5751
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Correlation between comprehensive evaluation of coronary artery lesion severity and long-term clinical outcomes in Chinese octogenarians with acute coronary syndrome. Heart Lung Circ 2014; 23:1125-31. [PMID: 25070683 DOI: 10.1016/j.hlc.2014.04.260] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2013] [Revised: 03/30/2014] [Accepted: 04/18/2014] [Indexed: 12/22/2022]
Abstract
BACKGROUND There is little known about long-term outcome data regarding acute coronary syndrome (ACS) in Chinese octogenarians (> 80 years old). Long-term outcomes of octogenarians with ACS may be associated with increased complicated coronary artery lesion severity. METHODS We classified 536 consecutive octogenarians with ACS into four groups based on Gensini score. Survival and major adverse cardiac event (MACE) rates were calculated using the Kaplan-Meier method. Multivariate Cox regression was used to identify mortality predictors. The follow-up period was 27 (IQR15-36) months. RESULTS The overall long-term mortality rate was 9.1% and increased from 3.0% in group 1 to 16.7% in group 4. Increasing coronary artery lesion severity was associated with increased long-term mortality and MACE rates. ROC curve analysis showed that the predictive cut-off value of Gensini score for mortality was 53. Gensini score provided significant reclassification of mortality (net reclassification index 0.195, P<0.01). Age, gender, heart rate, SBP, chronic renal failure, e-GFR, GRACE score, Gensini score, and ACS type were different between surviving and deceased patients. Notably, chronic renal failure (OR=2.55, P=0.036), GRACE score (OR=1.10, P=0.006), and Gensini score(OR=1.11, P=0.003) were the independent predictors of long-term mortality. CONCLUSIONS Long-term mortality of octogenarians with ACS was associated with increased comprehensive coronary artery lesion severity. Gensini score was an effective parameter for evaluation of long-term mortality.
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5752
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Modification of diet in renal disease (MDRD) study and CKD epidemiology collaboration (CKD-EPI) equations for Taiwanese adults. PLoS One 2014; 9:e99645. [PMID: 24927124 PMCID: PMC4057229 DOI: 10.1371/journal.pone.0099645] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Accepted: 05/17/2014] [Indexed: 12/03/2022] Open
Abstract
Background Estimated glomerular filtration rate (eGFR) using the Modification of Diet in Renal Disease (MDRD) study or the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations may not be accurate for Asians; thus, we developed modified eGFR equations for Taiwanese adults. Methods This cross-sectional study compared the Taiwanese eGFR equations, the MDRD study, and the CKD-EPI equations with inulin clearance (Cin). A total of 695 adults including 259 healthy volunteers and 436 CKD patients were recruited. Participants from the Kaohsiung Medical University Hospital were used as the development set (N = 556) to develop the Taiwanese eGFR equations, whereas participants from the National Taiwan University Hospital were used as the validation set (N = 139) for external validation. Results The Taiwanese eGFR equations were developed by using the extended Bland-Altman plot in the development set. The Taiwanese MDRD equation was 1.309×MDRD0.912, Taiwanese CKD-EPI was 1.262×CKD-EPI0.914 and Taiwanese four-level CKD-EPI was 1.205×four-level CKD-EPI0.914. In the validation set, the Taiwanese equations had the lowest bias, the Taiwanese equations and the Japanese CKD-EPI equation had the lowest RMSE, whereas the Taiwanese and the Japanese equations had the best precision and the highest P30 among all equations. However, the Taiwanese MDRD equation had higher concordance correlation than did the Taiwanese CKD-EPI, the Taiwanese four-level CKD-EPI and the Japanese equations. Moreover, only the Taiwanese equations had no proportional bias among all of the equations. Finally, the Taiwanese MDRD equation had the best diagnostic performance in terms of ordinal logistic regression among all of the equations. Conclusion The Taiwanese MDRD equation is better than the MDRD, CKD-EPI, Japanese, Asian, Thai, Taiwanese CKD-EPI, and Taiwanese four-level CKD-EPI equations for Taiwanese adults.
