Publications by authors named "Elke Schaeffner"
The 2024 Kidney Disease: Improving Global Outcomes (KDIGO) guidelines for chronic kidney disease (CKD) evaluation and management bring important updates, particularly for European laboratories. These guidelines emphasize the need for harmonization in CKD testing, promoting the use of regional equations. In Europe, the European Kidney Function Consortium (EKFC) equation is particularly suited for European populations, particularly compared to the CKD-EPI 2021 race-free equation.
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- The study evaluates the effectiveness of machine learning (ML) techniques in predicting glomerular filtration rate (GFR) compared to the traditional EKFC equation, which measures kidney function.
- Using data from 19,629 patients across 13 cohorts, the researchers tested various ML methods, particularly focusing on factors like age, sex, and serum creatinine levels.
- Results indicated that the random forest (RF) method performed similarly to EKFC, with slight advantages for RF in younger patients, suggesting ML could enhance future GFR prediction methods.
Rationale & Objective: The benefits of kidney transplantation compared with treatment with dialysis, including in older adults, are primarily limited by the number of donated kidneys. We studied the potential to expand the use of older living kidney donors.
Study Design: Secondary analysis of the Berlin Initiative Study, a population-based cohort.
Background: The development of clinical guidelines aimed at GPs is a key strategy to improving the management of chronic kidney disease (CKD). In 2019, the first CKD guideline aimed specifically at GPs practicing in Germany was published by the German College of General Practitioners and Family Physicians (DEGAM.) AIMS: The aim of this study is to identify the barriers and enablers for the implementation of this guideline.
View Article and Find Full Text PDFInternational consensus supports the development of standardized protocols for measured glomerular filtration rate (mGFR) to facilitate the integration of mGFR testing in both clinical and research settings. To this end, the European Kidney Function Consortium convened an international group of experts with relevant experience in mGFR. The working group performed an extensive literature search to inform the development of recommendations for mGFR determination using 1-compartment plasma clearance models and iohexol as the exogenous filtration marker.
View Article and Find Full Text PDFObjectives: Despite the growing evidence regarding the influence of social factors on frailty in older adults, the effect of social support remains unclear. This study aims to assess the association between social support and frailty progression (transition and incidence) in a sample of community-dwelling older adults.
Methods: Using a cohort study design, 1,059 older adults from the Berlin Initiative Study were followed up for 2.
Background And Hypothesis: The estimation of glomerular filtration rate (GFR) is one main tool to detect renal disease. The most used biomarker remains serum creatinine and the European Kidney Function Consortium (EKFCcrea) equation is the most validated in Europe. More recently, cystatin C, has been proposed.
View Article and Find Full Text PDFBackground: The use of diuretics in patients on haemodialysis (HD) is thought to maintain diuresis. However, this assumption and the optimal dose are based on little scientific evidence, and associations with clinical outcomes are unclear.
Methods: We reported international variations in diuretic use and loop diuretic dose across 27 759 HD patients with dialysis vintage <1 year in the Dialysis Outcomes and Practice Patterns Study phases 2-5 (2002-2015), a prospective cohort study.
Rationale & Objective: Biomarkers that enable better identification of persons with chronic kidney disease (CKD) who are at higher risk for disease progression and adverse events are needed. This study sought to identify urine and plasma metabolites associated with progression of kidney disease.
Study Design: Prospective metabolome-wide association study.
Interactive exploration of adverse events and multimorbidity in CKD.
Nephrol Dial Transplant
November 2024
Background: Persons with chronic kidney disease (CKD) are at increased risk of adverse events, early mortality and multimorbidity. A detailed overview of adverse event types and rates from a large CKD cohort under regular nephrological care is missing. We generated an interactive tool to enable exploration of adverse events and their combinations in the prospective, observational German CKD (GCKD) study.
View Article and Find Full Text PDFBackground: Sharing data from clinical studies can accelerate scientific progress, improve transparency, and increase the potential for innovation and collaboration. However, privacy concerns remain a barrier to data sharing. Certain concerns, such as reidentification risk, can be addressed through the application of anonymization algorithms, whereby data are altered so that it is no longer reasonably related to a person.
View Article and Find Full Text PDFBackground: Frailty and polypharmacy are common conditions in older adults, especially in those with chronic kidney disease (CKD). Therefore, we analyzed the association of polypharmacy and incident frailty and the effect modification by CKD in very old adults.
Methods: In non-frail individuals within the Berlin Initiative (cohort) Study, polypharmacy (≥ 5 medications) was assessed according to multiple definitions based on the number of regular and on demand prescription and over the counter drugs, as well as vitamins and supplements.
Background: Despite the high prevalence of chronic kidney disease (CKD) in Germany, only a small proportion of patients are currently diagnosed with CKD. Patients with hypertension, diabetes mellitus, and/or cardiovascular disease have a significantly increased risk of developing CKD and rapid disease progression and should therefore be screened and monitored in accordance with the guidelines.
