rural part of Croatia (results of the ENAH study). Materials and Methods: This cross-sectional observational study included random, representative sample of general adults in Croatia, 781 subjects who were part of the large cohort from the EH-UH 2 study. The eGFR was calculated by creatinine-based CKD EPI equation. Albuminuria was determined from the albumin to creatinine ratio in urine (ACR) in 691 subjects. Results: The overall prevalence of CKD in Croatia was 12.7%, of which 9.5% were newly discovered CKD, and only 3.2% were subjects with previously known CKD. According to the albuminuria level, 30.7% of the adult population belonged to the group with a moderate risk of CKD progression, and 7% had a high risk, while 2.5% of the study subjects had a very high risk. Predictors for newly discov- ered CKD are older age, higher urate and potassium, antihypertensive therapy, angina pectoris, atrial fibrillation, lower hemoglobin level. Conclusions: These results continue in a pilot project of the Croatian Kidney Society and the Croatian Hypertension League on the implementation of an action plan to detect new kidney disease in the general population in real life, in a collaboration of primary care physicians and nephrologists

Kronična bubrežna bolest kod seoskog stanovništva

The aims of the study were to provide data on chronic kidney disease (CKD) prevalence in rural population and to analyze the association with cardiovascular risk factors and aging. A random sample of 2193 farmers (1333 female (F) and 860 male (M), mean age 50.61±17.12) were enrolled. Questionnaire and clinical examination were conducted. Participants provided a spot urine and fasting blood sample. Estimated glomerular filtration rate (eGFR) was estimated using Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. Subjects were classified according to the KDIGO guidelines. The overall prevalence of CKD (eGFR <60 mL/min/1.73 m2) was 8.83% (F vs. M 9.9% vs. 6.3%; p30 mg/g) was found in 8.45% (F vs. M p>0.05). Sharp increase in CKD prevalence was found to begin after the sixth decade (29.44% in subjects older than 65 years; F vs. M 30.9% vs. 26.8%; p<0.01). The strongest predictor factors for CKD were age >65 years (OR 22.12), hypertension (OR 6.53), albuminuria (OR 5.71), fasting blood glucose >7 mmol/L (OR 5.49), diabetes (OR 3.07), abdominal obesity (OR 2.05) and non-smoking (OR 0.41). In multivariate analysis, age (OR 1.13), female gender (OR 0.60) and diabetes (OR 1.75) were the independent predictor factors for CKD. In conclusion, CKD prevalence is high in rural population, being higher in women than in men. In both genders, eGFR significantly decreased with aging. Aging is a significant independent predictor of CKD.Cilj ove studije bio je istražiti učestalost kronične bubrežne bolesti (KBB) kod seoskog stanovništva i analizirati povezanost s čimbenicima kardiovaskularnoga rizika i starenjem. U studiju je bilo uključeno 2193 ispitanika (1333 žena, 860 muškaraca, srednja dob 50,61±17,12 godina). Svi ispitanici su ispunili opsežan upitnik i klinički su pregledani. Uzet im je uzorak krvi natašte i drugi jutarnji uzorak mokraće. Procijenjena stopa glomerularne filtracije (eGFR) utvrđena je pomoću jednadžbe CKD-EPI. Ispitanici su klasificirani prema smjernicama KDIGO. Sveukupna učestalost KBB (eGFR <60 mL/ min/1,73 m2) bila je 8,83% (žene prema muškarcima 9,9% prema 6,3%; p<0,001). Albuminurija je potvrđena (omjer albumina i kreatinina (ACR) >30 mg/g) u 8,45% ispitanika bez razlike među spolovima. Učestalost KBB bila je značajno veća kod ispitanika starijih od 65 godina u oba spola (29,44%; žene prema muškarcima 30,9% prema 26,6%; p<0,01). Najjači prediktorski čimbenici za KBB bili su dob >65 godina (OR 22,12), hipertenzija (OR 6,53), albuminurija (OR 5,71), glukoza u krvi natašte >7 mmol/L (OR 5,49), dijabetes (OR 3,07), trbušna pretilost (OR 2,05) i nepušenje (OR 0,41). U multivarijatnoj analizi (OR 1,13) su ženski spol (OR 0,60) i dijabetes (OR 1,75) bili nezavisni prediktorski čimbenici za KBB. U zaključku, učestalost KBB je velika u ruralnoj populaciji. U oba spola eGFR se značajno smanjila starenjem, koje se pokazalo kao značajan nezavisni prediktor za KBB