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5753
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Sueta S, Morozumi K, Takeda A, Horike K, Otsuka Y, Shinjo H, Murata M, Kato Y, Goto K, Inaguma D. Ability of vitamin D receptor activator to prevent pulmonary congestion in advanced chronic kidney disease. Clin Exp Nephrol 2014; 19:371-8. [PMID: 24916005 DOI: 10.1007/s10157-014-0994-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 05/24/2014] [Indexed: 01/21/2023]
Abstract
BACKGROUND Vitamin D deficiency is common among patients with chronic kidney disease (CKD). However, the benefits of vitamin D supplementation versus vitamin D receptor activator (VDRA) administration have yet to be established. Recently, an association between activated vitamin D and cardiovascular factors was reported. To evaluate the benefits of VDRA in advanced CKD, we analyzed the association between VDRA administration and the prevalence of pulmonary congestion. METHODS This retrospective, cross-sectional analysis included patients initiated on dialysis between October 2011 and September 2013 at 17 Japanese institutions. Data from 952 participants were analyzed using a multivariate logistic regression model and a linear regression model. We also analyzed subgroup data for groups classified by selection of peritoneal dialysis or hemodialysis. RESULTS Of the 952 participants, 303 patients received VDRA. VDRA administration was associated with a low prevalence of pulmonary congestion in the multivariate logistic regression model (odds ratio [OR], 0.64; 95 % confidence interval [CI], 0.44-0.94; P = 0.02). There was no significant association between VDRA administration and systolic blood pressure, diastolic blood pressure, or pulse pressure. Subgroup analysis revealed a tendency that VDRA administration was associated with low prevalence of pulmonary congestion in both groups. CONCLUSIONS In this study, VDRA administration was associated with a low prevalence of pulmonary congestion in patients initiated on dialysis. Appropriate VDRA administration may prevent pulmonary congestion.
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Affiliation(s)
- Shinichi Sueta
- Kidney Disease Center, Japanese Red Cross Nagoya Daini Hospital, 2-9, Myoken-cho, Showa-ku, Nagoya, 466-8650, Japan.
| | - Kunio Morozumi
- Kidney Disease Center, Japanese Red Cross Nagoya Daini Hospital, 2-9, Myoken-cho, Showa-ku, Nagoya, 466-8650, Japan
| | - Asami Takeda
- Kidney Disease Center, Japanese Red Cross Nagoya Daini Hospital, 2-9, Myoken-cho, Showa-ku, Nagoya, 466-8650, Japan
| | - Keiji Horike
- Kidney Disease Center, Japanese Red Cross Nagoya Daini Hospital, 2-9, Myoken-cho, Showa-ku, Nagoya, 466-8650, Japan
| | - Yasuhiro Otsuka
- Kidney Disease Center, Japanese Red Cross Nagoya Daini Hospital, 2-9, Myoken-cho, Showa-ku, Nagoya, 466-8650, Japan
| | - Hibiki Shinjo
- Kidney Disease Center, Japanese Red Cross Nagoya Daini Hospital, 2-9, Myoken-cho, Showa-ku, Nagoya, 466-8650, Japan
| | - Minako Murata
- Kidney Disease Center, Japanese Red Cross Nagoya Daini Hospital, 2-9, Myoken-cho, Showa-ku, Nagoya, 466-8650, Japan
| | - Yuki Kato
- Kidney Disease Center, Japanese Red Cross Nagoya Daini Hospital, 2-9, Myoken-cho, Showa-ku, Nagoya, 466-8650, Japan
| | - Kazunori Goto
- Kidney Disease Center, Japanese Red Cross Nagoya Daini Hospital, 2-9, Myoken-cho, Showa-ku, Nagoya, 466-8650, Japan
| | - Daijo Inaguma
- Kidney Disease Center, Japanese Red Cross Nagoya Daini Hospital, 2-9, Myoken-cho, Showa-ku, Nagoya, 466-8650, Japan
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5754
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Association Between Metabolic Syndrome and Osteoporotic Fracture in Middle-aged and Elderly Chinese Peoples. Cell Biochem Biophys 2014; 70:1297-303. [DOI: 10.1007/s12013-014-0054-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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5755
