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Introduction: Clinical practice guidelines recommend different blood pressure (BP) goals for chronic kidney disease (CKD) patients. Usage of antihypertensive medication and attainment of BP targets in Asian CKD patients remain unclear. This study describes the profile of antihypertensive agents used and BP components in a multiethnic Asian population with stable CKD.Methods: Stable CKD outpatients with variability of serum creatinine levels < 20%, taken > 3 months apart, were recruited. Mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured using automated manometers, according to practice guidelines. Serum creatinine was assayed and the estimated glomerular filtration rate (GFR) calculated using the CKD Epidemiology Collaboration equation. BP and antihypertensive medication profile was examined using univariate analyses.Results: 613 patients (55.1% male; 74.7% Chinese, 6.4% Indian, 11.4% Malay; 35.7% diabetes mellitus) with a mean age of 57.8 ± 14.5 years were recruited. Mean SBP was 139 ± 20 mmHg, DBP was 74 ± 11 mmHg, serum creatinine was 166 ± 115 µmol/L and GFR was 53 ± 32 mL/min/1.73 m(2). At a lower GFR, SBP increased (p < 0.001), whereas DBP decreased (p = 0.0052). Mean SBP increased in tandem with the number of antihypertensive agents used (p < 0.001), while mean DBP decreased when ≥ 3 antihypertensive agents were used (p = 0.0020).Conclusion: Different targets are recommended for each BP component in CKD patients. A majority of patients cannot attain SBP targets and/or exceed DBP targets. Research into monitoring and treatment methods is required to better define BP targets in CKD patients. [ABSTRACT FROM AUTHOR]

Background: Retinal microvascular signs may provide insights into the structure and function of small vessels that are associated with renal disease. We examined the relationship of retinal microvascular signs with both prevalent and incident end-stage renal disease (ESRD) in a multi-ethnic Asian population. Methods: A total of 5763 subjects (aged ≥40 years) from two prospective population-based studies (the Singapore Malay Eye Study and the Singapore Prospective Study) were included for the current analysis. Retinopathy was graded using the modified Airlie House classification system. Retinal vascular parameters were measured using computer-assisted programs to quantify the retinal vessel widths (arteriolar and venular caliber) and retinal vascular network (fractal dimension). Data on ESRD was obtained by record linkage with the ESRD cases registered by National Registry of Diseases Office, Singapore. Multi-variable adjusted regression analyses were performed to assess the associations of baseline retinal vascular parameters and prevalent and incident ESRD. Results: At baseline, 21(0.36%) persons had prevalent ESRD. During a median follow-up of 4.3 years, 33 (0.57%) subjects developed ESRD. In our analyses, retinopathy was associated with prevalent ESRD (multi-variable adjusted odds ratio [OR], 3.21, 95% confidence interval [CI]: 1.28–8.05) and incident ESRD (multi-variable adjusted hazard ratio [HR], 2.51, 95%CI: 1.14–5.54). This association was largely seen in person with diabetes (HR, 2.60, 95%CI: 1.01–6.66) and not present in persons without diabetes (HR, 1.65, 95%CI: 0.14–18.98). Retinal arteriolar caliber, retinal venular caliber and retinal vascular fractal dimension were not associated with ESRD. Conclusion: Retinopathy signs in persons with diabetes are related to an increased risk of ESRD; however, other microvascular changes in the retina are not associated with ESRD. [ABSTRACT FROM AUTHOR]

Background. The use of spot urine protein to creatinine ratios in estimating 24 hr urine protein excretion rates for diagnosing and managing chronic kidney disease (CKD) predated the standardization of creatinine assays. The comparative predictive performance of spot urine ratios and 24 hr urine collections (of albumin or protein) for the clinical outcomes of CKD progression, end-stage renal disease (ESRD), and mortality in Asians is unclear. We compared 4 methods of assessing urine protein excretion in a multiethnic population of CKD patients. Methods. Patients with CKD (n=232) provided 24 hr urine collections followed by spot urine samples the next morning. We created multiple linear regression models to assess the factors associated with GFR decline (median follow-up: 37 months, IQR 26–41) and constructed Cox proportional-hazards models for predicting the combined outcome of ESRD and death. Results. The linear regression models showed that 24 hr urine protein excretion was most predictive of GFR decline but all other methods were similar. For the combined outcomes of ESRD and death, the proportional hazards models had similar predictive performance. Conclusions. We showed that all methods of assessments were comparable for clinical end-points, and any method can be used in clinical practice or research. [ABSTRACT FROM AUTHOR]

