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Editorial

Chronic Kidney Disease: The Silent Epidemy

by
Antonio Bellasi
1,*,
Luca Di Lullo
2 and
Biagio Di Iorio
3
1
Department of Research, Innovation, Brand Reputation, Ospedale di Bergamo, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy
2
Department of Nephrology and Dialysis, “L. Parodi–Delfino” Hospital, 00034 Colleferro, Italy
3
Department of Medicine, Nephrology Unit, AORN “Antonio Cardarelli”, 80131 Neaples, Italy
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2019, 8(11), 1795; https://doi.org/10.3390/jcm8111795
Submission received: 21 October 2019 / Accepted: 22 October 2019 / Published: 26 October 2019
(This article belongs to the Special Issue Clinical Symptoms, Diagnostics and Treatments of Chronic Kidney Diseases (CKD))
Versions Notes
Numerous observations suggest that chronic kidney disease (CKD) is an epidemic condition [1]. Although its prevalence varies according to geographical region, it has been reported that about 8–10% of the population show some degree of renal function impairment [1]. It is worth noting that CKD not only portends poor prognosis but it has also been demonstrated that CKD patients are among the most complex subjects (complexity being defined as number of comorbidities, presence of mental illness, number of types of physicians involved in each patient’s care, number of physicians involved in each patient’s care, number of prescribed medications, number of emergency department visits, rate of death, rate of hospitalization, and rate of placement in a long-term care facility) to be managed, and consumes a large proportion of health care resources [2].
Contrary to diabetes or other metabolic diseases as prevalent as CKD, renal function impairment is often asymptomatic or pauci-symptomatic until very late stages of the disease. However, in the course of the disease many metabolic abnormalities may develop and aggravate patients’ well-being and prognosis [3]. Needless to say, great effort is being devoted to characterizing clinical symptoms, developing diagnostics, as well as treatments, to prevent CKD occurrence or progression toward end stage renal disease (ESRD).
The aim of this special issue is to collect data and share ideas on different aspects of these topics. The 25 papers published (Table 1) and the 26 (highest citations of 9) citations document will be of interest to investigators and readers interested in the complexity of CKD. Four articles [4,5,6,7] investigated the usefulness of various biomarkers to assess renal function or complications associated with CKD in adult, as well as pediatric, patients. Indeed, current strategies to assess renal function rely on serum creatinine levels a marker highly influenced by factors such as age, gender, race, comorbid conditions and/or use of concomitant medications. These articles highlight the need for a more accurate approach to assess the presence and severity of renal impairment [8]. Similarly, nephrologists’ lack of an accurate prognostic score system that integrates serological and histopathological pieces of information is documented in two other studies [9,10] published within this special issue.
Four other articles [11,12,13,14] report on the complicated interplay between CKD and other comorbid conditions. Although prevalence varies according to the region of the world, diabetes and Human Immunodeficiency Virus (HIV) infection are among the most common factors associated with renal dysfunction [12,13,14]. All comorbid conditions need to be taken into account to individualize and improve patient care. However, these articles call for more and dedicated studies to address how to appropriately manage highly comorbid CKD patients, especially in consideration of the fact that these subjects are often excluded by randomized clinical trials (RCT).