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Yuzbashian E, Asghari G, Mirmiran P, Hosseini FS, Azizi F. Associations of dietary macronutrients with glomerular filtration rate and kidney dysfunction: Tehran lipid and glucose study. J Nephrol 2014; 28:173-80. [DOI: 10.1007/s40620-014-0095-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 04/04/2014] [Indexed: 01/08/2023]
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5756
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Freedman BI, Skorecki K. Gene-gene and gene-environment interactions in apolipoprotein L1 gene-associated nephropathy. Clin J Am Soc Nephrol 2014; 9:2006-13. [PMID: 24903390 DOI: 10.2215/cjn.01330214] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Molecular genetics have revolutionized the understanding of susceptibility to the broad spectrum of kidney diseases with light microscopic appearance of FSGS, particularly in populations with recent African ancestry. These disorders include idiopathic FSGS, HIV-associated nephropathy, severe lupus nephritis, sickle cell nephropathy, and the primary kidney disorder focal global glomerulosclerosis, which had historically been ascribed to systemic hypertension. FSGS was once thought to include a multitude of unrelated disorders with similar histologic appearance. However, variation in the apolipoprotein L1 gene locus is now known to account for the vast majority of such cases in African Americans as well as nearly all the excess risk for FSGS and related forms of progressive nondiabetic nephropathy in populations with recent African ancestry, relative to European ancestry. Inheriting two coding apolipoprotein L1 gene nephropathy risk variants is necessary for susceptibility to CKD; however, these variants alone are insufficient to produce disease. This work reviews the evidence supporting second hits or modifying factors that affect risk for apolipoprotein L1 gene-associated nephropathy and produce the protean manifestations of this common and complex syndrome. Targeting modifiable second factors will lead to preventive therapies for slowing progression of nondiabetic nephropathy in many patients possessing two apolipoprotein L1 gene risk variants. This model of genetic risk coupled with modifiable second hits will serve as a paradigm applicable to patients with CKD of various etiologies as well as a host of other complex disorders.
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Affiliation(s)
- Barry I Freedman
- Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, North Carolina; and
| | - Karl Skorecki
- Molecular Medicine Laboratory, Rambam Healthcare Campus, Haifa, Israel
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5757
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Jian Y, Li X, Cheng X, Chen Y, Liu L, Tao Z, Zuo L. Comparison of bioimpedance and clinical methods for dry weight prediction in maintenance hemodialysis patients. Blood Purif 2014; 37:214-20. [PMID: 24902760 DOI: 10.1159/000362109] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Accepted: 03/04/2014] [Indexed: 02/05/2023]
Abstract
BACKGROUND Bioelectrical impedance analysis (BIA) is a promising technique to evaluate dry weight. We compared the dry weight calculated by the three BIA equations Carlo Basile (CB) , Yanna Dou (YD) and the body composition spectroscopy (BCS) with clinical evaluation in maintenance hemodialysis (MHD) patients. METHODS The dry weight of enrolled MHD patients (DWClin) was evaluated under strict clinical surveillance. The whole-body resistances at 50 kHz, intra- and extracellular resistances were measured to calculate the dry weight (DWCB, DWYD and DWBCS) using each of the three equations. RESULTS Neither DWCB nor DWBCS were statistically different compared to DWClin (DWCB 63.2 ± 17.2 vs. 63.1 ± 16.1 kg; DWBCS 62.8 ± 16.8 vs. 63.1 ± 16.1 kg, p > 0.05). DWYD was significantly lower than DWClin (DWYD 62.0 ± 16.1 vs. 63.1 ± 16.1 kg, p < 0.05). The bias between DWCB and DWClin was the smallest among these three methods (ΔDWCB -0.1 ± 1.4 kg; ΔDWYD 1.1 ± 2.9 kg; ΔDWBCS 0.3 ± 1.8 kg). CONCLUSION The CB equations have better consistency with clinical dry weight in MHD patients.
