201
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Yacoub R, Nadkarni GN, Cravedi P, He JC, Delaney VB, Kent R, Chauhan KN, Coca SG, Florman SS, Heeger PS, Murphy B, Menon MC. Analysis of OPTN/UNOS registry suggests the number of HLA matches and not mismatches is a stronger independent predictor of kidney transplant survival. Kidney Int 2017; 93:482-490. [PMID: 28965746 DOI: 10.1016/j.kint.2017.07.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 06/20/2017] [Accepted: 07/20/2017] [Indexed: 12/14/2022]
Abstract
HLA matching and mismatching, while inversely related, are not exact opposites. Here we determined the independent effects of HLA matching and mismatching on outcomes in deceased donor kidney transplant recipients. The United Network for Organ Sharing database (1995-2012) was utilized and analyzed for delayed graft function, one-year acute rejection, and death-censored graft survival using combined multivariable models including HLA matching and mismatching. Sensitivity analyses were performed using the subgroup of deceased donor kidney transplant patients after 2003 with more uniform HLA nomenclature and resampling analyses using bootstrapping on complete data available from 96,236 recipients. Individually, both HLA matching and mismatching showed significant associations with graft survival. Adjusting the model to take into account both matching and mismatching simultaneously, the degree of HLA mismatching lost significance while matching continued to have a significant prediction for delayed graft function, the one-year acute rejection rate, and graft survival. Sensitivity analyses and bootstrapping showed similar results for all studied outcomes. Thus, analysis of this large cohort demonstrates the apparent greater association of HLA matching over HLA mismatching on both early allograft events as well as graft survival. Future analyses should preferentially utilize HLA matching as a covariate over mismatching for accurately reflecting impact on graft outcomes.
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Affiliation(s)
- Rabi Yacoub
- Division of Nephrology, Department of Medicine, University at Buffalo, Buffalo, New York, USA
| | - Girish N Nadkarni
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Paolo Cravedi
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - John Cijiang He
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Veronica B Delaney
- Recanati-Miller Transplant Institutes, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Rebecca Kent
- Recanati-Miller Transplant Institutes, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Kinsuk N Chauhan
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Steven G Coca
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Sander S Florman
- Recanati-Miller Transplant Institutes, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Peter S Heeger
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Recanati-Miller Transplant Institutes, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Barbara Murphy
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Madhav C Menon
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Recanati-Miller Transplant Institutes, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
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202
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Ferrandino R, Roof S, Ma Y, Chan L, Poojary P, Saha A, Chauhan K, Coca SG, Nadkarni GN, Teng MS. Unplanned 30-Day Readmissions after Parathyroidectomy in Patients with Chronic Kidney Disease: A Nationwide Analysis. Otolaryngol Head Neck Surg 2017; 157:955-965. [PMID: 28949797 DOI: 10.1177/0194599817721154] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective To examine rates of readmission after parathyroidectomy in patients with chronic kidney disease and determine primary etiologies, timing, and risk factors for these unplanned readmissions. Study Design Retrospective cohort study. Setting Nationwide Readmissions Database. Subjects and Methods The Nationwide Readmissions Database was queried for parathyroidectomy procedures performed in patients with chronic kidney disease between January 2013 and November 2013. Patient-, admission-, and hospital-level characteristics were compared for patients with and without at least 1 unplanned 30-day readmission. Outcomes of interest included rates, etiology, and timing of readmission. Multivariate logistic regression was used to identify predictors of 30-day readmission. Results There were 2756 parathyroidectomies performed in patients with chronic kidney disease with an unplanned readmission rate of 17.2%. Hypocalcemia/hungry bone syndrome accounted for 40% of readmissions. Readmissions occurred uniformly throughout the 30 days after discharge, but readmissions for hypocalcemia/hungry bone syndrome peaked in the first 10 days and decreased over time. Weight loss/malnutrition at time of parathyroidectomy and length of stay of 5 to 6 days conferred increased risk of readmission with adjusted odds ratios (aOR) of 3.31 (95% confidence interval [CI], 1.55-7.05; P = .002) and 1.87 (95% CI, 1.10-3.19; P = .02), respectively. Relative to primary hyperparathyroidism, parathyroidectomies performed for secondary hyperparathyroidism (aOR, 2.53; 95% CI, 1.07-5.95; P = .03) were associated with higher risk of readmission. Conclusion Postparathyroidectomy readmission rates for patients with chronic kidney disease are nearly 5 times that of the general population. Careful consideration of postoperative care and electrolyte management is crucial to minimize preventable readmissions in this vulnerable population.
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Affiliation(s)
- Rocco Ferrandino
- 1 Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Scott Roof
- 2 Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Yue Ma
- 2 Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Lili Chan
- 3 Department of Nephrology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
| | - Priti Poojary
- 3 Department of Nephrology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
| | - Aparna Saha
- 3 Department of Nephrology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
| | - Kinsuk Chauhan
- 3 Department of Nephrology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
| | - Steven G Coca
- 3 Department of Nephrology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
| | - Girish N Nadkarni
- 3 Department of Nephrology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
| | - Marita S Teng
- 2 Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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203
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Yacoub R, Nugent M, Cai W, Nadkarni GN, Chaves LD, Abyad S, Honan AM, Thomas SA, Zheng W, Valiyaparambil SA, Bryniarski MA, Sun Y, Buck M, Genco RJ, Quigg RJ, He JC, Uribarri J. Advanced glycation end products dietary restriction effects on bacterial gut microbiota in peritoneal dialysis patients; a randomized open label controlled trial. PLoS One 2017; 12:e0184789. [PMID: 28931089 PMCID: PMC5607175 DOI: 10.1371/journal.pone.0184789] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 08/28/2017] [Indexed: 12/12/2022] Open
Abstract
The modern Western diet is rich in advanced glycation end products (AGEs). We have previously shown an association between dietary AGEs and markers of inflammation and oxidative stress in a population of end stage renal disease (ESRD) patients undergoing peritoneal dialysis (PD). In the current pilot study we explored the effects of dietary AGEs on the gut bacterial microbiota composition in similar patients. AGEs play an important role in the development and progression of cardiovascular (CVD) disease. Plasma concentrations of different bacterial products have been shown to predict the risk of incident major adverse CVD events independently of traditional CVD risk factors, and experimental animal models indicates a possible role AGEs might have on the gut microbiota population. In this pilot randomized open label controlled trial, twenty PD patients habitually consuming a high AGE diet were recruited and randomized into either continuing the same diet (HAGE, n = 10) or a one-month dietary AGE restriction (LAGE, n = 10). Blood and stool samples were collected at baseline and after intervention. Variable regions V3-V4 of 16s rDNA were sequenced and taxa was identified on the phyla, genus, and species levels. Dietary AGE restriction resulted in a significant decrease in serum Nε-(carboxymethyl) lysine (CML) and methylglyoxal-derivatives (MG). At baseline, our total cohort exhibited a lower relative abundance of Bacteroides and Alistipes genus and a higher abundance of Prevotella genus when compared to the published data of healthy population. Dietary AGE restriction altered the bacterial gut microbiota with a significant reduction in Prevotella copri and Bifidobacterium animalis relative abundance and increased Alistipes indistinctus, Clostridium citroniae, Clostridium hathewayi, and Ruminococcus gauvreauii relative abundance. We show in this pilot study significant microbiota differences in peritoneal dialysis patients’ population, as well as the effects of dietary AGEs on gut microbiota, which might play a role in the increased cardiovascular events in this population and warrants further studies.
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Affiliation(s)
- Rabi Yacoub
- Department of Internal Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, United States of America
- * E-mail:
| | - Melinda Nugent
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Weijin Cai
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Girish N. Nadkarni
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Lee D. Chaves
- Department of Internal Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, United States of America
| | - Sham Abyad
- Department of Internal Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, United States of America
| | - Amanda M. Honan
- Department of Internal Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, United States of America
| | - Shruthi A. Thomas
- Department of Internal Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, United States of America
| | - Wei Zheng
- Department of Computer Science and Engineering, University at Buffalo, Buffalo, New York, United States of America
| | - Sujith A. Valiyaparambil
- Department of Biochemistry, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, United States of America
| | - Mark A. Bryniarski
- Department of Phamaceutical Sciences, University at Buffalo School of Pharmacy and Pharmaceutical Sciences, Buffalo, New York, United States of America
| | - Yijun Sun
- Department of Microbiology and Immunology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, United States of America
| | - Michael Buck
- Department of Biochemistry, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, United States of America
| | - Robert J. Genco
- Department of Oral Biology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, United States of America
| | - Richard J. Quigg
- Department of Internal Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, United States of America
| | - John C. He
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Jaime Uribarri
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
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204
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Belbin GM, Odgis J, Sorokin EP, Yee MC, Kohli S, Glicksberg BS, Gignoux CR, Wojcik GL, Van Vleck T, Jeff JM, Linderman M, Schurmann C, Ruderfer D, Cai X, Merkelson A, Justice AE, Young KL, Graff M, North KE, Peters U, James R, Hindorff L, Kornreich R, Edelmann L, Gottesman O, Stahl EE, Cho JH, Loos RJ, Bottinger EP, Nadkarni GN, Abul-Husn NS, Kenny EE. Genetic identification of a common collagen disease in puerto ricans via identity-by-descent mapping in a health system. eLife 2017; 6:25060. [PMID: 28895531 PMCID: PMC5595434 DOI: 10.7554/elife.25060] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 08/09/2017] [Indexed: 11/16/2022] Open
Abstract
Achieving confidence in the causality of a disease locus is a complex task that often requires supporting data from both statistical genetics and clinical genomics. Here we describe a combined approach to identify and characterize a genetic disorder that leverages distantly related patients in a health system and population-scale mapping. We utilize genomic data to uncover components of distant pedigrees, in the absence of recorded pedigree information, in the multi-ethnic BioMe biobank in New York City. By linking to medical records, we discover a locus associated with both elevated genetic relatedness and extreme short stature. We link the gene, COL27A1, with a little-known genetic disease, previously thought to be rare and recessive. We demonstrate that disease manifests in both heterozygotes and homozygotes, indicating a common collagen disorder impacting up to 2% of individuals of Puerto Rican ancestry, leading to a better understanding of the continuum of complex and Mendelian disease. Diseases often run in families. These disease are frequently linked to changes in DNA that are passed down through generations. Close family members may share these disease-causing mutations; so may distant relatives who inherited the same mutation from a common ancestor long ago. Geneticists use a method called linkage mapping to trace a disease found in multiple members of a family over generations to genetic changes in a shared ancestor. This allows scientists to pinpoint the exact place in the genome the disease-causing mutation occurred. Using computer algorithms, scientists can apply the same technique to identify mutations that distant relatives inherited from a common ancestor. Belbin et al. used this computational technique to identify a mutation that may cause unusually short stature or bone and joint problems in up to 2% of people of Puerto Rican descent. In the experiments, the genomes of about 32,000 New Yorkers who have volunteered to participate in the BioMe Biobank and their health records were used to search for genetic changes linked to extremely short stature. The search revealed that people who inherited two copies of this mutation from their parents were likely to be extremely short or to have bone and joint problems. People who inherited one copy had an increased likelihood of joint or bone problems. This mutation affects a gene responsible for making a form of protein called collagen that is important for bone growth. The analysis suggests the mutation first arose in a Native American ancestor living in Puerto Rico around the time that European colonization began. The mutation had previously been linked to a disorder called Steel syndrome that was thought to be rare. Belbin et al. showed this condition is actually fairly common in people whose ancestors recently came from Puerto Rico, but may often go undiagnosed by their physicians. The experiments emphasize the importance of including diverse populations in genetic studies, as studies of people of predominantly European descent would likely have missed the link between this disease and mutation.
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Affiliation(s)
- Gillian Morven Belbin
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, United States.,Department of Genetics and Genomics, Icahn School of Medicine at Mount Sinai, New York, United States.,The Icahn Institute of Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, United States
| | - Jacqueline Odgis
- Department of Genetics and Genomics, Icahn School of Medicine at Mount Sinai, New York, United States
| | - Elena P Sorokin
- Department of Genetics, Stanford University School of Medicine, Stanford, United States
| | - Muh-Ching Yee
- Department of Plant Biology, Carnegie Institution for Science, Stanford, United States
| | - Sumita Kohli
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, United States
| | - Benjamin S Glicksberg
- Department of Genetics and Genomics, Icahn School of Medicine at Mount Sinai, New York, United States.,The Icahn Institute of Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, United States.,Harris Center for Precision Wellness, Icahn School of Medicine at Mt Sinai, New York, United States
| | - Christopher R Gignoux
- Department of Genetics, Stanford University School of Medicine, Stanford, United States
| | - Genevieve L Wojcik
- Department of Genetics, Stanford University School of Medicine, Stanford, United States
| | - Tielman Van Vleck
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, United States
| | - Janina M Jeff
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, United States
| | - Michael Linderman
- Department of Genetics and Genomics, Icahn School of Medicine at Mount Sinai, New York, United States.,The Icahn Institute of Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, United States
| | - Claudia Schurmann
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, United States
| | - Douglas Ruderfer
- Broad Institute, Cambridge, United States.,Division of Psychiatric Genomics, Icahn School of Medicine at Mt Sinai, New York, United States.,Center for Statistical Genetics, Icahn School of Medicine at Mt Sinai, New York, United States
| | - Xiaoqiang Cai
- Department of Genetics and Genomics, Icahn School of Medicine at Mount Sinai, New York, United States
| | - Amanda Merkelson
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, United States
| | - Anne E Justice
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, United States
| | - Kristin L Young
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, United States
| | - Misa Graff
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, United States
| | - Kari E North
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, United States
| | - Ulrike Peters
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, United States.,Department of Epidemiology, University of Washington School of Public Health, Seattle, United States
| | - Regina James
- National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, United States
| | - Lucia Hindorff
- National Human Genome Research Institute, National Institutes of Health, Bethesda, United States
| | - Ruth Kornreich
- Department of Genetics and Genomics, Icahn School of Medicine at Mount Sinai, New York, United States
| | - Lisa Edelmann
- Department of Genetics and Genomics, Icahn School of Medicine at Mount Sinai, New York, United States
| | - Omri Gottesman
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, United States
| | - Eli Ea Stahl
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, United States.,The Icahn Institute of Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, United States.,Harris Center for Precision Wellness, Icahn School of Medicine at Mt Sinai, New York, United States.,Broad Institute, Cambridge, United States
| | - Judy H Cho
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, United States.,Department of Genetics and Genomics, Icahn School of Medicine at Mount Sinai, New York, United States.,Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, United States
| | - Ruth Jf Loos
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, United States.,The Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, United States
| | - Erwin P Bottinger
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, United States
| | - Girish N Nadkarni
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, United States
| | - Noura S Abul-Husn
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, United States.,Department of Genetics and Genomics, Icahn School of Medicine at Mount Sinai, New York, United States.,The Icahn Institute of Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, United States
| | - Eimear E Kenny
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, United States.,Department of Genetics and Genomics, Icahn School of Medicine at Mount Sinai, New York, United States.,The Icahn Institute of Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, United States.,Center for Statistical Genetics, Icahn School of Medicine at Mt Sinai, New York, United States
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205
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Nadkarni GN, Chauhan K, Patel A, Saha A, Poojary P, Kamat S, Patel S, Ferrandino R, Konstantinidis I, Garimella PS, Menon MC, Thakar CV. Temporal trends of dialysis requiring acute kidney injury after orthotopic cardiac and liver transplant hospitalizations. BMC Nephrol 2017; 18:244. [PMID: 28724404 PMCID: PMC5516358 DOI: 10.1186/s12882-017-0657-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 07/05/2017] [Indexed: 12/29/2022] Open
Abstract
Background The epidemiology and outcomes of acute kidney injury (AKI) in prevalent non-renal solid organ transplant recipients is unknown. Methods We assessed the epidemiology of trends in acute kidney injury (AKI) in orthotopic cardiac and liver transplant recipients in the United States. We used the Nationwide Inpatient Sample to evaluate the yearly incidence trends (2002 to 2013) of the primary outcome, defined as AKI requiring dialysis (AKI-D) in hospitalizations after cardiac and liver transplantation. We also evaluated the trend and impact of AKI-D on hospital mortality and adverse discharge using adjusted odds ratios (aOR). Results The proportion of hospitalizations with AKI (9.7 to 32.7% in cardiac and 8.5 to 28.1% in liver transplant hospitalizations; ptrend<0.01) and AKI-D (1.63 to 2.33% in cardiac and 1.32 to 2.65% in liver transplant hospitalizations; ptrend<0.01) increased from 2002-2013. This increase in AKI-D was explained by changes in race and increase in age and comorbidity burden of transplant hospitalizations. AKI-D was associated with increased odds of in hospital mortality (aOR 2.85; 95% CI 2.11-3.80 in cardiac and aOR 2.00; 95% CI 1.55-2.59 in liver transplant hospitalizations) and adverse discharge [discharge other than home] (aOR 1.97; 95% CI 1.53-2.55 in cardiac and 1.91; 95% CI 1.57-2.30 in liver transplant hospitalizations). Conclusions This study highlights the growing burden of AKI-D in non-renal solid organ transplant recipients and its devastating impact, and emphasizes the need to develop strategies to reduce the risk of AKI to improve health outcomes. Electronic supplementary material The online version of this article (doi:10.1186/s12882-017-0657-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Girish N Nadkarni
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kinsuk Chauhan
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Achint Patel
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Aparna Saha
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Priti Poojary
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sunil Kamat
- Division of Critical Care, Department of Medicine, Sir H.N. Reliance Hospital and Research Center, Mumbai, India
| | - Shanti Patel
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rocco Ferrandino
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ioannis Konstantinidis
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Pranav S Garimella
- Division of Nephrology, Department of Medicine, University of California San Diego, San Diego, CA, USA
| | - Madhav C Menon
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Charuhas V Thakar
- Division of Nephrology, Kidney CARE Program, University of Cincinnati, Cincinnati, USA. .,Renal Section, Cincinnati VA Medical Center, Cincinnati, OH, USA. .,Division of Nephrology and Hypertension, ML 0585, 231 Albert B Sabin Way, Cincinnati, OH, 45267, USA.