Visoka učestalost neliječene i nedovoljno liječene deficijencije i insuficijencije vitamina D u bolesnika s upalnim bolestima crijeva

Inflammatory bowel disease (IBD) patients with vitamin D deficiency show an increased risk of hospital admission, surgery, and loss of response to biologic therapy while high vitamin D levels are identified as a protective factor. Our goal was to investigate the prevalence of untreated and undertreated vitamin D deficiency and factors associated with vitamin D deficiency. In this cross-sectional study, we measured serum vitamin D in a random sample of Caucasian IBD patients. Vitamin D deficiency was defined as <50 nmol/L and insufficiency as 50-75 nmol/L. Supplementation was defined as taking 800-2000 IU vitamin D daily. Untreated patients were defined as not taking supplementation and undertreated group as receiving supplementation but showing vitamin D deficiency or insufficiency despite treatment. Our study included 185 IBD patients, i.e. 126 (68.1%) with Crohn’s disease (CD) and 59 (31.9%) with ulcerative colitis (UC). Overall, 108 (58.4%) patients had vitamin D deficiency and 60 (32.4%) patients vitamin D insufficiency. There were 16 (14.8%) and 11 (18.3%) treated patients in vitamin D deficiency and vitamin D insufficiency group, respectively. The rate of untreated patients was 81.7% (n=49) in vitamin D deficiency group and 85.2% (n=92) in vitamin D insufficiency group. Tumor necrosis factor alpha inhibitors were associated with higher serum vitamin D levels in CD and UC, and ileal involvement, ileal and ileocolonic resection with lower levels. In conclusion, not only is vitamin D deficiency common in IBD patients but the proportion of untreated and undertreated patients is considerably high. We suggest regular monitoring of vitamin D levels in IBD patients regardless of receiving vitamin D supplementation therapy.Bolesnici s upalnim bolestima crijeva (inflammatory bowel disease, IBD) i manjkom vitamina D su pod povećanim rizikom hospitalizacije, operacije i gubitka odgovora na biološku terapiju, dok visoke serumske razine vitamina D predstavljaju zaštitni čimbenik. Cilj ove studije bio je istražiti učestalost neliječenih i nedovoljno liječenih bolesnika s IBD i manjkom vitamina D te čimbenike rizika. U ovoj presječnoj studiji mjerene su serumske razine vitamina D u slučajnom uzorku bolesnika s IBD bijele rase. Deficijencija je definirana kao razine <50 nmol/L, a insuficijencija kao 50-75 nmol/L. Nadoknada vitamina D je definirana kao uzimanje 800-2000 IJ vitamina D na dan. Neliječeni bolesnici su oni bez nadoknade, a nedovoljno liječeni oni s deficijencijom ili insuficijencijom usprkos nadoknadi. Uključeno je ukupno 185 bolesnika s IBD, tj. 126 (68,1%) s Crohnovom bolešću i 59 (31,9%) s ulceroznim kolitisom. Ukupno je 108 (58,4%) bolesnika imalo deficijenciju, a 60 (32,4%) insuficijenciju. Udio liječenih bolesnika s deficijencijom i insuficijencijom vitamina D iznosio je 14,8% (n=16) i 18,3% (n=11). Udio neliječenih s deficijencijom iznosio je 81,7% (n=49), a s insuficijencijom 85,2% (n=92). Terapija inhibitorima faktora tumorske nekroze alfa bila je povezana s višim razinama vitamina D. Niže razine vitamina D su zabilježene kod bolesnika s upalom u području ileuma i resekcijom ileuma ili ileokolona. U zaključku, niske serumske razine vitamina D su česta pojava kod bolesnika s IBD, a dodatno je udio neliječenih i nedovoljno liječenih također visok. Naša preporuka je kontinuirano praćenje razina vitamina D u serumu svih bolesnika s IBD uključujući i one na nadoknadi vitaminom D