Objectives: The aim of this retrospective, cross-sectional study was to gain insights into appropriate diagnosis of patients at risk for CKD in German general practitioner practices.
Article Synopsis
- The KDIGO Clinical Practice Guideline for Chronic Kidney Disease (CKD) updates the 2012 guideline, reflecting a comprehensive review of new evidence and advancements in treatment but does not apply to dialysis patients or those with transplants.
- The guideline addresses evaluation, risk assessment, and management strategies to slow CKD progression, using a systematic approach to assess the quality and strength of recommendations.
- It includes practice points, infographics, and highlights future research needs, aiming to serve a wide audience and consider implications for healthcare policies and payment systems.*
Article Synopsis
- The study aimed to evaluate how accurate ICD-10 diagnostic codes are for identifying chronic kidney disease (CKD) in an older population over time, using data from the Berlin Initiative Study.
- Researchers assessed the sensitivity and specificity of these codes among participants aged 70 and older across five visits from 2009 to 2019, finding that the sensitivity for detecting CKD varied but improved over the study period.
- Although the ability to differentiate between CKD stages was limited, the overall performance of health claims data to identify CKD in older adults was deemed acceptable, indicating better diagnosis and awareness over the years.
Background: Chronic kidney failure (CKF) is often treated with dialysis, which is invasive and costly and carries major medical risks. The existing studies of patients with CKF requiring dialysis that are based on claims data from German statutory health insurance (SHI) carriers employ varying definitions of this entity, with unclear consequences for the resulting statistical estimates.
Methods: We carried out a cohort study on four random samples, each consisting of 62 200 persons aged 70 or above, from among the insurees of the SHI AOK Nordost, with one sample for each of the years 2012, 2014, 2016, and 2018.
Estimating glomerular filtration rate (GFR) is important in daily practice to assess kidney function and adapting the best clinical care of patients with and without chronic kidney disease. The new creatinine-based European Kidney Function Consortium (EKFC) equation is used to estimate GFR. This equation was developed and validated mainly in European individuals and based on a rescaled creatinine, with the rescaling factor (Q-value) defined as the median normal value of serum creatinine in a given population.
View Article and Find Full Text PDFBackground: The Cockcroft-Gault equation (CrCl) is recommended for dose adjustment of direct oral anticoagulant drugs (DOACs) to kidney function. We aimed to assess whether defining DOAC dose appropriateness according to various kidney function estimators changed the associations between dose appropriateness and adverse events in older adults with atrial fibrillation (AF).
Methods: Participants of the Berlin Initiative Study with AF and treated with DOACs were included.
Article Synopsis
- Chronic kidney disease (CKD) patients show significant regional and sex-based differences in hemoglobin levels, contrary to the one-size-fits-all hemoglobin treatment approach.
- In a study involving over 58,000 participants, it was found that females, especially in Asian and African populations, had notably lower hemoglobin levels compared to males.
- Key factors influencing hemoglobin levels include female sex, lower eGFR, older age, lower body mass index, and diabetic kidney disease, but these only explain a small portion of the overall variance, highlighting a need for further research into hemoglobin determinants in CKD.
Article Synopsis
- * This study analyzes data from over 27 million individuals to assess the impact of low eGFR and severe albuminuria on health outcomes like kidney failure, mortality, and cardiovascular events.
- * Results indicate differing health risks associated with the methods of estimating kidney function, revealing significant correlations between lower eGFR and adverse health outcomes over time.
Background: In older adults, epidemiological data on incidence rates (IR) of hospital-acquired acute kidney injury (AKI) are scarce. Also, little is known about trajectories of kidney function before hospitalization with AKI.
Methods: We used data from biennial face-to-face study visits from the prospective Berlin Initiative Study (BIS) including community-dwelling participants aged 70+ with repeat estimated glomerular filtration rate (eGFR) based on serum creatinine and cystatin C.
Background And Objectives: Studies analysing the association of albuminuria and prevalent frailty in community-dwelling very old adults are scarce and lack information on incident frailty. We investigated the association of kidney function decline and increase of albuminuria with frailty worsening or death in very old adults.
Design: Longitudinal analyses with biennial visits of the Berlin Initiative (cohort) Study and a frailty follow-up of 2.
Rationale & Objective: Serum creatinine and cystatin C are used to estimate glomerular filtration rate, but creatinine-based estimated glomerular filtration rate (eGFRcr), cystatin C-based estimated glomerular filtration rate (eGFRcys), and combined creatinine- and cystatin C-based estimated glomerular filtration rate (eGFRcr-cys) are often divergent, particularly in older adults. We investigated which estimated glomerular filtration rate (eGFR) was more accurate and less biased compared with measured glomerular filtration rate (mGFR).
Study Design: A diagnostic test study from the Berlin Initiative Study.