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Affiliation(s)
- Yusu Jian
- Institute of Nephrology, Peking University First Hospital, Beijing, PR China
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5758
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Improved glomerular filtration rate estimation using new equations combined with standardized cystatin C and creatinine in Chinese adult chronic kidney disease patients. Clin Biochem 2014; 47:1220-6. [PMID: 24886770 DOI: 10.1016/j.clinbiochem.2014.05.060] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2014] [Revised: 05/20/2014] [Accepted: 05/21/2014] [Indexed: 01/08/2023]
Abstract
OBJECTIVES The newly developed glomerular filtration rate (GFR)-estimating equations developed by the CKD-EPI Collaboration and Feng et al. (2013) that are based on standardized serum cystatin C (ScysC), combined/not combined with serum creatinine (Scr), require further validation in China. We compared the performance of four new equations (CKD-EPIcys, CKD-EPIcr-cys, Fengcys, and Fengcr-cys equations) with the CKD-EPI creatinine equation (CKD-EPIcr) in adult Chinese chronic kidney disease (CKD) patients to clarify their clinical application. DESIGN AND METHODS GFR was measured using the dual plasma sampling (99m)Tc-DTPA method (mGFR) in 252 adult CKD patients enrolled from four centres. Scr and ScysC were measured by standardized assays in a central laboratory. Each equation's performance was assessed using bias, precision, accuracy, agreement, and correct classification of the CKD stage. RESULTS The measured GFR was 46 [25-83] mL/min per 1.73 m(2). The CKD-EPIcys, CKD-EPIcr-cys and Fengcys equations provided significantly higher accuracy (P15: 38.9%, 39.7%, and 38.9%) than the CKD-EPIcr equation (29.8%). The CKD-EPIcr-cys and Fengcr-cys equations presented higher precision (IQR of the difference, 16.4 and 17.3 mL/min per 1.73 m(2), respectively) and narrower acceptable limits in Bland-Altman analysis (56.6 and 50.8 mL/min per 1.73 m(2), respectively) than single marker-based equations. The CKD-EPIcr-cys equation achieved the highest overall correct proportion (61.5%) in classification of CKD stages. CONCLUSIONS Combining ScysC and Scr measurements for GFR estimation improves diagnostic performance. The Scr-ScysC equation showed better performance than equations based on either marker alone. The CKD-EPIcr-cys equation showed the best performance for GFR estimation in Chinese adult CKD patients.
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5759
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Chiang CH, Lee LT, Hung SH, Lin WY, Hung HF, Yang WS, Sung PK, Huang KC. Opposite association between diabetes, dyslipidemia, and hepatocellular carcinoma mortality in the middle-aged and elderly. Hepatology 2014; 59:2207-15. [PMID: 24425422 DOI: 10.1002/hep.27014] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Accepted: 01/10/2014] [Indexed: 12/20/2022]
Abstract
UNLABELLED Limited data exist regarding metabolic risk factors for deaths from hepatocellular carcinoma (HCC) in aging individuals. We investigated the association between diabetes, dyslipidemia, and HCC mortality in those aged 40 years or more (middle-aged and elderly). In this prospective cohort study based on nationwide health screening units, we consecutively followed middle-aged and elderly participants who had no chronic hepatitis B or C virus infection and received health screening from January 1 1998 to December 31 2008. There were 235 deaths from HCC among 50,080 individuals, ascertained by validated death certificates and the national death registry. Diabetes (adjusted hazard ratio [HR], 3.38; 95% confidence interval [CI], 2.35 to 4.86) was positively associated with deaths from HCC. However, hypertriglyceridemia (HR, 0.38; 95% CI, 0.26 to 0.55) and hypercholesterolemia (HR, 0.50; 95% CI, 0.37 to 0.67) were inversely associated with HCC mortality. The above significant associations remained in the lag time analyses, applied to check for reverse causation. Metabolic syndrome, as defined by the American Heart Association / National Heart Lung Blood Institute criteria (HR, 0.63; 95% CI, 0.46 to 0.86) or by the International Diabetes Federation criteria (HR, 0.62; 95% CI, 0.43 to 0.89), was inversely associated with deaths from HCC, especially in men. CONCLUSION Middle-aged and elderly individuals, once having diabetes, deserve HCC surveillance to reduce HCC mortality. More research is needed to elucidate why having baseline dyslipidemia relates to lower future HCC mortality.
