Global health inequalities of chronic kidney disease:a meta-analysis

Background and hypothesis: Chronic kidney disease (CKD) is a significant contributor to global morbidity and mortality. This study investigated disparities in age, sex and socio-economic status in CKD and updated global prevalence estimates through systematic review and meta-analysis.Methods: Five databases were searched from 2014 to 2022, with 14,871 articles screened, 119 papers included and data analysed on 29,159,948 participants. Random effects meta-analyses were conducted to determine overall prevalence, prevalence of stages 3 – 5 and prevalence in males/females. Influences of age, sex and socio-economic status were assessed in subgroup analyses, and risk of bias assessment and meta-regressions were conducted to explore heterogeneity.Results: Overall prevalence of CKD was 13.0% (11.3 – 14.8%) and 6.6% (5.6 – 7.8%) for stages 3 – 5. Prevalence was higher in studies of older populations (19.3% for stages 1 – 5, 15.0% for stages 3 – 5) and meta-regression demonstrated association of age, body mass index, diabetes and hypertension with prevalence of stages 3 – 5. The prevalence of CKD stages 1 – 5 was similar in males and females (13.1% versus 13.2%) but prevalence of stages 3 – 5 was higher in females (6.4% versus 7.5%). Overall prevalence was 11.4%, 15.0% and 10.8% in low, middle and high-income countries respectively; for stages 3 – 5 prevalence was 4.0%, 6.7% and 6.8%, respectively. Included studies were at moderate-high risk of bias in the majority of cases (92%), and heterogeneity was high.Conclusion: This study provides a comprehensive assessment of CKD prevalence, highlighting important disparities related to age, sex and socio-economic status. Future research should focus on targeted screening and treatment approaches, improving access to care and more effective data monitoring, particularly in low or middle income countries

Global health inequalities of chronic kidney disease:a meta-analysis

Background and hypothesis: Chronic kidney disease (CKD) is a significant contributor to global morbidity and mortality. This study investigated disparities in age, sex and socio-economic status in CKD and updated global prevalence estimates through systematic review and meta-analysis.Methods: Five databases were searched from 2014 to 2022, with 14,871 articles screened, 119 papers included and data analysed on 29,159,948 participants. Random effects meta-analyses were conducted to determine overall prevalence, prevalence of stages 3 – 5 and prevalence in males/females. Influences of age, sex and socio-economic status were assessed in subgroup analyses, and risk of bias assessment and meta-regressions were conducted to explore heterogeneity.Results: Overall prevalence of CKD was 13.0% (11.3 – 14.8%) and 6.6% (5.6 – 7.8%) for stages 3 – 5. Prevalence was higher in studies of older populations (19.3% for stages 1 – 5, 15.0% for stages 3 – 5) and meta-regression demonstrated association of age, body mass index, diabetes and hypertension with prevalence of stages 3 – 5. The prevalence of CKD stages 1 – 5 was similar in males and females (13.1% versus 13.2%) but prevalence of stages 3 – 5 was higher in females (6.4% versus 7.5%). Overall prevalence was 11.4%, 15.0% and 10.8% in low, middle and high-income countries respectively; for stages 3 – 5 prevalence was 4.0%, 6.7% and 6.8%, respectively. Included studies were at moderate-high risk of bias in the majority of cases (92%), and heterogeneity was high.Conclusion: This study provides a comprehensive assessment of CKD prevalence, highlighting important disparities related to age, sex and socio-economic status. Future research should focus on targeted screening and treatment approaches, improving access to care and more effective data monitoring, particularly in low or middle income countries

Cardiovascular outcomes in patients with chronic kidney disease and COVID-19:a multi-regional data-linkage study

BACKGROUND: Data describing cardiovascular outcomes in patients with COVID-19 and chronic kidney disease (CKD) are lacking. We compared cardiovascular outcomes of patients with and without COVID-19, stratified by CKD status. METHODS: This retrospective, multi-regional data-linkage study utilised individual patient-level data from two Scottish cohorts. All patients tested for SARS-CoV-2 in Cohort 1 between 01/02/2020 and 31/03/2021, and in Cohort 2 between 28/02/2020 and 08/02/2021, were included. RESULTS: Overall, 86 964 patients were tested for SARS-CoV-2. There were 36 904 patients (61±21 years, 58.1% women, 15.9% CKD, 10.1% COVID-19 positive) in Cohort 1 and 50 060 patients (63±20 years, 62.0% women, 16.4% CKD, 9.1% COVID-19 positive) in Cohort 2. In CKD patients, COVID-19 increased the risk of cardiovascular death by more than two-fold within 30 days (cause-specific hazard ratio [csHR] meta-estimate 2.34, 95% confidence interval [CI] 1.83–2.99), and by 57% at the end of follow-up (csHR meta-estimate 1.57, 95% CI 1.31–1.89). Similarly, the risk of all-cause death in COVID-19 positive versus negative CKD patients was greatest within 30 days (HR 4.53, 95% CI 3.97–5.16). Compared to patients without CKD, those with CKD had a higher risk of testing positive (11.5% versus 9.3%). Following a positive test, CKD patients had higher rates of cardiovascular death (11.1% versus 2.7%), cardiovascular complications, and cardiovascular hospitalisations (7.1% versus 3.3%) than those without CKD. CONCLUSIONS: COVID-19 increases the risk of cardiovascular and all-cause death in CKD patients, especially in the short-term. CKD patients with COVID-19 are also at a disproportionate risk of cardiovascular complications than those without CKD