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206
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Nadkarni GN, Galarneau G, Ellis SB, Nadukuru R, Zhang J, Scott SA, Schurmann C, Li R, Rasmussen-Torvik LJ, Kho AN, Hayes MG, Pacheco JA, Manolio TA, Chisholm RL, Roden DM, Denny JC, Kenny EE, Bottinger EP. Apolipoprotein L1 Variants and Blood Pressure Traits in African Americans. J Am Coll Cardiol 2017; 69:1564-1574. [PMID: 28335839 DOI: 10.1016/j.jacc.2017.01.040] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 11/06/2016] [Accepted: 01/03/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND African Americans (AA) are disproportionately affected by hypertension-related health disparities. Apolipoprotein L1 (APOL1) risk variants are associated with kidney disease in hypertensive AAs. OBJECTIVES This study assessed the APOL1 risk alleles' association with blood pressure traits in AAs. METHODS The discovery cohort included 5,204 AA participants from Mount Sinai's BioMe biobank. Replication cohorts included additional BioMe (n = 1,623), Vanderbilt BioVU (n = 1,809), and Northwestern NUgene (n = 567) AA biobank participants. Single nucleotide polymorphisms determining APOL1 G1 and G2 risk alleles were genotyped in BioMe and imputed in BioVU/NUgene participants. APOL1 risk alleles' association with blood pressure-related traits was tested in the discovery cohort, a meta-analysis of replication cohorts, and a combined meta-analysis under recessive and additive models after adjusting for age, sex, body mass index, and estimated glomerular filtration rate. RESULTS There were 14% to 16% of APOL1 variant allele homozygotes (2 copies of G1/G2) across cohorts. APOL1 risk alleles were associated under an additive model with systolic blood pressure (SBP) and age at diagnosis of hypertension, which was 2 to 5 years younger in the APOL1 variant allele homozygotes (Cox proportional hazards analysis, p value for combined meta-analysis [pcom] = 1.9 × 10-5). APOL1 risk alleles were associated with overall SBP (pcom = 7.0 × 10-8) and diastolic blood pressure (pcom = 2.8 × 10-4). After adjustment for all covariates, those in the 20- to 29-year age range showed an increase in SBP of 0.94 ± 0.44 mm Hg (pcom = 0.01) per risk variant copy. APOL1-associated estimated glomerular filtration rate decline was observed starting a decade later in life in the 30- to 39-year age range. CONCLUSIONS APOL1 risk alleles are associated with higher SBP and earlier hypertension diagnoses in young AAs; this relationship appears to follow an additive model.
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Affiliation(s)
- Girish N Nadkarni
- Charles Bronfman Institute of Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Geneviève Galarneau
- Charles Bronfman Institute of Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Stephen B Ellis
- Charles Bronfman Institute of Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Rajiv Nadukuru
- Charles Bronfman Institute of Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jinglan Zhang
- Charles Bronfman Institute of Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Stuart A Scott
- Charles Bronfman Institute of Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Claudia Schurmann
- Charles Bronfman Institute of Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Rongling Li
- Division of Genomic Medicine, National Human Genome Research Institute, Bethesda, Maryland
| | - Laura J Rasmussen-Torvik
- Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Abel N Kho
- Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - M Geoffrey Hayes
- Division of Endocrinology, Metabolism, & Molecular Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jennifer A Pacheco
- Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Teri A Manolio
- Division of Genomic Medicine, National Human Genome Research Institute, Bethesda, Maryland
| | - Rex L Chisholm
- Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Dan M Roden
- Department of Medicine and Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville Tennessee
| | - Joshua C Denny
- Department of Medicine and Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville Tennessee
| | - Eimear E Kenny
- Charles Bronfman Institute of Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Erwin P Bottinger
- Charles Bronfman Institute of Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
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Nadkarni GN, Coca SG, Meisner A, Patel S, Kerr KF, Patel UD, Koyner JL, Garg AX, Philbrook HT, Edelstein CL, Shlipak M, El-Khoury J, Parikh CR. Urinalysis findings and urinary kidney injury biomarker concentrations. BMC Nephrol 2017; 18:218. [PMID: 28683730 PMCID: PMC5499057 DOI: 10.1186/s12882-017-0629-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 06/21/2017] [Indexed: 01/23/2023] Open
Abstract
Introduction Urinary biomarkers of kidney injury are presumed to reflect renal tubular damage. However, their concentrations may be influenced by other factors, such as hematuria or pyuria. We sought to examine what non-injury related urinalysis factors are associated with urinary biomarker levels. Methods We examined 714 adults who underwent cardiac surgery in the TRIBE-AKI cohort that did not experience post-operative clinical AKI (patients with serum creatinine change of ≥ 20% were excluded). We examined the association between urinalysis findings and the pre- and first post-operative urinary concentrations of 4 urinary biomarkers: neutrophil gelatinase-associated lipocalin (NGAL), interleukin-18 (IL-18), kidney injury molecule-1 (KIM-1), and liver fatty acid binding protein (L-FABP). Results The presence of leukocyte esterase and nitrites on urinalysis was associated with increased urinary NGAL (R2 0.16, p < 0.001 and R2 0.07, p < 0.001, respectively) in pre-operative samples. Hematuria was associated with increased levels of all 4 biomarkers, with a much stronger association seen in post-operative samples (R2 between 0.02 and 0.21). Dipstick proteinuria concentrations correlated with levels of all 4 urinary biomarkers in pre-operative and post-operative samples (R2 between 0.113 and 0.194 in pre-operative and between 0.122 and 0.322 in post-operative samples). Adjusting the AUC of post-operative AKI for dipstick proteinuria lowered the AUC for all 4 biomarkers at the pre-operative time point and for 2 of the 4 biomarkers at the post-operative time point. Conclusions Several factors available through urine dipstick testing are associated with increased urinary biomarker concentrations that are independent of clinical kidney injury. Future studies should explore the impact of these factors on the prognostic and diagnostic performance of these AKI biomarkers. Electronic supplementary material The online version of this article (doi:10.1186/s12882-017-0629-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Girish N Nadkarni
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1243, New York, NY, 10029, USA
| | - Steven G Coca
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1243, New York, NY, 10029, USA.
| | - Allison Meisner
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Shanti Patel
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1243, New York, NY, 10029, USA
| | - Kathleen F Kerr
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Uptal D Patel
- Division of Nephrology, Department of Medicine, Duke University, Durham, NC, USA
| | - Jay L Koyner
- Division of Nephrology, Department of Medicine, University of Chicago, Pritzker School of Medicine, Chicago, IL, USA
| | - Amit X Garg
- Division of Nephrology, Department of Medicine, Western University, London, ON, Canada
| | - Heather Thiessen Philbrook
- Program of Applied Translational Research, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Charles L Edelstein
- Division of Nephrology, Department of Medicine, University of Colorado, Denver, CO, USA
| | - Michael Shlipak
- Division of General Internal Medicine, San Francisco VA Medical Center, University of California, San Francisco, USA
| | - Joe El-Khoury
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Chirag R Parikh
- Program of Applied Translational Research, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.,Division of Nephrology, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
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208
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Coca SG, Nadkarni GN, Huang Y, Moledina DG, Rao V, Zhang J, Ferket B, Crowley ST, Fried LF, Parikh CR. Plasma Biomarkers and Kidney Function Decline in Early and Established Diabetic Kidney Disease. J Am Soc Nephrol 2017; 28:2786-2793. [PMID: 28476763 DOI: 10.1681/asn.2016101101] [Citation(s) in RCA: 138] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 03/29/2017] [Indexed: 11/03/2022] Open
Abstract
Biomarkers of diverse pathophysiologic mechanisms may improve risk stratification for incident or progressive diabetic kidney disease (DKD) in persons with type 2 diabetes. To evaluate such biomarkers, we performed a nested case-control study (n=190 cases of incident DKD and 190 matched controls) and a prospective cohort study (n=1156) using banked baseline plasma samples from participants of randomized, controlled trials of early (ACCORD) and advanced (VA NEPHRON-D) DKD. We assessed the association and discrimination obtained with baseline levels of plasma TNF receptor-1 (TNFR-1), TNFR-2, and kidney injury molecule-1 (KIM-1) for the outcomes of incident DKD (ACCORD) and progressive DKD (VA-NEPHRON-D). At baseline, median concentrations of TNFR-1, TNFR-2, and KIM-1 were roughly two-fold higher in the advanced DKD population (NEPHRON-D) than in the early DKD population (ACCORD). In both cohorts, patients who reached the renal outcome had higher baseline levels than those who did not reach the outcome. Associations between doubling in TNFR-1, TNFR-2, and KIM-1 levels and risk of the renal outcomes were significant for both cohorts. Inclusion of these biomarkers in clinical models increased the area under the curve (SEM) for predicting the renal outcome from 0.68 (0.02) to 0.75 (0.02) in NEPHRON-D. Systematic review of the literature illustrated high consistency in the association between these biomarkers of inflammation and renal outcomes in DKD. In conclusion, TNFR-1, TNFR-2, and KIM-1 independently associated with higher risk of eGFR decline in persons with early or advanced DKD. Moreover, addition of these biomarkers to clinical prognostic models significantly improved discrimination for the renal outcome.
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Affiliation(s)
| | | | - Yuan Huang
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut.,Cooperative Studies Program Coordinating Center, Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut
| | - Dennis G Moledina
- Program of Applied Translational Research, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Veena Rao
- Program of Applied Translational Research, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Jane Zhang
- Cooperative Studies Program Coordinating Center, Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut
| | - Bart Ferket
- Institute for Healthcare Delivery Science, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Susan T Crowley
- Cooperative Studies Program Coordinating Center, Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut
| | - Linda F Fried
- Renal Section, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania; and.,Epidemiology and Clinical and Translational Science, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Chirag R Parikh
- Cooperative Studies Program Coordinating Center, Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut; .,Program of Applied Translational Research, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
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209
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Konstantinidis I, Patel S, Camargo M, Patel A, Poojary P, Coca SG, Nadkarni GN. Representation and reporting of kidney disease in cerebrovascular disease: A systematic review of randomized controlled trials. PLoS One 2017; 12:e0176145. [PMID: 28426831 PMCID: PMC5398672 DOI: 10.1371/journal.pone.0176145] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 04/05/2017] [Indexed: 12/03/2022] Open
Abstract
Patients with kidney disease (KD) are at increased risk for cerebrovascular disease (CVD) and CVD patients with KD have worse outcomes. We aimed to determine the representation of KD patients in major randomized controlled trials (RCTs) of CVD interventions. We searched MEDLINE for reports of major CVD trials published through February 9, 2017. We excluded trials that did not report mortality outcomes, enrolled fewer than 100 participants, or were subgroup, follow-up, or post-hoc analyses. Two independent reviewers performed study selection and data extraction. We included 135 RCTs randomizing 194,977 participants. KD patients were excluded in 48 (35.6%) trials, but were less likely to be excluded from trials of class I/II recommended interventions (n = 7; 15.9%; p = 0.001) and more likely to be excluded in trials with registered protocols (45.5% vs. 22.4%; p = 0.007). Exclusion was lower in trials supported by academic or governmental grants compared to industry or combined funding (21.2% vs. 42.0% and 47.8%; p = 0.033 and 0.028, respectively). Among trials excluding KD patients, 24 (50.0%) used serum creatinine, 7 (14.6%) used estimated glomerular filtration rate or creatinine clearance, 7 (14.6%) used renal replacement therapy, and 19 (39.6%) used non-specific kidney-related criteria. Only 4 (3.0%) trials reported baseline renal function. No trials prespecified or reported subgroup analyses by baseline renal function. Although 19 (14.1%) trials reported the incidence of acute kidney injury, no trial examined adverse event rates according to renal function. In summary, more than one third of major CVD trials excluded patients with KD, primarily based on serum creatinine or non-specific criteria, and outcomes were not stratified by renal parameters. Therefore, purposeful efforts to increase inclusion of KD patients in CVD trials and evaluate the impact of renal function on efficacy and safety are needed to improve the quality of evidence for interventions in this vulnerable population.
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Affiliation(s)
- Ioannis Konstantinidis
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
- * E-mail:
| | - Shanti Patel
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Marianne Camargo
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Achint Patel
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Priti Poojary
- Department of Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Steven G. Coca
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Girish N. Nadkarni
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
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210
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Chan L, Tummalapalli SL, Ferrandino R, Poojary P, Saha A, Chauhan K, Nadkarni GN. The Effect of Depression in Chronic Hemodialysis Patients on Inpatient Hospitalization Outcomes. Blood Purif 2017; 43:226-234. [PMID: 28114133 DOI: 10.1159/000452750] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS Depression is common in patients with end-stage renal disease (ESRD) on hemodialysis (HD). Although, depression is associated with mortality, the effect of depression on in-hospital outcomes has not been studied as yet. METHODS We analyzed the National Inpatient Sample for trends and outcomes of hospitalizations with depression in patients with ESRD. RESULTS The proportion of ESRD hospitalizations with depression doubled from 2005 to 2013 (5.01-11.78%). Hospitalized patients on HD with depression were younger (60.47 vs. 62.70 years, p < 0.0001), female (56.93 vs. 47.81%, p < 0.0001), white (44.92 vs. 34.01%, p < 0.0001), and had higher proportion of comorbidities. However, there was a statistically significant lower risk of mortality in HD patients within the top 5 reasons for admissions. CONCLUSION There were significant differences in demographics and comorbidities for hospitalized HD patients with depression. Depression was associated with an increased rate of adverse effects in discharged patients, and decreased in-hospital mortality.
