Strategy to estimate risk progression of chronic kidney disease, cardiovascular risk, and referral to nephrology: the EPIRCE Study

Background: Although the prevalence of chronic kidney disease (CKD) is 10-14%, several prospective studies note a low rate of progression to end-stage renal disease (ESRD) in stages 3 and 4. A correct classification of risk of progression, based on demonstrated predictive factors, would allow better management of CKD. Recent studies have demonstrated the high predictive value of a classification that combines estimated (e) glomerular filtration rate (GFR) and urine albumin-creatinine ratio (ACR). We estimated the clinical risk of progression to ESRD and cardiovascular mortality predicted by the combined variable of eGFR and ACR in the Spanish general population. Materials and Methods: This study was a cross-sectional evaluation in the Epirce sample, representative of Spanish population older than 20 years. GFR was estimated using MDRD and CKD-EPI formulas; microalbuminuria was considered to be an ACR 20-200 mg/g (men) or 30-300 mg/g (women) and macroalbuminuria was indicated beyond these limits. Population-weighted prevalence of risk (..) (AU)

Antecedentes: Si bien la prevalencia de la enfermedad renal crónica (ERC) es del 10-14 %, diversos estudios prospectivos indican que en las fases 3 y 4 existe una tasa baja de progresión hacia enfermedad renal terminal (ERT). Una clasificación correcta del riesgo de progresión basada en factores predictivos demostrados permitiría un mejor manejo de la ERC. Estudios recientes han demostrado el elevado valor predictivo de la clasificación que combina el valor estimado (e) de la tasa de filtrado glomerular (FG) con la ratio albúmina-creatinina (RAC) en orina. Realizamos una estimación del riesgo clínico de una progresión hacia una ERT y de mortalidad cardiovascular existente en la población general española basando la predicción en el uso combinado de las variables tasa (e) de FG y RAC. Materiales y métodos: Evaluación cruzada en la muestra Epirce, que era representativa de la población española mayor de 20 años. Para la estimación del FG se emplearon las fórmulas MDRD y CKD-EPI; se consideraba la existencia de microalbuminuria cuando los valores de RAC oscilaban entre 20-200 mg/g (hombres) o entre 30-300 mg/g (mujeres) y de macroalbuminuria cuando los valores superaban dichos límites. Se realizó una estimación de la prevalencia ponderada poblacionalmente del riesgo de progresión de ERC hacia ERT. Resultados: Con MDRD, el 1,4 % de la población (..) (AU)

Strategy to estimate risk progression of chronic kidney disease, cardiovascular risk, and referral to nephrology: the EPIRCE Study.

BACKGROUND: Although the prevalence of chronic kidney disease (CKD) is 10­14%, several prospective studies note a low rate of progression to end-stage renal disease (ESRD) in stages 3 and 4. A correct classification of risk of progression, based on demonstrated predictive factors, would allow better management of CKD. Recent studies have demonstrated the high predictive value of a classification that combines estimated (e) glomerular filtration rate (GFR) and urine albumin­creatinine ratio (ACR). We estimated the clinical risk of progression to ESRD and cardiovascular mortality predicted by the combined variable of eGFR and ACR in the Spanish general population. MATERIALS AND METHODS: This study was a cross-sectional evaluation in the Epirce sample, representative of Spanish population older than 20 years. GFR was estimated using MDRD and CKD-EPI formulas; microalbuminuria was considered to be an ACR 20­200 mg/g (men) or 30­300 mg/g (women) and macroalbuminuria was indicated beyond these limits. Population-weighted prevalence of risk of progression of CKD to ESRD was estimated. RESULTS: With MDRD, 1.4% of the adult Spanish population was at moderate risk of progression to ESRD, 0.1% at high risk, and 12.3% at low risk. With CKD-EPI, the moderate risk ratio rose to 1.7% and low risk to 12.6%, but high risk remained stable. CONCLUSIONS: The addition of ACR to eGFR best classifies the population at risk for renal impairment relative to Kidney/Disease Outcomes Quality Initiative grades 3 and 4. Estimating GFR with CKD-EPI modifies the distribution of low and moderate risk.

Ecological determinants of the occurrence and dynamics of Vibrio parahaemolyticus in offshore areas.

The life cycle of Vibrio parahaemolyticus has been conventionally associated with estuarine areas characterized by moderate salinity and warm seawater temperatures. Recent evidence suggests that the distribution and population dynamics of V. parahaemolyticus may be shaped by the existence of an oceanic transport of communities of this organism mediated by zooplankton. To evaluate this possibility, the presence of V. parahaemolyticus in the water column of offshore areas of Galicia was investigated by PCR monthly over an 18-month period. Analysis of zooplankton and seawater showed that the occurrence of V. parahaemolyticus in offshore areas was almost exclusively associated with zooplankton and was present in 80% of the samples. The influence of environmental factors assessed by generalized additive models revealed that the abundance and seasonality of V. parahaemolyticus in zooplankton was favoured by the concurrence of downwelling periods that promoted the zooplankton patchiness. These results confirm that offshore waters may be common habitats for V. parahaemolyticus, including strains with virulent traits. Additionally, genetically related populations were found in offshore zooplankton and in estuaries dispersed along 1500 km. This finding suggests that zooplankton may operate as a vehicle for oceanic dispersal of V. parahaemolyticus populations, connecting distant regions and habitats, and thereby producing impacts on the local community demography and the spread of Vibrio-related diseases.