Prediction of CKD progression and cardiovascular events using albuminuria and pulse wave velocity

Introduction: Chronic kidney disease (CKD) is associated with cardiovascular disease (CVD) and death. Albuminuria is an established risk factor, but additional biomarkers predicting CKD progression or CVD are needed. Arterial stiffness is an easily measurable parameter that has been associated with CVD and mortality. We evaluated the ability of carotid-femoral pulse wave velocity (PWV) and urine albumin-creatinine (UAC) ratio to predict CKD progression, cardiovascular events and mortality in a cohort of CKD patients. Methods: In CKD stage 3-5 patients PWV and UAC were measured at baseline. CKD progression was defined as 50% decline in estimated glomerular filtration rate (eGFR), initiation of dialysis or renal transplantation. A composite endpoint was defined as CKD progression, myocardial infarction, stroke, or death. Endpoints were analyzed using Cox regression analysis adjusted for possible confounders. Results: We included 181 patients (median age 69 [interquartile range 60-75] years, 67% males) with a mean eGFR of 37±12 ml/min/1.73 m2 and UAC 52 [5-472] mg/g. Mean PWV was 10.6 m/s. Median follow-up until first event was 4 [3-6] years with 44 and 89 patients reaching a CKD progression or composite endpoint, respectively. UAC (g/g) significantly predicted both CKD progression (HR 1.5 [1.2;1.8]) and composite endpoints (HR 1.4 [1.1;1.7]) in adjusted Cox regression. In contrast, PWV (m/s) was not associated with neither CKD progression (HR 0.99 [0.84;1.18]) nor the composite endpoint (HR 1.03 [0.92;1.15]). Conclusion: In an ageing CKD population, UAC predicted both CKD progression and a composite endpoint of CKD progression, cardiovascular events, or death, while PWV did not

MO507: Prediction of CKD Progression and Cardiovascular Events Using Pulse Wave Velocity and Albuminuria

Abstract BACKGROUND AND AIMS Chronic kidney disease (CKD) is associated with an increased risk of cardiovascular disease (CVD) and death. Albuminuria has been identified as a risk factor, however, additional biomarkers predicting CKD progression and CVD are needed. Arterial stiffness is an easily measurable candidate that has been associated with CVD and mortality. We compared the ability of carotid-femoral pulse wave velocity (PWV) and urine albumin-creatinine (UAC) ratios to predict CKD progression, cardiovascular events (myocardial infarction or stroke) and mortality in a cohort of CKD patients. METHOD In stage, CKD stage 3–4 patients PWV and UAC were measured at baseline. The endpoint of CKD progression was defined as a 50% decline in estimated glomerular filtration rate (eGFR), the initiation of dialysis or renal transplantation. The composite endpoint was defined as the CKD progression endpoint, myocardial infarction, stroke or death. Endpoints were analyzed in a Cox regression analysis adjusted for age, gender, blood pressure, baseline eGFR, BMI and including both PWV and UAC. Data were collected from individual patient biochemistry files, the Danish National Nephrology Registry and the Danish Health Data Registry. RESULTS We included 182 patients [median age 69 (interquartile range 60–75) years, 68% males] with a mean eGFR 37 ± 12 mL/min/1.73 m2 and a UAC of 52 (5–453) mg/g. The mean PWV was 10.6 m/s. The median follow-up until the first event was 4 (3–6) years, with 44 and 89 patients reaching the CKD progression and the composite endpoints, respectively. UAC (mg/g) significantly predicted both the CKD endpoint [HR: 1.0005 (1.0002–1.0008)] and the composite endpoint [HR 1.0004 (1.0001–1.0007)] in adjusted cox regression. In contrast, PWV (m/s) was not associated with the CKD endpoint [HR: 0.99 (0.84–1.18)] nor the composite endpoint (HR: 1.03 (0.92–1.15)]. CONCLUSION In an ageing CKD population, UAC predicted both CKD progression and a composite endpoint of CKD progression, cardiovascular events, or death, while PWV at baseline did not. </jats:sec

Feasibility and acceptability of the ShareD dEciSIon making for patients with kidney failuRE to improve end-of-life care intervention: A pilot multicentre randomised controlled trial