Aim The Chronic Kidney Disease Collaboration - Epidemiology ( CKD-EPI) glomerular filtration rates ( GFR) estimation equation is believed to estimate GFR more accurately in healthy people but this has not been validated in Asians. We studied the distribution of GFR in a multi-ethnic Asian population without CKD, and compared the performance of measures of GFR estimation, including the CKD-EPI equation, Cockroft- Gault equation, and 24-hour urine creatinine clearances. Materials and Methods A total of 103 healthy volunteers without a history of kidney disease, hypertension, or diabetes underwent GFR measurement using 3-sample plasma clearance of 99m Tc- DTPA. Cockroft- Gault estimated GFR and 24-hour urine creatinine clearances were normalized to body surface area. Results The mean measured GFR was 101 ± 15.8 m L/min per 1.73 m2 and was lowest in Indians (93 ± 12.3 m L/min per 1.73 m2; P < 0.001). The CKD-EPI equation appears to be more accurate for healthy participants. Estimated GFR correlated with measured GFR ( r = 0.57, P < 0.001), and the mean difference is 3.72 ± 14.43 m L/min per 1.73 m2 ( P < 0.001). However, estimating GFR using self-directed 24-hour urine creatinine clearances is poorer than using the CKD-EPI equation. Conclusions GFR estimation using self-directed 24-hour urine collection for creatinine clearance is less accurate than using the CKD-EPI equation. A larger study is required to clarify GFR in healthy Asians, and the association of health outcomes of Asian kidney donors with lower GFR thresholds. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To examine the ethnic differences in the association between metabolic syndrome components and CKD in Asian populations. Methods: We analyzed data from three independent populations in Singapore representing the three major Asian ethnic groups (n =3167 Chinese, 3082 Malays and 3228 Indians) aged 40–80 years. CKD was defined as an estimated glomerular filtration rate <60mL/min/1.73m2. Factor analysis of metabolic syndrome components was conducted and factor scores were used as independent variables in multivariable logistic regression models. Results: The prevalence of CKD was highest among Malays (21.0% vs. 7.4%, 5.9% in Indians and Chinese). Factor analysis identified three factors among Chinese (glycemia, blood pressure [BP], and obesity/lipid) and Malays (glycemia, BP, and lipids) accounting for 70% of the variance and four factors (glycemia, BP, lipids, and obesity) among Indians accounting for 82% of the variance. Glycemia was positively associated with CKD in all three ethnic groups. BP was positively associated with CKD among Malays (OR [95% CI] of 1.16 [1.06–1.28]), whereas it showed an inverse association among Chinese (0.84 [0.71–0.99]) and Indians (0.84 [0.73–0.97]). However, this inverse association lost significance after adjusting for antihypertensive medication use in Chinese and Indians. Obesity/lipids among Chinese and obesity among Indians showed a positive association; lipids showed an inverse association among Malays. Conclusions: These data suggest that while hyperglycemia was associated with CKD in all three ethnic groups, the impact of BP, lipids, obesity on CKD varies across ethnic groups. Understanding the specific associations may allow greater understanding of how CKD develops in different racial/ethnic groups. [Copyright &y& Elsevier]

AFCKDI RECOMMENDATIONS FOR EARLY DETECTION OF CHRONIC KIDNEY DISEASE 1. Targets Patients with diabetes, hypertension Those with family history of chronic kidney disease (CKD) Individuals receiving potentially nephrotoxic drugs, herbs or substances or taking indigenous medicine Patients with past history of acute kidney injury Individuals older than 65 years 2. Tools Spot urine sample for protein with standard urine Dipstick test (need a repeat confirmatory test if positive) Dipstick for red blood cells (need confirmation by urine microscopy) An estimate of glomerular filtration rate based on serum creatinine concentration 3. Frequency of screening Screening frequency for targeted individuals should be yearly if no abnormality is detected on initial evaluation. 4. Who should perform the screening Doctors, nurses, paramedical staff and other trained healthcare professionals 5. Intervention after screening Patients detected to have CKD should be referred to primary care physicians with experience in management of kidney disease for follow up. A management protocol should be provided to the primary care physicians. Further referral to nephrologists for management will be based on the protocol together with clinical judgment of the primary care physicians with their assessment of the severity of CKD and the likelihood of progression. 6. Screening for cardiovascular disease risk It is recommended that cardiovascular disease risk factors should be screened in all patients with CKD. [ABSTRACT FROM AUTHOR]

The article discusses a study which examined serum high-sensitivity troponin concentrations in a multi-ethnic Asian population with stable chronic kidney disease. Topics covered include the cardiac effect of elevated troponins in CKD, the use of a high-sensitivity assay in the study, and basic characteristics of the study participants.