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Affiliation(s)
- Chien-Hsieh Chiang
- Department of Family Medicine, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan; Department of Community and Family Medicine, National Taiwan University Hospital Yun-Lin Branch, Yunlin, Taiwan
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5760
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Is blood pressure load associated, independently of blood pressure level, with target organ damage? J Hypertens 2014; 31:1812-8. [PMID: 23743810 DOI: 10.1097/hjh.0b013e3283624f9b] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Blood pressure (BP) load, defined as the percentage of abnormally elevated BP readings, is usually provided on the report of ambulatory BP monitoring. However, the usefulness of BP load is still uncertain. In the present study, we examined whether BP load would be associated, independently of BP level, with target organ damage. METHODS We recruited 869 individuals (430 men, mean age 51 years) who were referred for 24-h ambulatory BP monitoring and were off antihypertensive medication for at least 2 weeks. BP load was defined as the percentage of daytime and nighttime SBP/DBP readings at least 135/85 and at least 120/70 mmHg, respectively. Brachial-ankle pulse wave velocity (baPWV) and carotid-femoral pulse wave velocity (cfPWV), left ventricular mass index (LVMI) and urinary albumin-to-creatinine ratio (ACR) were determined as measures of target organ damage. RESULTS SBP and DBP load had a skewed distribution (P<0.001). In multivariate-adjusted categorical analyses, baPWV (13.8, 14.6 and 15.6 m/s), cfPWV (7.4, 7.7 and 8.4 m/s), LVMI (90.1, 94.8 and 100.7 g/m) and ACR (0.47, 0.58 and 0.77 mg/mmol) all increased from tertiles 1-3 of SBP load (P<0.001). However, these differences became nonsignificant (P ≥ 0.16) after additionally adjusted for 24-h SBP level. In a continuous analysis in individuals with a BP load greater than zero (n=838), adding the logarithmically transformed SBP load did not improve the fit of models relating measures of target organ damage to SBP level (P ≥ 0.14), except for cfPWV (P=0.01) that was however negatively associated with BP load. Analyses on DBP load produced similar results. CONCLUSION BP load was associated with target organ damage, but not independently of BP level.
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5761
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Xin Z, Du B, Yan S, Du S, Ding J, Yang Z, Ren W. Surface modification of poly(styrene-b-(ethylene-co-butylene)-b-styrene) (SEBS) elastomer via covalent immobilization of nonionic sugar-based Gemini surfactants. JOURNAL OF BIOMATERIALS SCIENCE-POLYMER EDITION 2014; 25:1045-61. [PMID: 24854325 DOI: 10.1080/09205063.2014.918458] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Gemini surfactants (GS) with sugar-containing head-groups and different alkyl chains were successfully prepared. Poly(styrene-b-(ethylene-co-butylene)-b-styrene) (SEBS) elastomer was grafted with glycidyl methacrylate (GMA) by means of UV-induced graft polymerization, and then the pGMA-grafted film was chemically immobilized with the GS. The surface graft polymerization was confirmed by ATR-FTIR and XPS. The wettability and hemocompatibility of the modified surface were characterized by means of water contact angle, protein adsorption, and platelet adhesion assays. The results showed that amphiphilic surfactant-containing polymer surfaces presented protein-resistant behavior and anti-platelet adhesion after functionalization with GS, GS1 and GS2. Besides, the hemocompatibility of the modified surface deteriorated as the length of hydrophobic chain of GS increased.