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Affiliation(s)
- Lili Chan
- Department of Nephrology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
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211
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Garimella PS, Balakrishnan P, Ammakkanavar NR, Patel S, Patel A, Konstantinidis I, Annapureddy N, Nadkarni GN. Impact of dialysis requirement on outcomes in tumor lysis syndrome. Nephrology (Carlton) 2016; 22:85-88. [DOI: 10.1111/nep.12806] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 04/19/2016] [Accepted: 04/21/2016] [Indexed: 12/13/2022]
Affiliation(s)
| | - Poojitha Balakrishnan
- Department of Environmental Health Sciences, Bloomberg School of Public Health; Johns Hopkins University; Baltimore MD
| | - Natraj R. Ammakkanavar
- Division of Hematology and Oncology; Indiana University School of Medicine; Indianapolis IN
| | - Shanti Patel
- Division of Nephrology, Department of Medicine; Icahn School of Medicine at Mount Sinai; New York NY
| | - Achint Patel
- Division of Nephrology, Department of Medicine; Icahn School of Medicine at Mount Sinai; New York NY
| | - Ioannis Konstantinidis
- Division of Nephrology, Department of Medicine; Icahn School of Medicine at Mount Sinai; New York NY
| | | | - Girish N. Nadkarni
- Division of Nephrology, Department of Medicine; Icahn School of Medicine at Mount Sinai; New York NY
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212
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Chan L, Mehta S, Chauhan K, Poojary P, Patel S, Pawar S, Patel A, Correa A, Patel S, Garimella PS, Annapureddy N, Agarwal SK, Gidwani U, Coca SG, Nadkarni GN. National Trends and Impact of Acute Kidney Injury Requiring Hemodialysis in Hospitalizations With Atrial Fibrillation. J Am Heart Assoc 2016; 5:JAHA.116.004509. [PMID: 27998917 PMCID: PMC5210405 DOI: 10.1161/jaha.116.004509] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Atrial fibrillation (AF) is a common cause for hospitalization, but there are limited data regarding acute kidney injury requiring dialysis (AKI-D) in AF hospitalizations. We aimed to assess temporal trends and outcomes in AF hospitalizations complicated by AKI-D utilizing a nationally representative database. METHODS AND RESULTS Utilizing the Nationwide Inpatient Sample, AF hospitalizations and AKI-D were identified using diagnostic and procedure codes. Trends were analyzed overall and within subgroups and utilized multivariable logistic regression to generate adjusted odds ratios (aOR) for predictors and outcomes including mortality and adverse discharge. Between 2003 and 2012, 3751 (0.11%) of 3 497 677 AF hospitalizations were complicated by AKI-D. The trend increased from 0.3/1000 hospitalizations in 2003 to 1.5/1000 hospitalizations in 2012, with higher increases in males and black patients. Temporal changes in demographics and comorbidities explained a substantial proportion but not the entire trend. Significant comorbidities associated with AKI-D included mechanical ventilation (aOR 13.12; 95% CI 9.88-17.43); sepsis (aOR 8.20; 95% CI 6.00-11.20); and liver failure (aOR 3.72; 95% CI 2.92-4.75). AKI-D was associated with higher risk of in-hospital mortality (aOR 3.54; 95% CI 2.81-4.47) and adverse discharge (aOR 4.01; 95% CI 3.12-5.17). Although percentage mortality within AKI-D decreased over the decade, attributable risk percentage mortality remained stable. CONCLUSIONS AF hospitalizations complicated by AKI-D have quintupled over the last decade with differential increase by demographic groups. AKI-D is associated with significant morbidity and mortality. Without effective AKI-D therapies, focus should be on early risk stratification and prevention to avoid this devastating complication.
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Affiliation(s)
- Lili Chan
- Icahn School of Medicine at Mount Sinai, New York, NY
| | - Swati Mehta
- Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Priti Poojary
- Icahn School of Medicine at Mount Sinai, New York, NY
| | - Sagar Patel
- Rutgers New Jersey Medical School, Newark, NJ
| | - Sumeet Pawar
- Boston University School of Medicine, Boston, MA
| | - Achint Patel
- Icahn School of Medicine at Mount Sinai, New York, NY
| | - Ashish Correa
- Icahn School of Medicine at Mount Sinai, New York, NY
| | - Shanti Patel
- Icahn School of Medicine at Mount Sinai, New York, NY
| | | | | | | | - Umesh Gidwani
- Icahn School of Medicine at Mount Sinai, New York, NY
| | - Steven G Coca
- Icahn School of Medicine at Mount Sinai, New York, NY
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213
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Patel A, Shah H, Patel S, Nadkarni GN, Uribarri J. Geographical Variation in Peritoneal Dialysis Catheter Insertion and Initiation within the United States. Perit Dial Int 2016; 36:691-693. [PMID: 27903854 PMCID: PMC5174880 DOI: 10.3747/pdi.2016.00006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Peritoneal dialysis (PD) is an effective but underutilized renal replacement therapy modality. There are limited data regarding geographical variation in PD catheter insertion and utilization of PD as a first renal replacement therapy in the United States. We explored the variation in catheter insertion and initiation of PD utilizing 2 large, nationally representative databases. The incidence of catheter insertion differed significantly by geographical region, being highest in the South (7.30/100 end-stage renal disease [ESRD] patients; 95% confidence [CI] interval 6.78 - 7.81) and lowest in the West (5.91/100 ESRD patients; 95% CI 5.43 - 6.38). Peritoneal dialysis initiation also differed by region, being highest in the West (7.10/100 ESRD patients; 95% CI 6.83 - 7.30) and lowest in the Northeast (5.12/100 ESRD patients; 95% CI 4.87 - 5.30). Interestingly, the Northeast region, with the lowest rate of PD utilization, had the highest number of nephrologists per population (3.95/100,000 persons), and the West, with the highest PD utilization, had the lowest number of nephrologists (2.54/100,000 persons). Reasons for this variation should be explored further and efforts should be made to standardize PD implementation throughout the United States.
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Affiliation(s)
- Achint Patel
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Harshil Shah
- Department of Medicine, Detroit Medical Center, Detroit, MI, USA
| | - Shanti Patel
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Girish N Nadkarni
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jaime Uribarri
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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214
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Vlassara H, Cai W, Tripp E, Pyzik R, Yee K, Goldberg L, Tansman L, Chen X, Mani V, Fayad ZA, Nadkarni GN, Striker GE, He JC, Uribarri J. Oral AGE restriction ameliorates insulin resistance in obese individuals with the metabolic syndrome: a randomised controlled trial. Diabetologia 2016; 59:2181-92. [PMID: 27468708 PMCID: PMC5129175 DOI: 10.1007/s00125-016-4053-x] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 06/14/2016] [Indexed: 12/17/2022]
Abstract
AIMS/HYPOTHESIS We previously reported that obese individuals with the metabolic syndrome (at risk), compared with obese individuals without the metabolic syndrome (healthy obese), have elevated serum AGEs that strongly correlate with insulin resistance, oxidative stress and inflammation. We hypothesised that a diet low in AGEs (L-AGE) would improve components of the metabolic syndrome in obese individuals, confirming high AGEs as a new risk factor for the metabolic syndrome. METHODS A randomised 1 year trial was conducted in obese individuals with the metabolic syndrome in two parallel groups: L-AGE diet vs a regular diet, habitually high in AGEs (Reg-AGE). Participants were allocated to each group by randomisation using random permuted blocks. At baseline and at the end of the trial, we obtained anthropometric variables, blood and urine samples, and performed OGTTs and MRI measurements of visceral and subcutaneous abdominal tissue and carotid artery. Only investigators involved in laboratory determinations were blinded to dietary assignment. Effects on insulin resistance (HOMA-IR) were the primary outcome. RESULTS Sixty-one individuals were randomised to a Reg-AGE diet and 77 to an L-AGE diet; the data of 49 and 51, respectively, were analysed at the study end in 2014. The L-AGE diet markedly improved insulin resistance; modestly decreased body weight; lowered AGEs, oxidative stress and inflammation; and enhanced the protective factors sirtuin 1, AGE receptor 1 and glyoxalase I. The Reg-AGE diet raised AGEs and markers of insulin resistance, oxidative stress and inflammation. There were no effects on MRI-assessed measurements. No side effects from the intervention were identified. HOMA-IR came down from 3.1 ± 1.8 to 1.9 ± 1.3 (p < 0.001) in the L-AGE group, while it increased from 2.9 ± 1.2 to 3.6 ± 1.7 (p < 0.002) in the Reg-AGE group. CONCLUSIONS/INTERPRETATION L-AGE ameliorates insulin resistance in obese people with the metabolic syndrome, and may reduce the risk of type 2 diabetes, without necessitating a major reduction in adiposity. Elevated serum AGEs may be used to diagnose and treat 'at-risk' obesity. TRIAL REGISTRATION ClinicalTrials.gov NCT01363141 FUNDING: The study was funded by the National Institute of Diabetes and Digestive and Kidney Diseases (DK091231).
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Affiliation(s)
- Helen Vlassara
- Department of Geriatrics, Division of Experimental Diabetes and Aging, The Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA
- Department of Medicine, The Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Weijing Cai
- Department of Geriatrics, Division of Experimental Diabetes and Aging, The Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA
| | - Elizabeth Tripp
- Department of Geriatrics, Division of Experimental Diabetes and Aging, The Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA
| | - Renata Pyzik
- Department of Geriatrics, Division of Experimental Diabetes and Aging, The Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA
| | - Kalle Yee
- Department of Geriatrics, Division of Experimental Diabetes and Aging, The Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA
| | - Laurie Goldberg
- Department of Geriatrics, Division of Experimental Diabetes and Aging, The Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA
| | - Laurie Tansman
- Department of Geriatrics, Division of Experimental Diabetes and Aging, The Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA
| | - Xue Chen
- Department of Geriatrics, Division of Experimental Diabetes and Aging, The Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA
| | - Venkatesh Mani
- Translational and Molecular Imaging Institute, The Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Zahi A Fayad
- Translational and Molecular Imaging Institute, The Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Girish N Nadkarni
- Department of Medicine, Division of Nephrology, The Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Gary E Striker
- Department of Geriatrics, Division of Experimental Diabetes and Aging, The Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA
- Department of Medicine, Division of Nephrology, The Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - John C He
- Department of Medicine, Division of Nephrology, The Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jaime Uribarri
- Department of Medicine, Division of Nephrology, The Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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215
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Coca SG, Nadkarni GN, Garg AX, Koyner J, Thiessen-Philbrook H, McArthur E, Shlipak MG, Parikh CR. First Post-Operative Urinary Kidney Injury Biomarkers and Association with the Duration of AKI in the TRIBE-AKI Cohort. PLoS One 2016; 11:e0161098. [PMID: 27537050 PMCID: PMC4990204 DOI: 10.1371/journal.pone.0161098] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 07/31/2016] [Indexed: 01/05/2023] Open
Abstract
Background We previously demonstrated that assessment of the duration of AKI, in addition to magnitude of rise in creatinine alone, adds prognostic information for long-term survival. We evaluated whether post-operative kidney injury biomarkers in urine collected immediately after cardiac surgery associate with duration of serum creatinine elevation. Methods We studied 1199 adults undergoing cardiac surgery in a prospective cohort study (TRIBE-AKI) and examined the association between the levels of five urinary biomarkers individually at 0–6 hours after surgery: interleukin-18 (IL-18), neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), liver fatty acid binding protein (L-FABP) and albumin with duration of serum creatinine-based AKIN criteria for AKI (0 (no AKI), 1–2, 3–6, ≥7 days). Results Overall, 407 (34%) patients had at least stage 1 AKI, of whom 251 (61.7%) had duration of 1–2 days, 118 (28.9%) had duration 3–6 days, and 38 (9.3%) had duration of ≥7 days. Higher concentrations of all biomarkers (per log increase) were independently associated with a greater odds of a longer duration of AKI; odds ratios and 95% confidence intervals using ordinal logistic regression were the following: IL-18: 1.22, 1.13–1.32; KIM-1: 1.36, 1.21–1.52; albumin 1.20, 1.09–1.32; L-FABP 1.11, 1.04–1.19; NGAL 1.06, 1.00–1.14). AKI duration of 7 days or longer was associated with a 5-fold adjusted risk of mortality at 3 years. Conclusions There was an independent dose-response association between urinary levels of injury biomarkers immediately after cardiac surgery and longer duration of AKI. Duration of AKI was also associated with long term mortality. Future studies should explore the potential utility of these urinary kidney injury biomarkers to enrich enrollment of patients at risk for longer duration of AKI into trials of interventions to prevent or treat post-operative AKI.
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Affiliation(s)
- Steven G. Coca
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Girish N. Nadkarni
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Amit X. Garg
- Division of Nephrology, Department of Medicine, Western University, London, Ontario, Canada
| | - Jay Koyner
- Section of Nephrology, Department of Medicine, University of Chicago, Pritzker School of Medicine, Chicago, Illinois, United States of America
| | | | - Eric McArthur
- Division of Nephrology, Department of Medicine, Western University, London, Ontario, Canada
| | - Michael G. Shlipak
- Division of General Internal Medicine, San Francisco VA Medical Center, University of California, San Francisco, California, United States of America
| | - Chirag R. Parikh
- Program of Applied Translational Research, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, United States of America
- * E-mail:
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Nadkarni GN, Rao V, Ismail-Beigi F, Fonseca VA, Shah SV, Simonson MS, Cantley L, Devarajan P, Parikh CR, Coca SG. Association of Urinary Biomarkers of Inflammation, Injury, and Fibrosis with Renal Function Decline: The ACCORD Trial. Clin J Am Soc Nephrol 2016; 11:1343-1352. [PMID: 27189318 PMCID: PMC4974890 DOI: 10.2215/cjn.12051115] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 04/12/2016] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND OBJECTIVES Current measures for predicting renal functional decline in patients with type 2 diabetes with preserved renal function are unsatisfactory, and multiple markers assessing various biologic axes may improve prediction. We examined the association of four biomarker-to-creatinine ratio levels (monocyte chemotactic protein-1, IL-18, kidney injury molecule-1, and YKL-40) with renal outcome. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We used a nested case-control design in the Action to Control Cardiovascular Disease Trial by matching 190 participants with ≥40% sustained eGFR decline over the 5-year follow-up period to 190 participants with ≤10% eGFR decline in a 1:1 fashion on key characteristics (age within 5 years, sex, race, baseline albumin-to-creatinine ratio within 20 μg/mg, and baseline eGFR within 10 ml/min per 1.73 m(2)), with ≤10% decline. We used a Mesoscale Multiplex Platform and measured biomarkers in baseline and 24-month specimens, and we examined biomarker associations with outcome using conditional logistic regression. RESULTS Baseline and 24-month levels of monocyte chemotactic protein-1-to-creatinine ratio levels were higher for cases versus controls. The highest quartile of baseline monocyte chemotactic protein-1-to-creatinine ratio had fivefold greater odds, and each log increment had 2.27-fold higher odds for outcome (odds ratio, 5.27; 95% confidence interval, 2.19 to 12.71 and odds ratio, 2.27; 95% confidence interval, 1.44 to 3.58, respectively). IL-18-to-creatinine ratio, kidney injury molecule-1-to-creatinine ratio, and YKL-40-to-creatinine ratio were not consistently associated with outcome. C statistic for traditional predictors of eGFR decline was 0.70, which improved significantly to 0.74 with monocyte chemotactic protein-1-to-creatinine ratio. CONCLUSIONS Urinary monocyte chemotactic protein-1-to-creatinine ratio concentrations were strongly associated with sustained renal decline in patients with type 2 diabetes with preserved renal function.