Background: Kidney failure is associated with a high disease burden and high mortality rates. National and international guidelines recommend health professionals involve patients with kidney failure in making decisions about end-of-life care, but implementation of these conversations within kidney services varies. We developed the DESIRE (ShareD dEciSIon-making for patients with kidney failuRE to improve end-of-life care) intervention from our studies investigating multiple decision maker needs and experiences of end-of-life care in kidney services. The DESIRE intervention's three components are a training programme for health professionals, a patient decision aid, and a kidney service consultation held to facilitate shared decision-making conversations about planning end-of-life care. Objectives: To assess the feasibility and acceptability of integrating the DESIRE intervention within kidney services. Design: A pilot study using a multicentre randomised controlled design. Setting: Four Danish nephrology departments. Participants: Patients with kidney failure who were 75 years of age or above, their relatives, and health professionals. Methods: Patients were randomised to either the intervention or usual care. Feasibility data regarding delivering the intervention, the trial design, and outcome measures were collected through questionnaires and audio recordings at four points in time: before, during, post, and 3 months after the intervention. Acceptability data were collected through semi-structured interviews with patients and relatives, as well as a focus group with health professionals post the intervention. Results: Twenty-seven patients out of the 32 planned were randomised either to the intervention (n= 14) or usual care (n= 13). In addition, four relatives and 12 health professionals participated. Follow-up was completed by 81 % (n= 22) of patient participants. We found that both feasibility and acceptability data suggested health professionals improved their decision support and shared decision-making skills via the training. Patient and relative participants experienced the intervention as supporting a shared decision-making process; from audio recordings, we showed health professionals were able to support proactively decision-making about end-of-life care within these consultations. All stakeholders perceived the intervention to be effective in promoting shared decision-making and relevant for supporting end-of-life care planning. Conclusions: Participant feedback indicated that the DESIRE intervention can be integrated into practice to support patients, relatives, and health professionals in planning end-of-life care alongside the management of worsening kidney failure. Minimising exhaustion and enhancing engagement with the intervention should be a focus for subsequent refinement of the intervention. Registration: The study has been registered at ClinicalTrials.gov with the identifier: NCT05842772. Date of first recruitment: March 20, 2023

Shared decision making and dialysis choice: an observational longitudinal cohort study

Abstract Background The ‘Shared decision making and dialysis choice’ intervention has been part of usual care at two hospitals in Denmark since 2018. The objective was to describe dialysis modality choice and outcomes for patients with kidney failure who received a shared decision making intervention. Methods Retrospective observational longitudinal cohort study design was used. Data were collected from 2018 to 2023 on 484 patients with kidney failure from one regional and one university hospital. The exposure was a shared decision making intervention for dialysis choice. The predictors were frailty, estimated glomerular filtration rate (eGFR), comorbidity, Body Mass Index (BMI), ethnicity, marital status and smoking. The outcomes were home-based dialysis, time, concordance, and death. Fisher’s exact tests and Wilcoxon rank-sum tests assessed whether choice of dialysis modality differed significantly. Aalen-Johansen estimation assessed time from the shared decision making intervention to treatment initiation, concordance between chosen and initiated treatment, and mortality before treatment initiation. Logistic regression and Cox proportional hazards evaluated the patient characteristics predicting these three outcomes. Results After the intervention, 68% chose home-based dialysis, while 32% chose center-based dialysis. With significant differences, more patients aged ≤ 70 years, at the university hospital, and living with a partner chose home-based dialysis. Half of the patients initiated treatment within 11 months, and predictors for initiating dialysis later than 11 months were age ≥ 70 years and eGFR > 15 ml/min/1.73 m². 83% of the patients received the treatment chosen, and predictors for concordance were center-based dialysis, regional hospital, and very mild to mild frailty. 12% of the patients died before treatment initiation, predicted by very mild to severe frailty and BMI < 25 kg/m². Conclusions A high proportion of patients chose a home-based treatment after receiving the intervention and initiated their preferred dialysis choice. 50% of patients received the intervention 11 months before initiating dialysis, and few patients died before initiating dialysis. Routinely assessing frailty and BMI prior to intervention could possibly improve patient pathways. Complete follow-up for all patients was not ensured