Other articles investigate the prevalence and impact of common metabolic abnormalities that frequently complicate the course of CKD in children or adults [15,16,17]. CKD should be perceived as a multifaced metabolic disease that accelerates aging. Anemia, hypoglycemia and phosphate metabolism abnormalities are only some examples of factors that have been associated with Cardio-Vascular (CV) senescence and/or morbity and mortality [15,16,17]. Indeed, as renal function declines, several toxins may accumulate and exert detrimental effects on various metabolic pathways including promoting inflammation and renal damage progression [18,19,20]. In these perspectives, balanced nutrition may modulate the intestinal microbiota [21,22], reduce some toxin productio, and accumulation, and hold promise to impact renal and overall survival of CKD patients [21,22].
Several other therapies have been proposed to tackle the abysmal risk of renal, cardiovascular and all-cause events at which CKD patients are exposed. Overall, eight out of 25 articles (32%) address the impact of different treatment strategies on various outcomes [23,24,25,26,27,28,29]. However, none of these reports on results of an RCT. Although this may be expected for a special issue of a journal of internal medicine, it also reflects the paucity of RCTs in the nephrology arena and the desperate call for more and ad hoc studies to investigate the impact and potential interaction of available drugs on renal function and outcomes of CKD patients.
In conclusion, the articles published in this issue reflect the complexity of CKD and the limitations of available tools to detect renal dysfunction and metabolic abnormalities associated with CKD, as well as the paucity of data to properly treat these patients. Nevertheless, they expand current understanding in some areas of nephrology and generate hypothesis to be tested in future studies.
Table
Table 1. List of all published articles with the special issue “Clinical Symptoms, Diagnostics and Treatments of Chronic Kidney Diseases (CKD)” between June 2018 and June 2019.
Table 1. List of all published articles with the special issue “Clinical Symptoms, Diagnostics and Treatments of Chronic Kidney Diseases (CKD)” between June 2018 and June 2019.
NYearAuthorsTitleKeywords
12018 [4]Maciejczyk, Mateusz; Szulimowska, Julita; Skutnik, Anna; Taranta-Janusz, Katarzyna; Wasilewska, Anna; Wiśniewska, Natalia; Zalewska, AnnaSalivary Biomarkers of Oxidative Stress in Children with Chronic Kidney Diseasechronic kidney disease; salivary biomarkers; oxidative stress; oxidative damage
22018 [21]Marzocco, Stefania; Fazeli, Gholamreza; Di Micco, Lucia; Autore, Giuseppina; Adesso, Simona; Dal Piaz, Fabrizio; Heidland, August; Di Iorio, BiagioSupplementation of Short-Chain Fatty Acid, Sodium Propionate, in Patients on Maintenance Hemodialysis: Beneficial Effects on Inflammatory Parameters and Gut-Derived Uremic Toxins, A Pilot Study (PLAN Study)propionic acid; chronic kidney disease; hemodialysis; gut microbiome; systemic micro-inflammation oxidative stress; indoxyl sulfate; p-cresyl sulfate
32018 [18]Adesso, Simona; Paterniti, Irene; Cuzzocrea, Salvatore; Fujioka, Masaki; Autore, Giuseppina; Magnus, Tim; Pinto, Aldo; Marzocco, StefaniaAST-120 Reduces Neuroinflammation Induced by Indoxyl Sulfate in Glial Cellsindoxyl sulfate; chronic kidney disease; neuroinflammation; glial cells; AST-120
42018 [19]Chaves, Maria; Mendes, Matheus; Schwermann, Maximilian; Queiroz, Raquel; Coelho, Regina; Salmito, Francisco; Meneses, Gdayllon; Martins, Alice; Moreira, Ana; Libório, AlexandreAngiopoietin-2: A Potential Mediator of the Glycocalyx Injury in Adult Nephrotic PatientsAgiopoietin-2; mediation analysis; nephrotic syndrome
52018 [23]Yang, Chen-Ta; Kor, Chew-Teng; Hsieh, Yao-PengLong-Term Effects of Spironolactone on Kidney Function and Hyperkalemia-Associated Hospitalization in Patients with Chronic Kidney Diseasechronic kidney disease (CKD); end-stage renal disease (ESRD); major adverse cardiovascular events (MACE); mortality; spironolactone