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Affiliation(s)
- Girish N. Nadkarni
- Department of Medicine, Division of Nephrology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Veena Rao
- Department of Medicine, Division of Nephrology, Yale University School of Medicine, New Haven, Connecticut
| | - Faramarz Ismail-Beigi
- Department of Medicine, Division of Clinical and Molecular Endocrinology, Case Western Reserve University, Cleveland, Ohio
| | - Vivian A. Fonseca
- Department of Medicine, Division of Endocrinology, Tulane University, New Orleans, Louisiana
| | - Sudhir V. Shah
- Department of Medicine, Division of Nephrology, University of Arkansas Medical Sciences, Little Rock, Arkansas; and
| | - Michael S. Simonson
- Department of Medicine, Division of Clinical and Molecular Endocrinology, Case Western Reserve University, Cleveland, Ohio
| | - Lloyd Cantley
- Department of Medicine, Division of Nephrology, Yale University School of Medicine, New Haven, Connecticut
| | - Prasad Devarajan
- Department of Pediatrics, Division of Nephrology, University of Cincinnati, Cincinnati, Ohio
| | - Chirag R. Parikh
- Department of Medicine, Division of Nephrology, Yale University School of Medicine, New Haven, Connecticut
| | - Steven G. Coca
- Department of Medicine, Division of Nephrology, Icahn School of Medicine at Mount Sinai, New York, New York
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Nadkarni GN, Coca SG, Wyatt CM. Big data in nephrology: promises and pitfalls. Kidney Int 2016; 90:240-241. [DOI: 10.1016/j.kint.2016.06.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 06/09/2016] [Indexed: 01/04/2023]
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Abstract
Recent advances in genomics and sequencing technology have led to a better understanding of genetic risk in CKD. Genetics could account in part for racial differences in treatment response for medications including antihypertensives and immunosuppressive medications due to its correlation with ancestry. However, there is still a substantial lag between generation of this knowledge and its adoption in routine clinical care. This review summarizes the recent advances in genomics and CKD, discusses potential reasons for its underutilization, and highlights potential avenues for application of genomic information to improve clinical care and outcomes in this particularly vulnerable population.
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219
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Grams ME, Sang Y, Levey AS, Matsushita K, Ballew S, Chang AR, Chow EK, Kasiske BL, Kovesdy CP, Nadkarni GN, Shalev V, Segev DL, Coresh J, Lentine KL, Garg AX. Kidney-Failure Risk Projection for the Living Kidney-Donor Candidate. N Engl J Med 2016; 374:411-21. [PMID: 26544982 PMCID: PMC4758367 DOI: 10.1056/nejmoa1510491] [Citation(s) in RCA: 299] [Impact Index Per Article: 37.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Evaluation of candidates to serve as living kidney donors relies on screening for individual risk factors for end-stage renal disease (ESRD). To support an empirical approach to donor selection, we developed a tool that simultaneously incorporates multiple health characteristics to estimate a person's probable long-term risk of ESRD if that person does not donate a kidney. METHODS We used risk associations from a meta-analysis of seven general population cohorts, calibrated to the population-level incidence of ESRD and mortality in the United States, to project the estimated long-term incidence of ESRD among persons who do not donate a kidney, according to 10 demographic and health characteristics. We then compared 15-year projections with the observed risk among 52,998 living kidney donors in the United States. RESULTS A total of 4,933,314 participants from seven cohorts were followed for a median of 4 to 16 years. For a 40-year-old person with health characteristics that were similar to those of age-matched kidney donors, the 15-year projections of the risk of ESRD in the absence of donation varied according to race and sex; the risk was 0.24% among black men, 0.15% among black women, 0.06% among white men, and 0.04% among white women. Risk projections were higher in the presence of a lower estimated glomerular filtration rate, higher albuminuria, hypertension, current or former smoking, diabetes, and obesity. In the model-based lifetime projections, the risk of ESRD was highest among persons in the youngest age group, particularly among young blacks. The 15-year observed risks after donation among kidney donors in the United States were 3.5 to 5.3 times as high as the projected risks in the absence of donation. CONCLUSIONS Multiple demographic and health characteristics may be used together to estimate the projected long-term risk of ESRD among living kidney-donor candidates and to inform acceptance criteria for kidney donors. (Funded by the National Institute of Diabetes and Digestive and Kidney Diseases and others.).
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Affiliation(s)
- Morgan E. Grams
- Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Yingying Sang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Andrew S. Levey
- Division of Nephrology at Tufts Medical Center, Boston, MA, USA
| | - Kunihiro Matsushita
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Shoshana Ballew
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Alex R. Chang
- Division of Nephrology, Geisinger Medical Center, Danville, PA, USA
| | - Eric K.H. Chow
- Departments of Surgery and Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - Bertram L. Kasiske
- Department of Medicine, Hennepin County Medical Center, and University of Minnesota, Minneapolis, MN, USA
| | - Csaba P. Kovesdy
- Memphis Veterans Affairs Medical Center, Memphis, TN, USA
- University of Tennessee Health Science Center, Memphis, TN, USA
| | - Girish N. Nadkarni
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Varda Shalev
- Medical Division, Maccabi Healthcare Services and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dorry L. Segev
- Departments of Surgery and Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - Josef Coresh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Krista L. Lentine
- Centers for Abdominal Transplantation and Outcomes Research, Saint Louis University, St. Louis, MO, USA
| | - Amit X. Garg
- Departments of Medicine and Epidemiology and Biostatistics, Western University, London, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Ontario, Canada
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Nadkarni GN, Simoes PK, Patel A, Patel S, Yacoub R, Konstantinidis I, Kamat S, Annapureddy N, Parikh CR, Coca SG. National trends of acute kidney injury requiring dialysis in decompensated cirrhosis hospitalizations in the United States. Hepatol Int 2016; 10:525-31. [PMID: 26825548 DOI: 10.1007/s12072-016-9706-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 01/11/2016] [Indexed: 01/20/2023]
Abstract
BACKGROUND AND AIMS Cirrhosis affects 5.5 million patients with estimated costs of US$4 billion. Previous studies about dialysis requiring acute kidney injury (AKI-D) in decompensated cirrhosis (DC) are from a single center/year. We aimed to describe national trends of incidence and impact of AKI-D in DC hospitalizations. METHODS We extracted our cohort from the Nationwide Inpatient Sample (NIS) from 2006-2012. We identified hospitalizations with DC and AKI-D by validated ICD9 codes. We analyzed temporal changes in DC hospitalizations complicated by AKI-D and utilized multivariable logistic regression models to estimate AKI-D impact on hospital mortality. RESULTS We identified a total of 3,655,700 adult DC hospitalizations from 2006 to 2012 of which 78,015 (2.1 %) had AKI-D. The proportion with AKI-D increased from 1.5 % in 2006 to 2.23 % in 2012; it was stable between 2009 and 2012 despite an increase in absolute numbers from 6773 to 13,930. The overall hospital mortality was significantly higher in hospitalizations with AKI-D versus those without (40.87 vs. 6.96 %; p < 0.001). In an adjusted multivariable analysis, adjusted odds ratio for mortality was 2.17 (95 % CI 2.06-2.28; p < 0.01) with AKI-D, which was stable from 2006 to 2012. Changes in demographics and increases in acute/chronic comorbidities and procedures explained temporal changes in AKI-D. CONCLUSIONS Proportion of DC hospitalizations with AKI-D increased from 2006 to 2009, and although this was stable from 2009 to 2012, there was an increase in absolute cases. These results elucidate the burden of AKI-D on DC hospitalizations and excess associated mortality, as well as highlight the importance of prevention, early diagnosis and testing of novel interventions in this vulnerable population.
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Affiliation(s)
- Girish N Nadkarni
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L Levy Place, Box 1243, New York, NY, 10029, USA.
| | - Priya K Simoes
- Division of Gastroenterology and Nutrition, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Achint Patel
- Department of Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Shanti Patel
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L Levy Place, Box 1243, New York, NY, 10029, USA
| | - Rabi Yacoub
- Division of Nephrology, Department of Medicine, University of Buffalo School of Medicine, Buffalo, NY, USA
| | - Ioannis Konstantinidis
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L Levy Place, Box 1243, New York, NY, 10029, USA
| | - Sunil Kamat
- Division of Critical Care, Department of Medicine, Sir H. N. Reliance Foundation Hospital and Research Centre, Mumbai, India
| | - Narender Annapureddy
- Division of Rheumatology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Chirag R Parikh
- Division of Nephrology, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Steven G Coca
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L Levy Place, Box 1243, New York, NY, 10029, USA
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Yacoub R, Kaji D, Patel SN, Simoes PK, Busayavalasa D, Nadkarni GN, He JC, Coca SG, Uribarri J. Association between probiotic and yogurt consumption and kidney disease: insights from NHANES. Nutr J 2016; 15:10. [PMID: 26818246 PMCID: PMC4728789 DOI: 10.1186/s12937-016-0127-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 01/19/2016] [Indexed: 12/03/2022] Open
Abstract
Background Data from experimental animals suggest that probiotic supplements may retard CKD progression. However, the relationship between probiotic use, frequent yogurt consumption (as a natural probiotic source), and kidney parameters have not been evaluated in humans. Findings We utilized NHANES data, and analyzed the association of probiotic alone (1999–2012) and yogurt/probiotic (2003–2006) use with albuminuria and eGFR after adjustment for demographic and clinical parameters. Frequent yogurt consumption was defined as thrice or more weekly over the year prior to the interview. Frequent yogurt/probiotic consumers had lower adjusted odds of developing combined outcome (albuminuria and/or eGFR < 60 ml/min/1.73 m2) compared to infrequent consumers (OR = 0.76; 95 % CI = 0.61-0.94). When evaluated separately, frequent consumers had lower odds of albuminuria and nonsignificant trend towards decreased odds of low eGFR compared to infrequent consumers. In the probiotic cohort, probiotic consumers were found to have a lower adjusted odds of albuminuria compared to nonusers (OR = 0.59; 95 % CI = 0.37–0.94). Conclusion Frequent yogurt and/or probiotics use is associated with decreased odds of proteinuric kidney disease. These hypothesis-generating results warrant further translational studies to further delineate the relationship between yogurt/probiotics with kidney dysfunction, as well as microbiome and dysbiosis as potential mediators. Electronic supplementary material The online version of this article (doi:10.1186/s12937-016-0127-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rabi Yacoub
- Department of Medicine, Division of Nephrology, University at Buffalo, Buffalo, NY, USA.
| | - Deepak Kaji
- Department of Medicine, Division of Nephrology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Shanti N Patel
- Department of Medicine, Division of Nephrology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Priya K Simoes
- Department of Medicine, Division of Gastroenterology and Clinical Nutrition, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Deepthi Busayavalasa
- Department of Medicine, Division of Nephrology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Girish N Nadkarni
- Department of Medicine, Division of Nephrology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - John C He
- Department of Medicine, Division of Nephrology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Steven G Coca
- Department of Medicine, Division of Nephrology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Jaime Uribarri
- Department of Medicine, Division of Nephrology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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Al Azzi Y, Zeldis E, Nadkarni GN, Schanzer H, Uribarri J. Outcomes of dialysis catheters placed by the Y-TEC peritoneoscopic technique: a single-center surgical experience. Clin Kidney J 2016; 9:158-61. [PMID: 26798478 PMCID: PMC4720193 DOI: 10.1093/ckj/sfv113] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 10/12/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND In the last few years, peritoneal dialysis (PD) catheter placement techniques and outcomes have become important because of the growing population of PD patients. Although there are a growing number of catheters placed by the minimally invasive Y-TEC peritoneoscopic technique, there are still limited data on outcomes for these catheters, especially those placed by a surgeon. We aimed to conduct a retrospective study of our experience with PD catheters placed by the Y-TEC peritoneoscopic technique in our institution. METHODS We reviewed patients with peritoneoscopic PD catheter insertion over the last decade and described their complications and outcomes. In a secondary analysis, we compared the outcomes and complications of these catheters with those with open placement placed by the same surgeon. RESULTS We had complete data on 62 patients with peritoneoscopic catheter placement during the study period. The mean age was 55 years, 48.4% were females and the most common cause of end-stage renal disease was diabetes mellitus (33%). Surgical complications were seen in only 6/62 (9.6%) and peritonitis in 16/62 (26%) of peritoneoscopic catheters. Most catheters were used after 2 months of placement, while 12.3% were used within 2 months. When compared with 93 patients with open placement of catheters as a secondary analysis, peritoneoscopic catheters were found to have a higher 2-year survival. CONCLUSION Our large series of peritoneoscopically placed catheters by a surgeon demonstrate low surgical complications and peritonitis rates as well as superior 2-year survival compared with open placement of catheters.
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Affiliation(s)
- Yorg Al Azzi
- Division of Nephrology, Department of Medicine , Mount Sinai Hospital, Icahn School of Medicine , New York, NY , USA
| | - Etti Zeldis
- Division of Nephrology, Department of Medicine , Mount Sinai Hospital, Icahn School of Medicine , New York, NY , USA
| | - Girish N Nadkarni
- Division of Nephrology, Department of Medicine , Mount Sinai Hospital, Icahn School of Medicine , New York, NY , USA
| | - Harry Schanzer
- Division of Vascular Surgery, Department of Surgery , Mount Sinai Hospital, Icahn School of Medicine , New York, NY , USA
| | - Jaime Uribarri
- Division of Nephrology, Department of Medicine , Mount Sinai Hospital, Icahn School of Medicine , New York, NY , USA
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Tangri N, Grams ME, Levey AS, Coresh J, Appel LJ, Astor BC, Chodick G, Collins AJ, Djurdjev O, Elley CR, Evans M, Garg AX, Hallan SI, Inker LA, Ito S, Jee SH, Kovesdy CP, Kronenberg F, Heerspink HJL, Marks A, Nadkarni GN, Navaneethan SD, Nelson RG, Titze S, Sarnak MJ, Stengel B, Woodward M, Iseki K. Multinational Assessment of Accuracy of Equations for Predicting Risk of Kidney Failure: A Meta-analysis. JAMA 2016; 315:164-74. [PMID: 26757465 PMCID: PMC4752167 DOI: 10.1001/jama.2015.18202] [Citation(s) in RCA: 387] [Impact Index Per Article: 48.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
IMPORTANCE Identifying patients at risk of chronic kidney disease (CKD) progression may facilitate more optimal nephrology care. Kidney failure risk equations, including such factors as age, sex, estimated glomerular filtration rate, and calcium and phosphate concentrations, were previously developed and validated in 2 Canadian cohorts. Validation in other regions and in CKD populations not under the care of a nephrologist is needed. OBJECTIVE To evaluate the accuracy of the risk equations across different geographic regions and patient populations through individual participant data meta-analysis. DATA SOURCES Thirty-one cohorts, including 721,357 participants with CKD stages 3 to 5 in more than 30 countries spanning 4 continents, were studied. These cohorts collected data from 1982 through 2014. STUDY SELECTION Cohorts participating in the CKD Prognosis Consortium with data on end-stage renal disease. DATA EXTRACTION AND SYNTHESIS Data were obtained and statistical analyses were performed between July 2012 and June 2015. Using the risk factors from the original risk equations, cohort-specific hazard ratios were estimated and combined using random-effects meta-analysis to form new pooled kidney failure risk equations. Original and pooled kidney failure risk equation performance was compared, and the need for regional calibration factors was assessed. MAIN OUTCOMES AND MEASURES Kidney failure (treatment by dialysis or kidney transplant). RESULTS During a median follow-up of 4 years of 721,357 participants with CKD, 23,829 cases kidney failure were observed. The original risk equations achieved excellent discrimination (ability to differentiate those who developed kidney failure from those who did not) across all cohorts (overall C statistic, 0.90; 95% CI, 0.89-0.92 at 2 years; C statistic at 5 years, 0.88; 95% CI, 0.86-0.90); discrimination in subgroups by age, race, and diabetes status was similar. There was no improvement with the pooled equations. Calibration (the difference between observed and predicted risk) was adequate in North American cohorts, but the original risk equations overestimated risk in some non-North American cohorts. Addition of a calibration factor that lowered the baseline risk by 32.9% at 2 years and 16.5% at 5 years improved the calibration in 12 of 15 and 10 of 13 non-North American cohorts at 2 and 5 years, respectively (P = .04 and P = .02). CONCLUSIONS AND RELEVANCE Kidney failure risk equations developed in a Canadian population showed high discrimination and adequate calibration when validated in 31 multinational cohorts. However, in some regions the addition of a calibration factor may be necessary.
