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Prevalence and risk factors of chronic kidney disease among Iranian adults with and without diabetes: a cross-sectional study using STEPS 2021 national survey

Por: Ataei · S. M.-N. · Almasi · G. · Kazemi · A. · Ahmadi · N. · Golestani · A. · Rashidi · M.-M. · Rezaei · N. · Azadnajafabad · S. · Rezaei · N. · Dilmaghani-Marand · A. · Ghasemi · E. · Farzi · Y. · Yoosefi · M. · Rezaee · K. · Foroutan Mehr · E. · Nasserinejad · M. · Haghshenas · R. · Al
Objectives

Chronic kidney disease (CKD) is a global health concern and a major long-term complication of diabetes, yet its burden remains understudied in regions with limited epidemiological data. This study aimed to evaluate the prevalence of CKD and its associated risk factors in the Iranian adult population, stratified by diabetes status.

Design

Population-based cross-sectional study.

Setting

Nationally representative survey across Iran (STEPS 2021).

Participants

17 607 adults aged ≥25 years with complete kidney function and albuminuria data, selected through systematic sampling with weighting to ensure national representativeness.

Primary and secondary outcome measures

CKD was defined as an estimated glomerular filtration rate (eGFR)

Results

The national prevalence of CKD was 11.9% (95% CI 11.2% to 12.6%), with 9.1% (8.5% to 9.9%) among individuals without diabetes and 28.6% (26.2% to 31.1%) among those with diabetes. According to KDIGO classification, 88.1% (87.4% to 88.8%) were at low risk, 9.0% (8.4% to 9.6%) at moderate risk, 2.0% (1.6% to 2.4%) at high risk and 0.9% (0.7% to 1.1%) at very high risk. Albuminuria was more prevalent than low eGFR in both groups with (22.5% (20.4% to 24.8%) vs 10.3% (8.7% to 12.1%)) and without (5.7% (5.2% to 6.3%) vs 4.3% (3.8% to 4.8%)) diabetes. Diabetes was more strongly linked to albuminuria than low eGFR and was progressively associated with higher risk categories (adjusted ORs (aORs) 2.41 (2.03–2.86) for moderate, 2.63 (1.74–3.97) for high, 3.93 (2.56–6.07) for very high vs low-risk). CKD prevalence was highest in northwest Iran, increased significantly with age, with a stronger association observed for low eGFR than albuminuria, and was associated with hypertension (aOR 2.41 (2.07–2.82)), dyslipidaemia (1.60 (1.31–1.94)), obesity (1.94 (1.59–2.36)), ischaemic heart disease (1.53 (1.25–1.87)) and physical inactivity (1.40 (1.20–1.62)). Higher socioeconomic status and education were associated with lower odds of CKD.

Conclusions

CKD is a major burden, especially in individuals with diabetes, with regional and socioeconomic disparities. Addressing risk factors, integrating CKD into non-communicable disease surveillance and prioritising it in global health agendas, including the Sustainable Development Goals, are essential.

Factors influencing physician-to-physician teleconsultation: a scoping review

Por: Ghasemi · S. · Changiz · T. · Omid · A.
Background

Teleconsultation has gained significant traction due to advancements in information and communication technologies. While much attention has been given to physician-to-patient teleconsultation, the factors influencing physician-to-physician teleconsultation remain underexplored.

Objectives

This scoping review aims to map and synthesise the existing evidence on the factors influencing physician-to-physician teleconsultation.

Eligibility criteria

We included publications of all methodological designs that specifically addressed factors affecting physician-to-physician teleconsultation. Studies focusing primarily on physician-to-patient teleconsultation without sufficient detail on physician-to-physician components were excluded. The search was limited to articles published in English and Persian between 2014 and 2024.

Sources of evidence

Eight electronic databases (PubMed, Scopus, Web of Science, etc) were searched from January 2014 to June 2024.

Charting methods

Data extraction was performed by two independent reviewers using a standardised form. Extracted data included study characteristics, key factors influencing teleconsultation and main findings.

Results

From 12 included studies, five key influencing components were identified: ‘patient-related factors’, ‘medical team competencies’, ‘infrastructure and technology’, ‘timing factors’ and ‘planning and programme evaluation’. Among these, infrastructure and technology were the most frequently reported factors across the studies, while patient-related factors were less commonly addressed.

Conclusions

This review identifies a comprehensive set of factors that influence physician-to-physician teleconsultation. The findings provide a foundation for developing effective teleconsultation programmes and highlight the need for more research in diverse healthcare settings.

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