62018 [5]Jhee, Jong; Hwang, Seun; Song, Joon; Lee, SeoungUpper Normal Serum Creatinine Concentrations as a Predictor for Chronic Kidney Disease: Analysis of 14 Years’ Korean Genome and Epidemiology Study (KoGES)serum creatinine; estimated glomerular filtration rate; chronic kidney disease; proteinuria
72018 [11]Lee, Wen-Chin; Lee, Yueh-Ting; Li, Lung-Chih; Ng, Hwee-Yeong; Kuo, Wei-Hung; Lin, Pei-Ting; Liao, Ying-Chun; Chiou, Terry; Lee, Chien-TeThe Number of Comorbidities Predicts Renal Outcomes in Patients with Stage 3–5 Chronic Kidney Diseasechronic kidney disease; multimorbidity; renal outcomes
82018 [9]Provenzano, Michele; Minutolo, Roberto; Chiodini, Paolo; Bellizzi, Vincenzo; Nappi, Felice; Russo, Domenico; Borrelli, Silvio; Garofalo, Carlo; Iodice, Carmela; De Stefano, Toni; Conte, Giuseppe; Heerspink, Hiddo; De Nicola, LucaCompeting-Risk Analysis of Death and End Stage Kidney Disease by Hyperkalaemia Status in Non-Dialysis Chronic Kidney Disease Patients Receiving Stable Nephrology CareCKD; ESKD; death; anti-RAS; hyperkalaemia; competing risk
92018 [6]Hoi, Shotaro; Takata, Tomoaki; Sugihara, Takaaki; Ida, Ayami; Ogawa, Masaya; Mae, Yukari; Fukuda, Satoko; Munemura, Chishio; Isomoto, HajimePredictive Value of Cortical Thickness Measured by Ultrasonography for Renal Impairment: A Longitudinal Study in Chronic Kidney Diseaseultrasonography; kidney size; cortex; CKD risk factors; kidney function
102018 [12]Hsu, Po-Ke; Kor, Chew-Teng; Hsieh, Yao-PengEffect of New-Onset Diabetes Mellitus on Renal Outcomes and Mortality in Patients with Chronic Kidney Diseasechronic kidney disease (CKD); end-stage renal disease (ESRD); incident diabetes; mortality; new-onset diabetes mellitus (DM)
112019 [15]Lee, Keum; Park, Eujin; Choi, Hyun; Kang, Hee; Ha, Il-Soo; Cheong, Hae; Park, Young; Cho, Heeyeon; Han, Kyoung; Kim, Seong; Cho, Min; Lee, Joo; Shin, JaeAnemia and Iron Deficiency in Children with Chronic Kidney Disease (CKD): Data from the Know-Ped CKD Studyanemia; iron deficiency; chronic kidney disease
122019 [24]Tesfaye, Wubshet; Peterson, Gregory; Castelino, Ronald; McKercher, Charlotte; Jose, Matthew; Zaidi, Syed; Wimmer, BarbaraMedication-Related Factors and Hospital Readmission in Older Adults with Chronic Kidney Diseasechronic kidney disease; medication appropriateness index; medication regimen complexity index; the elderly
132019 [17]Hsiao, Ching-Chung; Tu, Hui-Tzu; Lin, Chi-Hung; Chen, Kuan-Hsing; Yeh, Yung-Hsin; See, Lai-ChuTemporal Trends of Severe Hypoglycemia and Subsequent Mortality in Patients with Advanced Diabetic Kidney Diseases Transitioning to Dialysisadvanced diabetic kidney disease; severe hypoglycemia; dialysis
142019 [7]Watson, Drew; Yang, Joshua; Sarwal, Reuben; Sigdel, Tara; Liberto, Juliane; Damm, Izabella; Louie, Victoria; Sigdel, Shristi; Livingstone, Devon; Soh, Katherine; Chakraborty, Arjun; Liang, Michael; Lin, Pei-Chen; Sarwal, MinnieA Novel Multi-Biomarker Assay for Non-Invasive Quantitative Monitoring of Kidney InjuryKIT Assay; chronic kidney disease; biomarker; non-invasive; urine; eGFR; cfDNA
152019 [25]Kim, Chan; Oh, Hyung; Kim, Yon; Kim, Yong-Lim; Chang, Jae; Ryu, Dong-RyeolThe Effect of Aspirin on Preventing Vascular Access Dysfunction in Incident Hemodialysis Patients: A Prospective Cohort Study in Korean Clinical Research Centers for End-Stage Renal Disease (CRC for ESRD)aspirin; vascular access failure; incident hemodialysis
162019 [26]Di Micco, Lucia; Di Lullo, Luca; Bellasi, Antonio; Di Iorio, BiagioVery Low Protein Diet for Patients with Chronic Kidney Disease: Recent Insightschronic kidney disease; nutritional therapy; urea; phosphorus; metabolic acidosis; vascular calcification; proteinuria; gut; microbioma; cardiovascular risk; very low protein diet