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Affiliation(s)
- Navdeep Tangri
- Department of Medicine, Seven Oaks General Hospital, University of Manitoba, Winnipeg, Canada2Department of Community Health Sciences, Seven Oaks General Hospital, University of Manitoba, Winnipeg, Canada
| | | | - Andrew S Levey
- Division of Nephrology at Tufts Medical Center, Boston, Massachusetts
| | - Josef Coresh
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Lawrence J Appel
- Johns Hopkins Medical Institutions, Baltimore, Maryland5Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Brad C Astor
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison7Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison
| | - Gabriel Chodick
- Medical Division, Maccabi Healthcare Services, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Allan J Collins
- Chronic Disease Research Group, Minneapolis Medical Research Foundation, Minneapolis, Minnesota10Department of Medicine, University of Minnesota, Minneapolis
| | - Ognjenka Djurdjev
- Department of Measurement & Reporting, Provincial Health Service Authority, Vancouver, British Columbia, Canada
| | - C Raina Elley
- Department of General Practice and Primary Health Care, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Marie Evans
- Division of Renal Medicine, CLINTEC, Karolinska Institutet, Stockholm, Sweden
| | - Amit X Garg
- Departments of Medicine and Epidemiology and Biostatistics, Western University, and Institute for Clinical Evaluative Sciences, Ontario, Canada
| | - Stein I Hallan
- Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science Technology, Trondheim16Division of Nephrology, Department of Medicine, St Olav University Hospital, Trondheim, Norway
| | - Lesley A Inker
- Division of Nephrology at Tufts Medical Center, Boston, Massachusetts
| | - Sadayoshi Ito
- Division of Nephrology, Endocrinology and Vascular Medicine, Department of Medicine, Tohoku University School of Medicine, Sendai, Japan
| | - Sun Ha Jee
- Department of Epidemiology and Health Promotion, Institute for Health Promotion, Graduate School of Public Health, Yonsei University, Seoul, Korea
| | - Csaba P Kovesdy
- Memphis Veterans Affairs Medical Center, Memphis, Tennessee20University of Tennessee Health Science Center, Memphis, Tennessee
| | - Florian Kronenberg
- Department of Medical Genetics, Molecular and Clinical Pharmacology, Division of Genetic Epidemiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Hiddo J Lambers Heerspink
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, the Netherlands
| | - Angharad Marks
- Division of Applied Health Sciences, University of Aberdeen, and NHS Grampian, Foresterhill, Aberdeen, Scotland
| | - Girish N Nadkarni
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Robert G Nelson
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, Arizona
| | - Stephanie Titze
- Department of Nephrology and Hypertension, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Mark J Sarnak
- Division of Nephrology at Tufts Medical Center, Boston, Massachusetts
| | - Benedicte Stengel
- CESP, INSERM, Villejuif, France29Université Paris-Saclay, Université Paris-Sud, UVSQ, Villejuif, France
| | - Mark Woodward
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland30The George Institute for Global Health, Nuffield Department of Population Health, University of Oxford, Oxford, England31The George Institute for Global Health, University of Sydney, Sy
| | - Kunitoshi Iseki
- Dialysis Unit, University Hospital of the Ryukyus, Nishihara, Okinawa, Japan
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Patel AA, Mahajan A, Benjo A, Jani VB, Annapureddy N, Agarwal SK, Simoes PK, Pakanati KC, Sinha V, Konstantinidis I, Pathak A, Nadkarni GN. A National Perspective of Do-Not-Resuscitate Order Utilization Predictors in Intracerebral Hemorrhage. Neurohospitalist 2016; 6:7-10. [PMID: 26753051 DOI: 10.1177/1941874415599577] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Nontraumatic intracerebral hemorrhage (ICH) is associated with substantial morbidity and mortality. Do-not-resuscitate (DNR) orders are linked to poorer outcomes in patients with ICH, possibly due to less active management. Demographic, regional, and social factors, not related to ICH severity, have not been adequately looked at as significant predictors of DNR utilization. We reviewed the Healthcare Cost and Utilization Project's Nationwide Inpatient Sample (NIS) database in 2011 for adult ICH admissions and DNR status. We generated hierarchical 2-level multivariate regression models to estimate adjusted odds ratios. We analyzed 25 768 ICH hospitalizations, 18% of which (4620 hospitalizations) had DNR orders, corresponding to national estimates of 126 254 and 22 668, respectively. In multivariable regression, female gender, white or Hispanic/Latino ethnicity, no insurance coverage, and teaching hospitals were significantly associated with increased DNR utilization after adjusting for confounders. There was also significantly more interhospital variability in the lowest quartile of hospital volume. In conclusion, demographic factors and insurance status are significantly associated with increased DNR utilization, with more individual hospital variability in low-volume hospitals. The reasons for this are likely qualitative and linked to patient, provider, and hospital practices.
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Affiliation(s)
- Achint A Patel
- Department of Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Alexandre Benjo
- Division of Cardiology, Oschner Clinic Foundation, New Orleans, LA, USA
| | - Vishal B Jani
- Department of Neurology, Michigan State University, East Lansing, MI, USA
| | - Narender Annapureddy
- Division of Rheumatology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Shiv Kumar Agarwal
- Division of Cardiology, University of Arkansas Medical Sciences, Little Rock, AR, USA
| | - Priya K Simoes
- Department of Medicine, St. Luke's Roosevelt Medical Center at Mount Sinai, New York, NY, USA
| | | | - Vikash Sinha
- Division of Nephrology, University of Chicago, Chicago, IL, USA
| | | | - Ambarish Pathak
- Department of Public Health, New York Medical College, Valhalla, NY
| | - Girish N Nadkarni
- Division of Nephrology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Nadkarni GN, Patel AA, Ahuja Y, Annapureddy N, Agarwal SK, Simoes PK, Konstantinidis I, Kamat S, Archdeacon M, Thakar CV. Incidence, Risk Factors, and Outcome Trends of Acute Kidney Injury in Elective Total Hip and Knee Arthroplasty. Am J Orthop (Belle Mead NJ) 2016; 45:E12-E19. [PMID: 26761921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Over the past decade, there has been a marked increase in the number of primary and revision total hip and knee arthroplasties performed in the United States. Acute kidney injury (AKI) is a common complication of these procedures; however, little is known about its epidemiology in the elective arthroplasty population. We conducted a study to determine the incidence, risk factors, and outcomes of AKI after elective joint arthroplasty. Drawing on the Nationwide Inpatient Sample database, we found that the proportion of hospitalizations complicated by AKI increased rapidly from 0.5% in 2002 to 1.8% to 1.9% in 2012. Multivariate analysis revealed that the key risk factors for AKI were chronic kidney disease and the postoperative events of sepsis, acute myocardial infarction, and blood transfusion. Moreover, codiagnosis with chronic kidney disease increased the risk for AKI associated with all 3 postoperative events. After adjusting for confounders, we found an association between AKI and a significantly increased risk for in-hospital mortality and discharge to long-term facilities. AKI serves as an important quality indicator in elective hip and knee surgeries. With elective arthroplasties expected to rise, carefully planned approach to interdisciplinary perioperative care is essential to reduce both the risk and consequences of AKI.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Charuhas V Thakar
- Division of Nephrology, Kidney CARE Program, University of Cincinnati College of Medicine, Cincinnati, OH.
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Konstantinidis I, Nadkarni GN, Yacoub R, Saha A, Simoes P, Parikh CR, Coca SG. Representation of Patients With Kidney Disease in Trials of Cardiovascular Interventions: An Updated Systematic Review. JAMA Intern Med 2016; 176:121-4. [PMID: 26619332 DOI: 10.1001/jamainternmed.2015.6102] [Citation(s) in RCA: 109] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
| | - Girish N Nadkarni
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Rabi Yacoub
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Aparna Saha
- Department of Public Health, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Priya Simoes
- Department of Medicine, St Luke's Roosevelt Hospital Center at Mount Sinai, New York, New York
| | - Chirag R Parikh
- Section of Nephrology, Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Steven G Coca
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
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Nadkarni GN, Patel A, Simoes PK, Yacoub R, Annapureddy N, Kamat S, Konstantinidis I, Perumalswami P, Branch A, Coca SG, Wyatt CM. Dialysis-requiring acute kidney injury among hospitalized adults with documented hepatitis C Virus infection: a nationwide inpatient sample analysis. J Viral Hepat 2016; 23:32-8. [PMID: 26189719 PMCID: PMC4695275 DOI: 10.1111/jvh.12437] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 06/04/2015] [Indexed: 12/13/2022]
Abstract
Chronic hepatitis C virus (HCV) infection may cause kidney injury, particularly in the setting of cryoglobulinemia or cirrhosis; however, few studies have evaluated the epidemiology of acute kidney injury in patients with HCV. We aimed to describe national temporal trends of incidence and impact of severe acute kidney injury (AKI) requiring renal replacement 'dialysis-requiring AKI' in hospitalized adults with HCV. We extracted our study cohort from the Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project using data from 2004 to 2012. We defined HCV and dialysis-requiring acute kidney injury based on previously validated ICD-9-CM codes. We analysed temporal changes in the proportion of hospitalizations complicated by dialysis-requiring AKI and utilized survey multivariable logistic regression models to estimate its impact on in-hospital mortality. We identified a total of 4,603,718 adult hospitalizations with an associated diagnosis of HCV from 2004 to 2012, of which 51,434 (1.12%) were complicated by dialysis-requiring acute kidney injury. The proportion of hospitalizations complicated by dialysis-requiring acute kidney injury increased significantly from 0.86% in 2004 to 1.28% in 2012. In-hospital mortality was significantly higher in hospitalizations complicated by dialysis-requiring acute kidney injury vs those without (27.38% vs 2.95%; adjusted odds ratio: 2.09; 95% confidence interval: 1.74-2.51). The proportion of HCV hospitalizations complicated by dialysis-requiring acute kidney injury increased significantly between 2004 and 2012. Similar to observations in the general population, dialysis-requiring acute kidney injury was associated with a twofold increase in odds of in-hospital mortality in adults with HCV. These results highlight the burden of acute kidney injury in hospitalized adults with HCV infection.
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Affiliation(s)
- Girish N Nadkarni
- Division of Nephrology; Department of Medicine; Icahn School of Medicine at Mount Sinai, New York, NY-10029
| | - Achint Patel
- Department of Public Health, Icahn School of Medicine at Mount Sinai, New York, NY-10029
| | - Priya K Simoes
- Department of Internal Medicine, St. Luke’s Roosevelt Hospital Center at Mount Sinai, New York, NY-10019
| | - Rabi Yacoub
- Division of Nephrology; Department of Medicine; Icahn School of Medicine at Mount Sinai, New York, NY-10029
| | - Narender Annapureddy
- Division of Rheumatology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Sunil Kamat
- Division of Critical Care, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, India
| | - Ioannis Konstantinidis
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY-10029
| | - Ponni Perumalswami
- Division of Gastroenterology and Hepatology, Icahn School of Medicine at Mount Sinai, New York, NY-10029
| | - Andrea Branch
- Division of Gastroenterology and Hepatology, Icahn School of Medicine at Mount Sinai, New York, NY-10029
| | - Steven G Coca
- Division of Nephrology; Department of Medicine; Icahn School of Medicine at Mount Sinai, New York, NY-10029
| | - Christina M Wyatt
- Division of Nephrology; Department of Medicine; Icahn School of Medicine at Mount Sinai, New York, NY-10029
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228
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Affiliation(s)
- Girish N Nadkarni
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Steven G Coca
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
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Nadkarni GN, Patel AA, Konstantinidis I, Mahajan A, Agarwal SK, Kamat S, Annapureddy N, Benjo A, Thakar CV. Dialysis Requiring Acute Kidney Injury in Acute Cerebrovascular Accident Hospitalizations. Stroke 2015; 46:3226-31. [PMID: 26486869 DOI: 10.1161/strokeaha.115.010985] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 09/16/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND AND PURPOSE The epidemiology of dialysis requiring acute kidney injury (AKI-D) in acute ischemic stroke (AIS) and intracerebral hemorrhage (ICH) admissions is poorly understood with previous studies being from a single center or year. METHODS We used the Nationwide Inpatient Sample to evaluate the yearly incidence trends of AKI-D in hospitalizations with AIS and ICH from 2002 to 2011. We also evaluated the trend of impact of AKI-D on in-hospital mortality and adverse discharge using adjusted odds ratios (aOR) after adjusting for demographics and comorbidity indices. RESULTS We extracted a total of 3,937,928 and 696,754 hospitalizations with AIS and ICH, respectively. AKI-D occurred in 1.5 and 3.5 per 1000 in AIS and ICH admissions, respectively. Incidence of admissions complicated by AKI-D doubled from 0.9/1000 to 1.7/1000 in AIS and from 2.1/1000 to 4.3/1000 in ICH admissions. In AIS admissions, AKI-D was associated with 30% higher odds of mortality (aOR, 1.30; 95% confidence interval, 1.12-1.48; P<0.001) and 18% higher odds of adverse discharge (aOR, 1.18; 95% confidence interval, 1.02-1.37; P<0.001). Similarly, in ICH admissions, AKI-D was associated with twice the odds of mortality (aOR, 1.95; 95% confidence interval, 1.61-2.36; P<0.01) and 74% higher odds of adverse discharge (aOR, 1.74; 95% confidence interval, 1.34-2.24; P<0.01). Attributable risk percent of mortality was high with AKI-D (98%-99%) and did not change significantly over the study period. CONCLUSIONS Incidence of AKI-D complicating hospitalizations with cerebrovascular accident continues to grow and is associated with increased mortality and adverse discharge. This highlights the need for early diagnosis, better risk stratification, and preparedness for need for complex long-term care in this vulnerable population.