Recovery of Kidney Function After Acute Kidney Disease - a Multi-Cohort Analysis

Background: There are no consensus definitions for evaluating kidney function recovery after acute kidney injury (AKI) and acute kidney disease (AKD), nor is it clear how recovery varies across populations and clinical subsets. We present a federated analysis of four population-based cohorts from Canada, Denmark, and Scotland, 2011-2018.Methods: We identified incident AKD defined by serum creatinine changes within 48 hours, 7 days, and 90 days based on KDIGO AKI and AKD criteria. Separately, we applied changes up to 365 days to address widely used e-alert implementations that extend beyond the KDIGO AKI and AKD timeframes. Kidney recovery was based on resolution of AKD and a subsequent creatinine measurement below 1.2x baseline. We evaluated transitions between non-recovery, recovery, and death up to one year; within age, sex, and comorbidity subgroups; between subset AKD definitions; and across cohorts.Results: There were 464,868 incident cases, median ages 67-75 years. At one year, results were consistent across cohorts, with pooled mortalities for creatinine changes within 48 hours, 7 days, 90 days and 365 days (and 95% CI) of 40% (34-45%), 40% (34-46%), 37% (31-42%), 22% (16-29%) respectively; and non-recovery of kidney function of 19% (15-23%), 30% (24-35%), 25% (21-29%), 37% (30-43%) respectively. Recovery by 14 and 90 days was frequently not sustained at one year. Older males and those with heart failure or cancer were more likely to die than experience sustained non-recovery, whereas the converse was true for younger females and those with diabetes.Conclusion: Consistently across multiple cohorts, based on one-year mortality and non-recovery, KDIGO AKD (up to 90 days) is at least prognostically similar to KDIGO AKI (7 days), and covers more people. Outcomes associated with AKD vary by age, sex and comorbidities such that older males are more likely to die, and younger females are less likely to recover

The impact of vaccination on incidence and outcomes of SARS-CoV-2 infection in patients with kidney failure in Scotland

Background: Patients with kidney failure requiring kidney replacement therapy (KRT) are at high risk of complications and death following SARS-CoV-2 infection with variable antibody responses to vaccination reported. We investigated the effects of COVID-19 vaccination on incidence of infection, hospitalization and death of COVID-19 infection. Methods: Study design was an observational data linkage cohort study. Multiple healthcare datasets were linked to ascertain all SARS-CoV-2 testing, vaccination, hospitalization, and mortality data for all patients treated with KRT in Scotland, from the start of the pandemic over a period of 20 months. Descriptive statistics, survival analyses, and vaccine effectiveness were calculated. Results: As of 19th September 2021, 93% (n=5281) of the established KRT population in Scotland had received two doses of an approved SARS-CoV-2 vaccine. Over the study period, there were 814 cases of SARS-CoV-2 infection (15.1% of the KRT population). Vaccine effectiveness against infection and hospitalization was 33% (95% CI 0-52) and 38% (95% CI 0-57) respectively. 9.2% of fully vaccinated individuals died within 28 days of a SARS-CoV-2 positive PCR test (7% dialysis patients and 10% kidney transplant recipients). This compares to <0.1% of the vaccinated Scottish population being admitted to hospital or dying death due to COVID19 during that period. Conclusions: These data demonstrate a primary vaccine course of two doses has limited impact on COVID-19 infection and its complications in patients treated with KRT. Adjunctive strategies to reduce risk of both COVID-19 infection and its complications in this population are urgently required

Use of a high-volume prescription database to explore health inequalities in England:assessing impacts of social deprivation and temperature on the prescription volume of medicines

International audienceAimSocial inequalities are widened by climate change, which increases extreme temperature events that disproportionally affect the most vulnerable people. While the diseases impacted have been reviewed in the literature, how this reflects upon pharmaceutical consumption remains unknown. We assess that effect on a panel of the most prescribed drug classes in terms of volume in the National Health Service (NHS) database.Subject and methodsA retrospective econometric analysis of NHS prescription data was carried out, focusing on antibiotics, antidepressants and bronchodilators (drugs associated to priority diseases in addition to being among the most prescribed ones) between 2011 and 2018. Data linkage enabled prescriptions to be related to the Index of Multiple Deprivation (IMD), disability adjusted life-years (DALYs) and temperature data. The analysis was then undertaken at lower layer super output areas (LSOAs) level, using fixed-effect negative binomial regression models.ResultsOur results show that prescription rates were higher across the most deprived LSOAs, even after adjusting for the associated disease DALYs. In addition, prescription volume also progressively increased under colder temperatures below 15 °C, with an exacerbated effect in the most deprived areas.ConclusionTherefore, health inequalities in England affect prescription volumes, with higher levels in the most deprived areas which are not fully explained by morbidity differences. Lowest temperature conditions appear to intensify vulnerabilities while hot temperatures do not increase these differences in terms of prescriptions. Populations residing in the most deprived LSOAs could be more sensitive to environmental variables, leading to higher consumption of medicine under cold temperature and increased air pollution