172019 [10]Tsai, Shang-Feng; Wu, Ming-Ju; Wen, Mei-Chin; Chen, Cheng-HsuSerologic and Histologic Predictors of Long-Term Renal Outcome in Biopsy-Confirmed IgA Nephropathy (Haas Classification): An Observational StudyIgA nephropathy; patient outcome; renal outcome
182019 [27]Mühlig, Anne; Lee, Jun; Kemper, Markus; Kronbichler, Andreas; Yang, Jae; Lee, Jiwon; Shin, Jae; Oh, JunLevamisole in Children with Idiopathic Nephrotic Syndrome: Clinical Efficacy and Pathophysiological Aspectslevamisole; nephrotic syndrome; podocyte; steroid-dependent nephrotic syndrome
192019 [16]Bellasi, Antonio; Di Micco, Lucia; Russo, Domenico; De Simone, Emanuele; Di Iorio, Mattia; Vigilante, Raffaella; Di Lullo, Luca; Di Iorio, BiagioFractional Excretion of Phosphate (FeP) Is Associated with End-Stage Renal Disease Patients with CKD 3b and 5phosphate; phosphate balance; CKD–MBD; outcome; fractional excretion of phosphate; FeP
202019 [20]Mohammed, Chrysan; Xie, Yanmei; Brewster, Pamela; Ghosh, Subhanwita; Dube, Prabhatchandra; Sarsour, Tiana; Kleinhenz, Andrew; Crawford, Erin; Malhotra, Deepak; James, Richard; Kalra, Philip; Haller, Steven; Kennedy, DavidCirculating Lactonase Activity but Not Protein Level of PON-1 Predicts Adverse Outcomes in Subjects with Chronic Kidney Diseaseparaoxonase; lactonase activity; chronic kidney disease; clinical outcomes
212019 [28]Russo, Domenico; Tripepi, Rocco; Malberti, Fabio; Di Iorio, Biagio; Scognamiglio, Bernadette; Di Lullo, Luca; Paduano, Immacolata; Tripepi, Giovanni; Panuccio, VincenzoEtelcalcetide in Patients on Hemodialysis with Severe Secondary Hyperparathyroidism. Multicenter Study in “Real Life”secondary hyperparathyroidism; cinacalcet; etelcalcetide; hypocalcemia; gastrointestinal side effects
222019 [29]Lee, Yookyung; Kwon, SuYeon; Moon, Jong; Han, Kyungdo; Paik, Nam-Jong; Kim, Won-SeokThe Effect of Health-Related Behaviors on Disease Progression and Mortality in Early Stages of Chronic Kidney Disease: A Korean Nationwide Population-Based Studychronic kidney disease; disease progression; end stage renal disease; mortality; health-related behaviors; physical activity; smoking; alcohol
232019 [13]Alfano, Gaetano; Cappelli, Gianni; Fontana, Francesco; Di Lullo, Luca; Di Iorio, Biagio; Bellasi, Antonio; Guaraldi, GiovanniKidney Disease in HIV InfectionCKD; chronic kidney disease; nephrotoxicity; HIV; antiretroviral therapy
242019 [14]Expósito, Carmen; Pera, Guillem; Rodríguez, Lluís; Arteaga, Ingrid; Martínez, Alba; Alumà, Alba; Doladé, María; Torán, Pere; Caballeria, LlorençPrevalence of Early Chronic Kidney Disease and Main Associated Factors in Spanish Population: Populational Studychronic kidney disease; prevalence; associated factors; albuminuria; obesity; arterial hypertension; type 2 diabetes
252019 [22]Di Iorio, Biagio; Rocchetti, Maria; De Angelis, Maria; Cosola, Carmela; Marzocco, Stefania; Di Micco, Lucia; di Bari, Ighli; Accetturo, Matteo; Vacca, Mirco; Gobbetti, Marco; Di Iorio, Mattia; Bellasi, Antonio; Gesualdo, LoretoNutritional Therapy Modulates Intestinal Microbiota and Reduces Serum Levels of Total and Free Indoxyl Sulfate and P-Cresyl Sulfate in Chronic Kidney Disease (Medika Study)CKD; microbiome; indoxyl sulfate; P-cresyl sulfate; very low protein diet; Mediterranean diet

Conflicts of Interest

The authors declare no conflict of interest.

References

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Bellasi, A.; Di Lullo, L.; Di Iorio, B. Chronic Kidney Disease: The Silent Epidemy. J. Clin. Med. 2019, 8, 1795. https://doi.org/10.3390/jcm8111795

AMA Style

Bellasi A, Di Lullo L, Di Iorio B. Chronic Kidney Disease: The Silent Epidemy. Journal of Clinical Medicine. 2019; 8(11):1795. https://doi.org/10.3390/jcm8111795

Chicago/Turabian Style

Bellasi, Antonio, Luca Di Lullo, and Biagio Di Iorio. 2019. "Chronic Kidney Disease: The Silent Epidemy" Journal of Clinical Medicine 8, no. 11: 1795. https://doi.org/10.3390/jcm8111795

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