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Affiliation(s)
- Girish N Nadkarni
- From the Division of Nephrology, Department of Medicine (G.N.N., I.K.) and Department of Public Health (A.A.P.), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Neurology, Henry Ford Hospital System, Detroit, MI (A.M.); Division of Cardiology, Department of Medicine, University of Arkansas Medical Center, Little Rock (S.K.A.); Division of Critical Care, Department of Medicine, Sir H.N. Reliance Foundation Hospital and Research Center, Mumbai, India (S.K.); Division of Rheumatology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN (N.A.); Division of Cardiology, Department of Medicine, Oschner Clinic Foundation, New Orleans, LA (A.B.); and Division of Nephrology, Department of Medicine, University of Cincinnati and Renal Section, Cincinnati VA Medical Center, OH (C.V.T.)
| | - Achint A Patel
- From the Division of Nephrology, Department of Medicine (G.N.N., I.K.) and Department of Public Health (A.A.P.), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Neurology, Henry Ford Hospital System, Detroit, MI (A.M.); Division of Cardiology, Department of Medicine, University of Arkansas Medical Center, Little Rock (S.K.A.); Division of Critical Care, Department of Medicine, Sir H.N. Reliance Foundation Hospital and Research Center, Mumbai, India (S.K.); Division of Rheumatology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN (N.A.); Division of Cardiology, Department of Medicine, Oschner Clinic Foundation, New Orleans, LA (A.B.); and Division of Nephrology, Department of Medicine, University of Cincinnati and Renal Section, Cincinnati VA Medical Center, OH (C.V.T.)
| | - Ioannis Konstantinidis
- From the Division of Nephrology, Department of Medicine (G.N.N., I.K.) and Department of Public Health (A.A.P.), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Neurology, Henry Ford Hospital System, Detroit, MI (A.M.); Division of Cardiology, Department of Medicine, University of Arkansas Medical Center, Little Rock (S.K.A.); Division of Critical Care, Department of Medicine, Sir H.N. Reliance Foundation Hospital and Research Center, Mumbai, India (S.K.); Division of Rheumatology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN (N.A.); Division of Cardiology, Department of Medicine, Oschner Clinic Foundation, New Orleans, LA (A.B.); and Division of Nephrology, Department of Medicine, University of Cincinnati and Renal Section, Cincinnati VA Medical Center, OH (C.V.T.)
| | - Abhimanyu Mahajan
- From the Division of Nephrology, Department of Medicine (G.N.N., I.K.) and Department of Public Health (A.A.P.), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Neurology, Henry Ford Hospital System, Detroit, MI (A.M.); Division of Cardiology, Department of Medicine, University of Arkansas Medical Center, Little Rock (S.K.A.); Division of Critical Care, Department of Medicine, Sir H.N. Reliance Foundation Hospital and Research Center, Mumbai, India (S.K.); Division of Rheumatology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN (N.A.); Division of Cardiology, Department of Medicine, Oschner Clinic Foundation, New Orleans, LA (A.B.); and Division of Nephrology, Department of Medicine, University of Cincinnati and Renal Section, Cincinnati VA Medical Center, OH (C.V.T.)
| | - Shiv Kumar Agarwal
- From the Division of Nephrology, Department of Medicine (G.N.N., I.K.) and Department of Public Health (A.A.P.), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Neurology, Henry Ford Hospital System, Detroit, MI (A.M.); Division of Cardiology, Department of Medicine, University of Arkansas Medical Center, Little Rock (S.K.A.); Division of Critical Care, Department of Medicine, Sir H.N. Reliance Foundation Hospital and Research Center, Mumbai, India (S.K.); Division of Rheumatology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN (N.A.); Division of Cardiology, Department of Medicine, Oschner Clinic Foundation, New Orleans, LA (A.B.); and Division of Nephrology, Department of Medicine, University of Cincinnati and Renal Section, Cincinnati VA Medical Center, OH (C.V.T.)
| | - Sunil Kamat
- From the Division of Nephrology, Department of Medicine (G.N.N., I.K.) and Department of Public Health (A.A.P.), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Neurology, Henry Ford Hospital System, Detroit, MI (A.M.); Division of Cardiology, Department of Medicine, University of Arkansas Medical Center, Little Rock (S.K.A.); Division of Critical Care, Department of Medicine, Sir H.N. Reliance Foundation Hospital and Research Center, Mumbai, India (S.K.); Division of Rheumatology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN (N.A.); Division of Cardiology, Department of Medicine, Oschner Clinic Foundation, New Orleans, LA (A.B.); and Division of Nephrology, Department of Medicine, University of Cincinnati and Renal Section, Cincinnati VA Medical Center, OH (C.V.T.)
| | - Narender Annapureddy
- From the Division of Nephrology, Department of Medicine (G.N.N., I.K.) and Department of Public Health (A.A.P.), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Neurology, Henry Ford Hospital System, Detroit, MI (A.M.); Division of Cardiology, Department of Medicine, University of Arkansas Medical Center, Little Rock (S.K.A.); Division of Critical Care, Department of Medicine, Sir H.N. Reliance Foundation Hospital and Research Center, Mumbai, India (S.K.); Division of Rheumatology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN (N.A.); Division of Cardiology, Department of Medicine, Oschner Clinic Foundation, New Orleans, LA (A.B.); and Division of Nephrology, Department of Medicine, University of Cincinnati and Renal Section, Cincinnati VA Medical Center, OH (C.V.T.)
| | - Alexandre Benjo
- From the Division of Nephrology, Department of Medicine (G.N.N., I.K.) and Department of Public Health (A.A.P.), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Neurology, Henry Ford Hospital System, Detroit, MI (A.M.); Division of Cardiology, Department of Medicine, University of Arkansas Medical Center, Little Rock (S.K.A.); Division of Critical Care, Department of Medicine, Sir H.N. Reliance Foundation Hospital and Research Center, Mumbai, India (S.K.); Division of Rheumatology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN (N.A.); Division of Cardiology, Department of Medicine, Oschner Clinic Foundation, New Orleans, LA (A.B.); and Division of Nephrology, Department of Medicine, University of Cincinnati and Renal Section, Cincinnati VA Medical Center, OH (C.V.T.)
| | - Charuhas V Thakar
- From the Division of Nephrology, Department of Medicine (G.N.N., I.K.) and Department of Public Health (A.A.P.), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Neurology, Henry Ford Hospital System, Detroit, MI (A.M.); Division of Cardiology, Department of Medicine, University of Arkansas Medical Center, Little Rock (S.K.A.); Division of Critical Care, Department of Medicine, Sir H.N. Reliance Foundation Hospital and Research Center, Mumbai, India (S.K.); Division of Rheumatology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN (N.A.); Division of Cardiology, Department of Medicine, Oschner Clinic Foundation, New Orleans, LA (A.B.); and Division of Nephrology, Department of Medicine, University of Cincinnati and Renal Section, Cincinnati VA Medical Center, OH (C.V.T.).
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Agarwal SK, Mohareb S, Patel A, Yacoub R, DiNicolantonio JJ, Konstantinidis I, Pathak A, Fnu S, Annapureddy N, Simoes PK, Kamat S, El-Hayek G, Prasad R, Kumbala D, Nascimento RM, Reilly JP, Nadkarni GN, Benjo AM. Systematic oral hydration with water is similar to parenteral hydration for prevention of contrast-induced nephropathy: an updated meta-analysis of randomised clinical data. Open Heart 2015; 2:e000317. [PMID: 26468404 PMCID: PMC4600249 DOI: 10.1136/openhrt-2015-000317] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 09/02/2015] [Accepted: 09/08/2015] [Indexed: 11/29/2022] Open
Abstract
Background Contrast-induced nephropathy (CIN) is the third most common cause of hospital-acquired kidney injury and is related to increased long-term morbidity and mortality. Adequate intravenous (IV) hydration has been demonstrated to lessen its occurrence. Oral (PO) hydration with water is inexpensive and readily available but its role for CIN prevention is yet to be determined. Methods PubMed, EMBASE and the Cochrane Central register of controlled trials (CENTRAL) databases were searched until April 2015 and studies were selected using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. All randomised clinical trials with head-to-head comparison between PO and IV hydration were included. Results A total of 5 studies with 477 patients were included in the analysis, 255 of those receiving PO water. The incidence of CIN was statistically similar in the IV and PO arms (7.7% and 8.2%, respectively; relative risk 0.97; 95% CI 0.36 to 2.94; p=0.95). The incidence of CIN was statistically similar in the IV and PO arms in patients with chronic kidney disease and with normal renal function. Rise in creatinine at 48–72 h was lower in the PO hydration group compared with IV hydration (pooled standard mean difference 0.04; 95% CI 0.03 to 0.06; p<0.001; I2=62%). Conclusions Our meta-analysis shows that systematic PO hydration with water is at least as effective as IV hydration with saline to prevent CIN. PO hydration is cheaper and more easily administered than IV hydration, thus making it more attractive and just as effective.
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Affiliation(s)
- Shiv Kumar Agarwal
- Division of Cardiovascular Diseases, Department of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas , USA
| | - Sameh Mohareb
- Division of Cardiology, Department of Internal Medicine , Ochsner Clinic Foundation , New Orleans, Louisiana , USA
| | - Achint Patel
- Department of Public Health , Icahn School of Medicine at Mount Sinai , New York, New York , USA
| | - Rabi Yacoub
- Division of Nephrology, Department of Medicine , Icahn School of Medicine at Mount Sinai , New York, New York , USA
| | | | - Ioannis Konstantinidis
- Department of Medicine , Icahn School of Medicine at Mount Sinai , New York, New York , USA
| | - Ambarish Pathak
- Department of Public Health , New York Medical College , Valhalla, New York , USA
| | - Shailesh Fnu
- Division of Cardiovascular Diseases, Department of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas , USA
| | - Narender Annapureddy
- Division of Rheumatology, Department of Medicine , Vanderbilt University Medical Center , Nashville, Tennessee , USA
| | - Priya K Simoes
- Department of Medicine , St Lukes Roosevelt Hospital Center at Mount Sinai , New York, New York , USA
| | - Sunil Kamat
- Division of Critical Care , Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute , Mumbai, Maharashtra , India
| | - Georges El-Hayek
- Department of Medicine , St Lukes Roosevelt Hospital Center at Mount Sinai , New York, New York , USA
| | - Ravi Prasad
- Division of Cardiology, Department of Internal Medicine , Ochsner Clinic Foundation , New Orleans, Louisiana , USA
| | - Damodar Kumbala
- Division of Nephrology, Department of Internal Medicine , Ochsner Clinic Foundation , New Orleans, Louisiana , USA
| | | | - John P Reilly
- Division of Cardiology, Department of Internal Medicine , Ochsner Clinic Foundation , New Orleans, Louisiana , USA
| | - Girish N Nadkarni
- Division of Nephrology, Department of Medicine , Icahn School of Medicine at Mount Sinai , New York, New York , USA
| | - Alexandre M Benjo
- Division of Cardiology, Department of Internal Medicine , Ochsner Clinic Foundation , New Orleans, Louisiana , USA
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Patel AA, Mahajan A, Benjo A, Pathak A, Kar J, Jani VB, Annapureddy N, Agarwal SK, Sabharwal MS, Simoes PK, Konstantinidis I, Yacoub R, Javed F, El Hayek G, Menon MC, Nadkarni GN. A Nationwide Analysis of Outcomes of Weekend Admissions for Intracerebral Hemorrhage Shows Disparities Based on Hospital Teaching Status. Neurohospitalist 2015; 6:51-8. [PMID: 27053981 DOI: 10.1177/1941874415601164] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND AND PURPOSE With the "weekend effect" being well described, the Brain Attack Coalition released a set of "best practice" guidelines in 2005, with the goal to uniformly provide standard of care to patients with stroke. We attempted to define a "weekend effect" in outcomes among patients with intracranial hemorrhage (ICH) over the last decade, utilizing the Nationwide Inpatient Sample (NIS) data. We also attempted to analyze the trend of such an effect. MATERIALS AND METHODS We determined the association of ICH weekend admissions with hospital outcomes including mortality, adverse discharge, length of stay, and cost compared to weekday admissions using multivariable logistic regression. We extracted our study cohort from the NIS, the largest all-payer data set in the United States. RESULTS Of 485 329 ICH admissions from 2002 to 2011, 27.5% were weekend admissions. Overall, weekend admissions were associated with 11% higher odds of in-hospital mortality. When analyzed in 3-year groups, excess mortality of weekend admissions showed temporal decline. There was higher mortality with weekend admissions in nonteaching hospitals persisted (odds ratios 1.16, 1.13, and 1.09, respectively, for 3-year subgroups). Patients admitted during weekends were also 9% more likely to have an adverse discharge (odds ratio 1.09; 95% confidence interval: 1.07-1.11; P < .001) with no variation by hospital status. There was no effect of a weekend admission on either length of stay or cost of care. CONCLUSION Nontraumatic ICH admissions on weekends have higher in-hospital mortality and adverse discharge. This demonstrates need for in-depth review for elucidating this discrepancy and stricter adherence to standard-of-care guidelines to ensure uniform care.
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Affiliation(s)
- Achint A Patel
- Department of Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Alexandre Benjo
- Department of Internal Medicine, Division of Cardiology, Ochsner Clinic Foundation, New Orleans, LA, USA
| | - Ambarish Pathak
- Department of Public Health, New York Medical College, Valhalla, NY
| | - Jitesh Kar
- Neurology Consultants of Huntsville, Huntsville, AL, USA
| | - Vishal B Jani
- Department of Neurology, Michigan State University, East Lansing, MI, USA
| | - Narender Annapureddy
- Division of Rheumatology, Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Shiv Kumar Agarwal
- Division of Cardiology, Department of Internal Medicine, University of Arkansas Medical Sciences, Little Rock, AR, USA
| | - Manpreet S Sabharwal
- Department of Internal Medicine, St. Luke's Roosevelt Medical Center at Mount Sinai, New York, NY, USA
| | - Priya K Simoes
- Department of Internal Medicine, St. Luke's Roosevelt Medical Center at Mount Sinai, New York, NY, USA
| | - Ioannis Konstantinidis
- Division of Nephrology, Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rabi Yacoub
- Division of Nephrology, Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Fahad Javed
- Department of Internal Medicine, Division of Cardiology, Ochsner Clinic Foundation, New Orleans, LA, USA
| | - Georges El Hayek
- Division of Nephrology, Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Madhav C Menon
- Division of Nephrology, Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Girish N Nadkarni
- Division of Nephrology, Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Abstract
Diabetic kidney disease (DKD) is a common, complex condition that has become a significant public health problem. The beneficial effects of intensive glycemic control in type 1 diabetes mellitus on development of DKD are proven; however, the evidence for nephroprotection in patients with type 2 diabetes is conflicting. Moreover, a strategy of intensive glycemic control increases the risk for adverse effects (hypoglycemic episodes) with no obvious impact on macrovascular events or mortality in recent large randomized controlled trials. The risk for hypoglycemia with intensive therapy is heightened in patients with significant renal dysfunction, due to decreased renal clearance of insulin. Establishing an ideal level of glycemic control in patients requires an individualized approach taking into account duration of diabetes and presence of coexisting comorbidities and pre-existing DKD. In this article, we review the available evidence from both observational studies and randomized controlled trials and provide suggestions about evaluating the potential benefits and harm from intensive glycemic control in patients. We also discuss how in the future, a personalized approach using biomarkers might help identify patients most likely to respond as well as those most susceptible to harm. We believe that using the optimal level of glycemic control in diabetic patients using a multi-pronged strategy will improve individual patient outcomes and decrease the overall burden of morbidity and mortality.
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Affiliation(s)
- Girish N Nadkarni
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L Levy Place, Box 1243, New York, NY, 10029, USA,
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233
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Cardoso RN, Benjo AM, DiNicolantonio JJ, Garcia DC, Macedo FYB, El-Hayek G, Nadkarni GN, Gili S, Iannaccone M, Konstantinidis I, Reilly JP. Incidence of cardiovascular events and gastrointestinal bleeding in patients receiving clopidogrel with and without proton pump inhibitors: an updated meta-analysis. Open Heart 2015. [PMID: 26196021 PMCID: PMC4488889 DOI: 10.1136/openhrt-2015-000248] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background Dual antiplatelet therapy is the standard of care after coronary stent placement but increases the bleeding risk. The effects of proton pump inhibitors (PPIs) on clopidogrel metabolism have been described, but the clinical significance is not yet definitive. We aimed to do an updated meta-analysis comparing outcomes in patients receiving clopidogrel with and without PPIs. Methods We systematically searched PubMed, Scopus and the Cochrane Central Register of Controlled Trials for randomised controlled trials (RCTs) and controlled observational studies in patients taking clopidogrel stratified by concomitant PPI use. Heterogeneity was examined with the Cochran Q test and I2 statistics; p values inferior to 0.10 and I2 >25% were considered significant for heterogeneity. Results We included 39 studies with a total of 214 851 patients, of whom 73 731 (34.3%) received the combination of clopidogrel and a PPI. In pooled analysis, all-cause mortality, myocardial infarction, stent thrombosis and cerebrovascular accidents were more common in patients receiving both drugs. However, among 23 552 patients from eight RCTs and propensity-matched studies, there were no significant differences in mortality or ischaemic events between groups. The use of PPIs in patients taking clopidogrel was associated with a significant reduction in the risk of gastrointestinal bleeding. Conclusions The results of our meta-analysis suggest that PPIs are a marker of increased cardiovascular risk in patients taking clopidogrel, rather than a direct cause of worse outcomes. The pharmacodynamic interaction between PPIs and clopidogrel most likely has no clinical significance. Furthermore, PPIs have the potential to decrease gastrointestinal bleeding in clopidogrel users.
