Updates in CKD: Recapping Poster Sessions on Day 5 of NKF

As the National Kidney Foundation (NKF) Spring Clinical Meeting comes to a close, let’s take a look at some of the posters focused on chronic kidney disease presented at this year’s meeting.

CKD & Rapid Kidney Function Decline During the COVID-19 Pandemic

Throughout the COVID-19 pandemic, it was unclear how COVID-19 infections, directly and indirectly, affected chronic kidney disease (CKD) and rapid kidney function decline (RKFD). A recent study attempted to answer the question by examining CKD patient data before and during the pandemic to see if measurable RKFD trends could be detected.  

The study was comprised of 90,734 Medicare Advantage enrollees with CKD stages G3-4. Pre-pandemic data was compared to data from the pandemic period from March 1, 2020, to August 31, 2021. 

The baseline characteristics of the cohort included:

• Media age of 75 years
• 59 percent male
• 70 percent White
• 62 percent CKD stage G3a
• 30 percent CKD stage G3b
• 8 percent CKD stage G4

According to the study, RKFD was observed in 20.4 percent of enrollees in the pre-pandemic period and increased to 26.8 percent during the pandemic. While this increase indicates COVID-19’s impact, the study noted an upsurge was observed in both those infected with COVID-19 and those not infected. During the pandemic, RKFD was detected in 28.2 percent of enrollees diagnosed with COVID-19, and 25.1 percent of those not infected.

The study found factors such as Black or Hispanic race/ethnicity and RKFD in the pre-pandemic period increased the odds of RFKD occurring during the pandemic period. COVID-19 infection had a direct impact and increased the odds of RKFD, but the indirect impact of the COVID-19 pandemic also contributed to the increased risk of RKFD.  

The study emphasized the need for more research to identify the downstream impact of RFKD diagnosed during the pandemic, as it relates to cardiovascular disease, kidney failure, or mortality.

Real-World Data-Driven Risk Prediction of Non-Diabetic CKD Progression

Diabetes is the leading cause of chronic kidney disease (CKD), but an improved risk prediction model can help healthcare providers treat the many non-diabetic CKD patients and prevent a common cause of death. To identify these non-diabetic CKD patients and pinpoint risk factors leading to end-stage kidney disease (ESKD)/kidney failure (KF)/dialysis, a new study coupled comprehensive patient data with modern analytic techniques.

The study examined data of 504,924 non-diabetic CKD stage 3 or 4 patients who had one year of continuous insurance coverage before diagnosis. This data from Optum Clinformatic Data Mart was collected between the years 2008 and 2018. CKD progression was defined by lab test results or specific codes from common clinical coding systems. A computational intelligence method categorized 6,000 variables of patient data at baseline.

Within 744 days, 24 percent of patients experienced ESKD/KF/dialysis outcomes. From this group, the risk factors leading to ESKD/KF/dialysis were identified and prioritized, beginning with the highest risk factor. Some of the main factors included:

1. CKD stage 4
2. Severely increased albuminuria-A3
3. Metastatic solid tumor
4. Anemia
5. Proteinuria

Because these risk factors are routinely collected and assessed by healthcare providers, researchers recommend this risk prediction model for non-diabetic CKD progression to ESKD/KF/dialysis be used in a variety of ways by stakeholders.

Kidney Stone Risk Factors & Stone Type Vary with CKD Stage

15 percent of Americans have chronic kidney disease (CKD), and kidney stone prevalence has increased to 10.1 percent in America. A new study suggests if a relationship between stone type, CKD, and renal function can be identified, it may improve nephrolithiasis management.

Recurrent kidney stones increase the risk of CKD. Yet the two stone types, uric acid and calcium, form in different ways, in different urinary environments. Hypercalciuria is associated with an increased risk of kidney stone formation but does not increase the risk of CKD, while uric acid stones are associated with lower eGRF. However, exactly how stone formation directly relates to CKD is unclear.

To discover the correlation between CKD and kidney stones, researchers reviewed 10,163 patients from Yale Urology and Nephrology between November 1994 and May 2021. Key patient data for the study included medical histories, stone pathologies, blood chemistries, and 24-hour urine analyses.

The 929 patients who completed a 24-hour urine and blood chemistry analysis within one year of their baseline stone pathology were categorized by CKD stage.

• 34 percent CKD stage 1
• 44 percent CKD stage 2
• 21.6 percent CKD stages 3-4

As CKD progressed, researchers found instances of calcium stones declined and instances of uric acid stones increased. Advanced CKD was associated with lower urine phosphorus (p=0.0001), calcium, urinary pH, citrate, and ammonium (p<0.0001). Urinary oxalate varied significantly by CKD stage. Kidney stone patients with advanced CKD were more likely to have an elevated supersaturation for uric acid, but reduced supersaturations for calcium salts.

The study concluded that CDK stage is related to urine risk factors that impact stone composition. According to the study, because renal function is a key factor for kidney stone formation in those with CKD, strategies to reduce stone risk may need to vary with CKD stage.