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Affiliation(s)
- Rhanderson N Cardoso
- Department of Internal Medicine , University of Miami/Jackson Memorial Hospital , Miami, Florida , USA
| | - Alexandre M Benjo
- Department of Cardiology , Ochsner Medical Center , New Orleans, Louisiana , USA
| | | | - Daniel C Garcia
- Department of Internal Medicine , University of Miami/Jackson Memorial Hospital , Miami, Florida , USA
| | - Francisco Y B Macedo
- Department of Cardiology , Baylor College of Medicine and Michael E. DeBakey VA Medical Center , Houston, Texas , USA
| | | | - Girish N Nadkarni
- Nephrology Department , Mount Sinai Hospital , New York, New York , USA
| | - Sebastiano Gili
- Department of Cardiology , University of Turin , Turin , Italy
| | | | | | - John P Reilly
- Department of Cardiology , Ochsner Medical Center , New Orleans, Louisiana , USA
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234
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Nadkarni GN, Konstantinidis I, Patel A, Yacoub R, Kumbala D, Patel RAG, Annapureddy N, Pakanati KC, Simoes PK, Javed F, Benjo AM. Trimetazidine Decreases Risk of Contrast-Induced Nephropathy in Patients With Chronic Kidney Disease. J Cardiovasc Pharmacol Ther 2015; 20:539-46. [DOI: 10.1177/1074248415573320] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2014] [Accepted: 01/13/2015] [Indexed: 11/16/2022]
Abstract
Objectives: We sought to synthesize and analyze the available data from randomized controlled trials (RCTs) for trimetazidine (TMZ) in the prevention of contrast-induced nephropathy (CIN). Background: Contrast-induced nephropathy after coronary angiography is associated with poor outcomes. Trimetazidine is an anti-ischemic drug that might reduce incidence of CIN, but current data are inconclusive. Methods: We searched MEDLINE/PubMed, EMBASE, Scopus, Cochrane Library, Web of Science, and ScienceDirect electronic databases for RCTs comparing intravenous hydration with normal saline (NS) and/or N-acetyl cysteine (NAC) versus TMZ plus NS ± NAC for prevention of CIN. We used RevMan 5.2 for statistical analysis with the fixed effects model. Results: Of the 808 studies, 3 RCTs met criteria with 290 patients in the TMZ plus NS ± NAC group and 292 patients in the NS ± NAC group. The mean age of patients was 59.5 years, and baseline serum creatinine ranged from 1.3 to 2 mg/dL. Trimetazidine significantly reduced the incidence of CIN by 11% (risk difference 0.11; 95% confidence interval, 0.16-0.06; P < .01). There was no significant heterogeneity between the studies (I2 statistic = 0). The number needed to treat to prevent 1 episode of CIN was 9. Conclusions: The addition of TMZ to NS ± NAC significantly decreased the incidence of CIN in patients undergoing coronary angiography. In conclusion, TMZ could be considered as a potential tool for prevention of CIN in patients with renal dysfunction.
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Affiliation(s)
- Girish N. Nadkarni
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ioannis Konstantinidis
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Achint Patel
- Department of Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rabi Yacoub
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Damodar Kumbala
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rajan A. G. Patel
- Division of Cardiology, Department of Medicine, Ochsner Clinic Foundation, Jefferson, LA, USA
| | - Narender Annapureddy
- Division of Rheumatology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Priya K. Simoes
- Department of Medicine, St. Luke’s Roosevelt Hospital Center at Mount Sinai, New York, NY, USA
| | - Fahad Javed
- Division of Cardiology, Department of Medicine, Ochsner Clinic Foundation, Jefferson, LA, USA
| | - Alexandre M. Benjo
- Division of Cardiology, Department of Medicine, Ochsner Clinic Foundation, Jefferson, LA, USA
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235
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Busani S, Nadkarni GN, Patel A, Ammakkanavar N, shah HK, Patel U, Simoes P, Jain VB. Abstract W P421: Trend in Concurrent Hospitalization for Moyamoya and Sickle Cell Disease: An Analysis of Nationwide Inpatient Sample Data. Stroke 2015. [DOI: 10.1161/str.46.suppl_1.wp421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND:
The association between Moyamoya disease and sickle cell disease is well recognized in the literature. However, there is limited data on inpatient admission of concurrent sickle cell disease and Moyamoya disease. We sought to determine the trend in incidence of admissions of concurrent Moyamoya and sickle cell disease as well as the most common presentation of these admissions.
METHODS:
We reviewed the Healthcare Cost and Utilization Project's Nationwide Inpatient Sample (NIS) database from 2000-2011 for concurrent Moyamoya and sickle cell admissions using the ICD 9-CM codes We obtained data on gender, clinical presentation, procedures, co-morbidities and patient outcomes
RESULTS:
From 2000 to 2011, an estimated patients 756 (weighted (n)=3692) with co-existing Moyamoya disease and sickle cell disease were admitted. The incidence of admission for concurrent disease increased significantly from 0.04/100,000 admissions in 2000 to 0.21/100,000 admissions in 2011(figure 1). This was very significant using the Cochrane Armitage trend test(p<0.001). The most likely reasons for admissions were ischemic stroke(7.2)% followed by hemorrhagic stroke(2.8 and transient ischemic attack(1.2%) (p = 0.0116). The most commonly performed treatment procedures included packed cell transfusion(33.7%) followed by exchange transfusion (8.8%). However there was no significant change in mortality from 2000-2011.
CONCLUSION:
The number of hospitalizations due to concurrent Moyamoya and sickle cell disease has increased significantly over the last decade and are likely to present with a cerebrovascular accident. Thus, it is important to maintain a high degree of suspicion for Moyamoya disease in sickle cell disease patients presenting with neurological symptoms since this could potentially impact their management.
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Affiliation(s)
| | | | | | | | | | | | - Priya Simoes
- St. Lukes Roosevelt Hosp Cntr at Mount Sinai, Manhattan, NY
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236
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Simoes PK, Annapureddy N, Avadhani V, Kasnia G, Nadkarni GN. An unusual presentation: A case of Multicentric Castleman's disease presenting as bilateral pleural effusions. HIV & AIDS Review 2015. [DOI: 10.1016/j.hivar.2015.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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237
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Nadkarni GN, Gottesman O, Linneman JG, Chase H, Berg RL, Farouk S, Nadukuru R, Lotay V, Ellis S, Hripcsak G, Peissig P, Weng C, Bottinger EP. Development and validation of an electronic phenotyping algorithm for chronic kidney disease. AMIA Annu Symp Proc 2014; 2014:907-916. [PMID: 25954398 PMCID: PMC4419875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Twenty-six million Americans are estimated to have chronic kidney disease (CKD) with increased risk for cardiovascular disease and end stage renal disease. CKD is frequently undiagnosed and patients are unaware, hampering intervention. A tool for accurate and timely identification of CKD from electronic medical records (EMR) could improve healthcare quality and identify patients for research. As members of eMERGE (electronic medical records and genomics) Network, we developed an automated phenotyping algorithm that can be deployed to identify rapidly diabetic and/or hypertensive CKD cases and controls in health systems with EMRs It uses diagnostic codes, laboratory results, medication and blood pressure records, and textual information culled from notes. Validation statistics demonstrated positive predictive values of 96% and negative predictive values of 93.3. Similar results were obtained on implementation by two independent eMERGE member institutions. The algorithm dramatically outperformed identification by ICD-9-CM codes with 63% positive and 54% negative predictive values, respectively.
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Affiliation(s)
| | | | | | - Herbert Chase
- Marshfield Clinic Research Foundation, Marshfield, WI
| | | | - Samira Farouk
- Icahn School Of Medicine at Mount Sinai, New York, NY
| | | | - Vaneet Lotay
- Icahn School Of Medicine at Mount Sinai, New York, NY
| | - Steve Ellis
- Icahn School Of Medicine at Mount Sinai, New York, NY
| | | | - Peggy Peissig
- Marshfield Clinic Research Foundation, Marshfield, WI
| | - Chunhua Weng
- Columbia University Medical Center, New York, NY
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238
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Benjo AM, Garcia DC, Jenkins JS, Cardoso RMN, Molina TP, El-Hayek GE, Nadkarni GN, Aziz EF, Dinicolantonio JJ, Collins T. Cilostazol increases patency and reduces adverse outcomes in percutaneous femoropopliteal revascularisation: a meta-analysis of randomised controlled trials. Open Heart 2014; 1:e000154. [PMID: 25392738 PMCID: PMC4225296 DOI: 10.1136/openhrt-2014-000154] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 09/11/2014] [Accepted: 10/01/2014] [Indexed: 01/17/2023] Open
Abstract
Background Cilostazol is an oral antiplatelet agent currently indicated for treatment of intermittent claudication. There is evidence that cilostazol may reduce femoropopliteal restenosis after percutaneous endovascular intervention. Methods We searched PubMed, Scopus and Cochrane databases from 1966 through September 2013 for randomised controlled trials (RCTs) evaluating the addition of cilostazol to standard care in patients receiving femoropopliteal endovascular treatment. Restenosis, target lesion revascularisation and combined adverse outcomes (death, revascularisation and amputation) within 1–2 years postprocedure were evaluated. Results Of 205 articles, three RCTs were included in the analysis. The pooled data provided a total of 396 patients, 195 of whom received cilostazol. When compared to standard medical therapy alone, cilostazol significantly reduced the risk of restenosis (risk difference −0.20; 95% CI −0.29 to −0.11; p<0.0001; number needed to treat 5), target lesion revascularisation (risk difference −0.17; 95% CI −0.25 to −0.09; p<0.0001; number needed to treat 6). Death and amputation were not different in between groups. Conclusions and limitation Cilostazol significantly increases femoropopliteal patency and decreases adverse outcomes in percutaneous endovascular intervention. However, further RCTs are needed because of limited sample size; this meta-analysis represents the best current evidence.
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Affiliation(s)
- Alexandre M Benjo
- Division of Interventional Cardiology , Ochsner Medical Center , New Orleans, Louisiana , USA
| | - Daniel C Garcia
- Department of Internal Medicine , University of Miami , Miami, Florida , USA
| | - J Stephen Jenkins
- Division of Interventional Cardiology , Ochsner Medical Center , New Orleans, Louisiana , USA
| | | | - Taina P Molina
- Department of Internal Medicine , Centro Universitario Luziadas School of Medicine , Santos , Brazil
| | - Georges E El-Hayek
- Department of Cardiology , St. Luke's-Roosevelt Hospital Center at Mount Sinai , New York , USA
| | - Girish N Nadkarni
- Division of Nephrology , Icahn School of Medicine at Mount Sinai , New York , USA
| | - Emad F Aziz
- Department of Cardiology , St. Luke's-Roosevelt Hospital Center at Mount Sinai , New York , USA
| | - James J Dinicolantonio
- Cardiology Department , St. Luke's Mid America Heart Institute , Kansas City, Missouri , USA
| | - Tyrone Collins
- Division of Interventional Cardiology , Ochsner Medical Center , New Orleans, Louisiana , USA
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239
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Udler MS, Nadkarni GN, Belbin G, Lotay V, Wyatt C, Gottesman O, Bottinger EP, Kenny EE, Peter I. Effect of Genetic African Ancestry on eGFR and Kidney Disease. J Am Soc Nephrol 2014; 26:1682-92. [PMID: 25349204 DOI: 10.1681/asn.2014050474] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 09/02/2014] [Indexed: 01/08/2023] Open
Abstract
Self-reported ancestry, genetically determined ancestry, and APOL1 polymorphisms are associated with variation in kidney function and related disease risk, but the relative importance of these factors remains unclear. We estimated the global proportion of African ancestry for 9048 individuals at Mount Sinai Medical Center in Manhattan (3189 African Americans, 1721 European Americans, and 4138 Hispanic/Latino Americans by self-report) using genome-wide genotype data. CKD-EPI eGFR and genotypes of three APOL1 coding variants were available. In admixed African Americans and Hispanic/Latino Americans, serum creatinine values increased as African ancestry increased (per 10% increase in African ancestry, creatinine values increased 1% in African Americans and 0.9% in Hispanic/Latino Americans; P≤1x10(-7)). eGFR was likewise significantly associated with African genetic ancestry in both populations. In contrast, APOL1 risk haplotypes were significantly associated with CKD, eGFR<45 ml/min per 1.73 m(2), and ESRD, with effects increasing with worsening disease states and the contribution of genetic African ancestry decreasing in parallel. Using genetic ancestry in the eGFR equation to reclassify patients as black on the basis of ≥50% African ancestry resulted in higher eGFR for 14.7% of Hispanic/Latino Americans and lower eGFR for 4.1% of African Americans, affecting CKD staging in 4.3% and 1% of participants, respectively. Reclassified individuals had electrolyte values consistent with their newly assigned CKD stage. In summary, proportion of African ancestry was significantly associated with normal-range creatinine and eGFR, whereas APOL1 risk haplotypes drove the associations with CKD. Recalculation of eGFR on the basis of genetic ancestry affected CKD staging and warrants additional investigation.
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Affiliation(s)
- Miriam S Udler
- Departments of Medicine and Genetics and Genomic Sciences, The Charles Bronfman Institute for Personalized Medicine,
| | - Girish N Nadkarni
- Departments of Medicine and The Charles Bronfman Institute for Personalized Medicine, Division of Nephrology
| | - Gillian Belbin
- Genetics and Genomic Sciences, The Charles Bronfman Institute for Personalized Medicine
| | - Vaneet Lotay
- The Charles Bronfman Institute for Personalized Medicine
| | | | - Omri Gottesman
- Departments of Medicine and The Charles Bronfman Institute for Personalized Medicine
| | - Erwin P Bottinger
- Departments of Medicine and The Charles Bronfman Institute for Personalized Medicine, Division of Nephrology
| | - Eimear E Kenny
- Genetics and Genomic Sciences, The Charles Bronfman Institute for Personalized Medicine, The Center for Statistical Genetics, and The Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Inga Peter
- Genetics and Genomic Sciences, The Charles Bronfman Institute for Personalized Medicine, The Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, New York
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240
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N. Nadkarni G, Singh Sabharwal M, Reddy Ammakkanavar N, Annapureddy N, Malhan R, Mehta B, Naag Kanakadandi V, Kumar Agarwal S, D. Fried E. Patient satisfaction and resident postgraduate year status. Int J Health Care Qual Assur 2014; 27:182-9. [DOI: 10.1108/ijhcqa-05-2012-0049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– Patient satisfaction has been recognized as an important variable affecting healthcare behavior. However, there are limited data on the relationship between doctor post-graduate year (PGY) status and patient satisfaction with provider interpersonal skills and humanistic qualities. The authors aims to assess this relationship using an American Board of Internal Medicine (ABIM) questionnaire.
Design/methodology/approach
– Participants were: patients attending a primary care clinic at a large urban academic hospital; and physicians treating them. The survey questionnaire was the ABIM patient satisfaction instrument; ten questions pertaining to humanistic qualities and communication skills with responses from poor to excellent. Mann Whitney U test and multi-variable logistic regression analyses were used to explore score differences by PGY level.
Findings
– The postgraduate year one (PGY1) had higher patient-satisfaction levels compared to PGY2/PGY3 residents. The PGY1 level residents were more likely to score in the 90th percentile and this remained constant even after adjusting for confounders.
Research limitations/implications
– The research was a single-center study and may have been subject to confounding factors such as patient personality types and a survey ceiling effect. The survey's cross-sectional nature may also be a potential limitation.
Practical implications
– Patient satisfaction varies significantly with PGY status. Though clinical skills may improve with increasing experience, findings imply that interpersonal and humanistic qualities may deteriorate.
Originality/value
– The study is the first to assess patient satisfaction with PGY status and provides evidence that advanced trainees may need support to keep their communication skills and humanistic qualities from deteriorating as stressors increase to ensure optimal patient satisfaction.
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241
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Hoskote SS, Nadkarni GN, Annapureddy N, Shetty AA, Fried ED. Internal medicine residents' perspectives on effects of 2011 ACGME work hour regulations on patient care. Teach Learn Med 2014; 26:274-278. [PMID: 25010239 DOI: 10.1080/10401334.2014.910458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND The Accreditation Council for Graduate Medical Education (ACGME) introduced new work hour limitations in July 2011. PURPOSES The aim is to assess internal medicine residents' perspectives on the impact of these limitations on their ability to discharge patient care duties. METHODS An anonymous survey was administered to 158 medicine residents in an urban university-affiliated internal medicine residency program. Residents' perspectives on various aspects of patient care were recorded on a 5-point Likert-type scale. RESULTS The response rate was 62%. The majority of residents (80%) agreed that patients had adequate continuity of care. Most residents agreed that they had enough time to follow up on consult notes (64% agreed) and investigations (80% agreed) daily. Most PGY-1 residents (59%) reported having enough time to prepare sign-outs. Most (60%) residents felt that reducing handoffs would improve patient care. CONCLUSIONS Most residents believe that the new work hour limitations would continue to uphold patient safety, but handoffs in care must be restricted.
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Affiliation(s)
- Sumedh S Hoskote
- a Department of Medicine, St. Luke's-Roosevelt Hospital Center , Columbia University College of Physicians and Surgeons , New York , New York , USA
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242
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Abstract
A major role of the kidneys is to maintain phosphorus homeostasis. High serum phosphorus has been linked to all-cause and cardiovascular mortality in chronic kidney disease (CKD) both before and after initiation of renal replacement therapy. Considering the clinical implications of uncontrolled hyperphosphatemia, maintenance of phosphorus concentrations within an optimum range is standard of care in this patient population. Recently, the epidemiologic associations between serum phosphorus and worse outcome have been extended to the general population. This becomes even more important in view of the increasing dietary phosphorus intake in the American diet due in large part to the greater consumption of foods processed with phosphate additives. A greater understanding of mechanisms and epidemiology of altered phosphorus metabolism and disease in CKD may help clarify the possible role of excess dietary phosphorus as a health risk factor in the general population.
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Affiliation(s)
| | - Jaime Uribarri
- Department of Medicine, Mount Sinai School of Medicine, New York, NY
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243
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Alviar CL, Devarapally S, Nadkarni GN, Romero J, Benjo AM, Javed F, Doherty B, Kang H, Bangalore S, Messerli FH. Efficacy and safety of dual calcium channel blockade for the treatment of hypertension: a meta-analysis. Am J Hypertens 2013; 26:287-97. [PMID: 23382415 DOI: 10.1093/ajh/hps009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Dual calcium-channel blocker (CCB) with a dihydropyridine (DHP) and a nondihydropyridine (NDHP) has been proposed for hypertension treatment. However, the safety and efficacy of this approach is not well known. METHODS A MEDLINE/EMBASE/CENTRAL search for randomized clinical trials published on this topic from 1966 to February 2012 was performed. Efficacy outcomes of decrease in systolic (SBP) and diastolic (DBP) blood pressures from baseline, changes in heart rate (HR), and adverse effects were compared between dual CCB therapy vs. DHP or NDHP. SBP, DBP, and HR were expressed as weighted mean deviation (WMD). RESULTS A total of 6 studies with 153 patients were included. Dual CCB produced a significantly greater reduction in SBP (21.6±9.2 mmHg) from baseline than DHP (10.3±6.3 mmHg (WMD = 10.9 mmHg, P < 0.0001)) or NDHP (8.9±4.2 mmHg (WMD = 14.1 mmHg, P = 0.002)). Dual CCB therapy reduced DBP from baseline more than either monotherapy (dual CCB = 17.5±10.2 mmHg vs. DHP = 11.6±8.7 mmHg, WMD = 5.5 mmHg, P < 0.001; and NDHP = 10.5±5.6 mmHg, WMD = 5.3 mmHg, P = 0.03). Dual CCB therapy had significantly lower HR compared to DHP (P < 0.001) but was comparable to NDHP (P = 0.12) (Delta change dual CCB = -4.0±3.5 vs. DHP = -2.0±1.5 and NDHP = -6.0±5.0 beats/min). Dual CCB therapy did not increase adverse effects. CONCLUSIONS Dual CCB therapy lowers blood pressure significantly better than CCB monotherapy, without an increase in adverse events. However, given the lack of long-term outcome data on efficacy and safety, dual CCB therapy should be used with restraint, if at all. Large-scale long-term trials are needed to further evaluate such a strategy.
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Affiliation(s)
- Carlos L Alviar
- St. Luke's-Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, NY, USA
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244
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Abstract
Lithium is used as a mood stabilizer in patients with manic-depressive disorder. It is a drug that requires close monitoring due to its narrow therapeutic window and many side effects. There are several case reports of lithium side effects and toxicity occurring even at the therapeutic levels. Cardiac toxicity is observed in approximately 5% of patients; however, severe bradycardia caused by a single dose of lithium is exceedingly rare. We herein report a case of severe symptomatic bradycardia in a young man that occurred after a single dose of lithium. This case emphasizes the need to closely monitor patients when initiating therapy, even before the lithium levels are high enough to be detected.
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Affiliation(s)
- Manpreet S Sabharwal
- Department of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, USA
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245
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Kanakadandi V, Annapureddy N, Agarwal SK, Sabharwal MS, Ammakkanavar N, Simoes P, Sanjani HP, Nadkarni GN. The Austrian syndrome: a case report and review of the literature. Infection 2012; 41:695-700. [PMID: 23124908 DOI: 10.1007/s15010-012-0361-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2012] [Accepted: 10/20/2012] [Indexed: 11/27/2022]
Abstract
A 61-year-old man presented with fever and altered mental status. He was intubated for respiratory distress and was found to have multilobar pneumonia for which antibiotic therapy was instituted. However, his mental status continued to deteriorate despite appropriate antibiotic therapy for his pneumonia. The results from lumar puncture revealed meningitis and endocarditis was evident on a trans-esophageal echocardiogram. His blood and respiratory cultures grew Streptococcus pneumoniae. The patient was diagnosed with Austrian syndrome. After appropriate changes to his antibiotic regimen and an aortic valve replacement, he recovered and was discharged.
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MESH Headings
- Anti-Bacterial Agents/therapeutic use
- Aortic Valve/surgery
- Bacteremia/complications
- Bacteremia/diagnosis
- Bacteremia/microbiology
- Bacteremia/pathology
- Blood/microbiology
- Endocarditis, Bacterial/complications
- Endocarditis, Bacterial/diagnosis
- Endocarditis, Bacterial/microbiology
- Endocarditis, Bacterial/pathology
- Humans
- Male
- Meningitis, Pneumococcal/complications
- Meningitis, Pneumococcal/diagnosis
- Meningitis, Pneumococcal/microbiology
- Meningitis, Pneumococcal/pathology
- Middle Aged
- Pneumonia, Pneumococcal/complications
- Pneumonia, Pneumococcal/diagnosis
- Pneumonia, Pneumococcal/microbiology
- Pneumonia, Pneumococcal/pathology
- Respiratory System/microbiology
- Streptococcus pneumoniae/isolation & purification
- Treatment Outcome
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Affiliation(s)
- V Kanakadandi
- Kansas City Veterans Affairs Medical Center, Kansas City, MO 64128, USA.
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Javed F, Khan SA, Ayers EW, Aziz EF, Akram MS, Nadkarni GN, Sabharwal MS, Ahmad Z, Benjo AM, Herzog E. Association of hypertension and bone mineral density in an elderly African American female population. J Natl Med Assoc 2012; 104:172-8. [PMID: 22774384 DOI: 10.1016/s0027-9684(15)30140-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Recent studies have shown that hypertension is inversely correlated with bone mineral density (BMD) as determined by dual energy x-ray absorptiometery (DXA) in different ethnic groups. But in most published studies, either the sample size was small or the study was limited by different measurement methods. These limitations leave this association controversial and inconclusive. The current study utilizes a sample of African American females referred for clinical screening of osteoporosis in our center to find out if any association of high blood pressure and BMD in this ethnic group exists. The secondary endpoint was to determine the effect of thiazide diuretics on BMD of the elderly African American females because, theoretically, thiazides are considered to have a positive impact on BMD. METHODS In this retrospective, cross-sectional study, 10 years of data were reviewed from 1113 medical records of African American females aged 65 years and older whose BMD values were measured by DXA at the lumbar spine (L1-L4) and both femoral necks (the standard sites for BMD determination) along with their T scores and Z scores (used to determine osteopenia vs osteoporosis). Our exclusion criteria included patients who: (1) were current smokers, (2) had a previous oophorectomy, (3) had a history of corticosteroid use, (4) had a history of biphosphonate use, (5) were on hormone replacement therapy, and (6) were diabetic and taking either pioglitazones or roziglitazones. A total of 148 patients were excluded from the analysis due to either incomplete data or exclusion criteria. The remaining sample was then divided into 2 groups based on their hypertensive status. For the subanalysis, the hypertensive group was further divided into 2 additional groups based on their thiazide usage. RESULTS We had complete data on 965 participants, of which 631 (65.3%) had a history of hypertension and 334 (34.7%) did not. Out of 631 hypertensive patients, 173 were found to be using thiazide diuretics as antihypertensive medication, while 458 were without thiazide diurectic use. The proportion of patients with both osteopenia and osteoporosis was similar in those with and without hypertension (50% vs 50%, p = .95 for osteopenia; 18% vs 19%, p = .95 for osteoporosis). There was no significant difference between the BMD at the lumbar spine, and right and left femoral necks between patients with and without hypertension. This lack of association held true when comparing the mean T scores and Z scores at the above sites. Within patients with a history of hypertension, there were no significant differences in the BMD, T score or Z score at any site with and without a history of thiazide diuretic use. CONCLUSION Hypertension in elderly African American females aged at least 65 years was not found to be correlated with low BMD at either the lumbar spine (L1-L4) or both femoral necks when confounding factors were taken into consideration. Mean BMD of the hypertensive cohort taking thiazide diuretics was found lower at the lumbar spine as compared to the hypertensive patients not taking thiazide diuretics.
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Affiliation(s)
- Fahad Javed
- St Luke's-Roosevelt Hospital Center, University Hospital of Columbia University College of Physician and Surgeons, New York, NY 10025, USA.
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247
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Hoskote SS, Nadkarni GN, Fried ED. Prostate cancer risk and vitamin E. JAMA 2012; 307:454; author reply 454. [PMID: 22298668 DOI: 10.1001/jama.2012.55] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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248
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Nadkarni GN. A Case of Unilateral Adrenal Hemorrhage in Pulmonary Tuberculosis Presenting as Acute Abdominal Pain. J Med Cases 2012. [DOI: 10.4021/jmc850w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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249
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Eslava DJ, Cordova JP, Korniyenko A, Nadkarni GN, Alviar CL, Romero JE, Chorzempa A, Fridman V, Wysoczanski M, Cianci C, Kearney K, Kantrowitz N, Fox J, Hong M, Tamis-Holland JE. Abstract P80: Lack of English Comprehension is Associated with Delays in Hospital Presentation in Patients with ST-Segment Elevation Myocardial Infarction. Circ Cardiovasc Qual Outcomes 2011. [DOI: 10.1161/circoutcomes.4.suppl_2.ap80] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Prior studies have demonstrated an association between ethnicity and symptom onset to presentation time (S2PT) among patients presenting with ST elevation MI (STEMI) in the USA, with a shorter S2PT among Caucasians when compared with other ethnicities. However, little is known regarding whether or not a patient's ability to comprehend English impacts the S2PT.
Methods:
Consecutive patients presenting to 4 hospitals in NYC with STEMI referred for primary angioplasty were included in the analysis. S2PT was recorded on the day of the infarct based on the patient's account of the onset of symptoms. We assessed a patient's ability to comprehend English through telephone interviews conducted during routine follow-up.
Results:
Among 210 patients, 83.8% (176 of 210) had either some English comprehension or were fluent in English (E) and 16.2% (34 of 210) reported no English comprehension (non-E). Of the non-E patients, 65% (22 of 34) spoke Spanish, 6% (2 of 34) spoke Russian, 6% (2 of 34) spoke Chinese and 23% (8 of 34) spoke another language. The baseline variables and mean S2PT are depicted in the table. Non-E patients had a significantly higher S2PT compared to E patients even after adjusting for differences in baseline variables. Increased odds were also observed among non-E patients with a longer S2PT (adjusted odds ratio for S2PT > 120 minutes 2.17; 95% CI 01.03-4.54; p=0.04). This association remained constant even after adjusting for confounders like age, sex, ethnicity, level of education and comorbidities (diabetes, previous history of MI and PCI).
Conclusions:
S2PT is strongly influenced by a patient's ability to comprehend English. This information emphasizes the need for more aggressive “multi-lingual” educational outreach and the use of multi-lingual emergency lines in an effort to decrease total ischemic time during STEMI.
English Comprehension Fair or Good (N=176)
No English Comprehension (N=34)
P
Age Mean (SD)
62 (14.2)
65 (11)
0.22
Male sex n (%)
129 (73)
26 (76)
0.70
Diabetes n (%)
25 (14)
9 (27)
0.09
Hypertension n (%)
107 (66)
20 (62.5)
0.70
Prior MI n (%)
21 (12)
2 (6)
0.284
Prior PCI or CABG n (%)
12 (6.8)
2 (6)
0.960
Education: n (%)
40 (23)
12 (35)
0.09
Less than HS
62 (35)
8 (23)
HS Diploma
8 (4)
0 (0)
College Diploma Unknown
66 (38)
14 (42)
Mean S2P time (SD)
225 (315)
387 (820.6)
0.05
S2P time > 120 minutes n (%)
70 (40)
20 (62.5)
0.04
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - John Fox
- Beth Israel Med Cntr, New York City, NY
| | - Mun Hong
- St Luke's-Roosevelt Hosp, New York City, NY
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250
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Geetha D, Parkhie S, Nadkarni GN, He C, Shafi T. Polyomavirus-associated nephropathy: a comparison of 2 different strategies for immunosuppression reduction. Medicine (Baltimore) 2011; 90:296-302. [PMID: 21857366 DOI: 10.1097/md.0b013e31822f238e] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Polyomavirus-associated nephropathy (PVAN) is an increasing cause of renal allograft dysfunction, but the optimal management of immunosuppression for these patients is unclear. We examined the clinical course of 58 patients with biopsy-proven PVAN diagnosed from 1997 to 2008 at Johns Hopkins Medical Institutions. Immunosuppression management was analyzed as 2 different immunosuppression reduction strategies, the first centered on eliminating a single immunosuppressive drug and reducing the doses of all other immunosuppressive drugs (Strategy A, n = 40), compared with the second, centered on reducing the doses of all immunosuppressive drugs and eliminating none (Strategy B, n = 18). Primary outcome was graft failure, defined as a 50% reduction in estimated glomerular filtration rate, or the need for dialysis within 2 years of PVAN diagnosis. Graft failure developed in 17 (29%) patients during follow-up. In unadjusted and adjusted Cox models, both strategies of immunosuppression reduction had similar efficacy in preventing graft failure (hazard ratio [HR], 0.61; 95% confidence interval, 0.18-2.06; p = 0.43). Rejection after PVAN occurred in 24 of 58 patients and was associated with a 3-fold higher risk of graft failure (HR, 2.99; p = 0.005). Ancillary therapies (cidofovir or leflunomide) were associated with a trend toward faster clearance of viremia (p = 0.65) but were not predictive of outcome.In conclusion, the 2 strategies of immunosuppression reduction had similar efficacy in preventing graft failure. Post-PVAN rejection leads to graft failure. Early repeat allograft biopsy should be considered in the management of PVAN with persistent graft dysfunction.
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Affiliation(s)
- Duvuru Geetha
- From Department of Medicine (DG, SP, TS), Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Medicine (GNN), St.Luke's-Roosevelt Hospital Center, New York, New York; Department of Pathology (CH), Medical College of Wisconsin, Milwaukee, Wisconsin; and Welch Center for Prevention, Epidemiology and Clinical Research (TS), Johns Hopkins Medical Institutions, Baltimore, Maryland
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