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5762
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Oc MA, Demir H, Cekmen MB, Isgoren S, Gorur GD, Bilgili U. Correlation of Cystatin-C and radionuclidic measurement method of glomerular filtration rate in patients with lung cancer receiving cisplatin treatment. Ren Fail 2014; 36:1043-50. [PMID: 24846459 DOI: 10.3109/0886022x.2014.918813] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Cisplatin is a chemotherapeutic agent which affects renal functions adversely. The best indicator of renal functions is glomerular filtration rate (GFR) measurement. Cystatin-C appears to be a good alternative to existing methods of measuring GFR. However, it is controversial whether Cystatin-C demonstrates GFR correctly for patients receiving chemotherapy. This study aimed to investigate the correlation between GFR values calculated by Cystatin-C based formulas, radionuclidic method (multiple blood sampling) and blood Cystatin-C values in patients with lung cancer, receiving cisplatin treatment in both pre-treatment and post-treatment periods. MATERIALS AND METHODS Thirty-six patients with lung cancer who were going to receive cisplatin treatment were included in this study. However, the evaluation was performed with 20 patients since 16 of them could not complete the treatment. Blood Cystatin-C values, GFR values calculated via Cystatin-C based formulas, and radionuclidic method were investigated before and after the cisplatin treatment. RESULTS After treatment significant decreases were detected in GFR values, obtained via radionuclidic measuring method. However, there was no significant difference in Cystatin-C values between pre-treatment and post-treatment periods. Also GFR values obtained by Cystatin-C based formulas were not significantly different in pre-treatment and post-treatment periods. There were meaningful correlations between radionuclidic method and Cystatin-C values and Cystatin-C based formulas before treatment. However, all correlations disappeared after the treatment. CONCLUSION GFR values, calculated by Cystatin-C may not be reliable in following renal functions in patients receiving chemotherapy. When reliable monitoring of the renal functions is necessary radionuclidic method may be preferred in these patients.
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5763
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Yu YL, Shao YK, Ding YQ, Lin KZ, Chen B, Zhang HZ, Zhao LN, Wang ZB, Zhang JS, Tang ML, Mei J. Decellularized kidney scaffold-mediated renal regeneration. Biomaterials 2014; 35:6822-8. [PMID: 24855960 DOI: 10.1016/j.biomaterials.2014.04.074] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 04/22/2014] [Indexed: 01/04/2023]
Abstract
Renal regeneration approaches offer great potential for the treatment of chronic kidney disease, but their availability remains limited by the clinical challenges they pose. In the present study, we used continuous detergent perfusion to generate decellularized (DC) rat kidney scaffolds. The scaffolds retained intact vascular trees and overall architecture, along with significant concentrations of various cytokines, but lost all cellular components. To evaluate its potential in renal function recovery, DC scaffold tissue was grafted onto partially nephrectomized rat kidneys. An increase of renal size was found, and regenerated renal parenchyma cells were observed in the repair area containing the grafted scaffold. In addition, the number of nestin-positive renal progenitor cells was markedly higher in scaffold-grafted kidneys compared to controls. Moreover, radionuclide scan analysis showed significant recovery of renal functions at 6 weeks post-implantation. Our results provide further evidence to show that DC kidney scaffolds could be used to promote renal recovery in the treatment of chronic kidney disease.
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Affiliation(s)
- Y L Yu
- Anatomy Department, Wenzhou Medical University, Wenzhou 325035, China; Institute of Bioscaffold Transplantation and Immunology, Wenzhou Medical University, Wenzhou 325035, China
| | - Y K Shao
- School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou 325035, China
| | - Y Q Ding
- Institute of Neuroscience, Wenzhou Medical University, Wenzhou 325035, China
| | - K Z Lin
- Institute of Bioscaffold Transplantation and Immunology, Wenzhou Medical University, Wenzhou 325035, China
| | - B Chen
- Institute of Bioscaffold Transplantation and Immunology, Wenzhou Medical University, Wenzhou 325035, China; Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 32000, China
| | - H Z Zhang
- Department of Nuclear Medicine, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 32000, China
| | - L N Zhao
- Anatomy Department, Wenzhou Medical University, Wenzhou 325035, China; Institute of Bioscaffold Transplantation and Immunology, Wenzhou Medical University, Wenzhou 325035, China
| | - Z B Wang
- Institute of Bioscaffold Transplantation and Immunology, Wenzhou Medical University, Wenzhou 325035, China
| | - J S Zhang
- Anatomy Department, Wenzhou Medical University, Wenzhou 325035, China; Institute of Bioscaffold Transplantation and Immunology, Wenzhou Medical University, Wenzhou 325035, China
| | - M L Tang
- Anatomy Department, Wenzhou Medical University, Wenzhou 325035, China; Institute of Bioscaffold Transplantation and Immunology, Wenzhou Medical University, Wenzhou 325035, China
| | - J Mei
- Anatomy Department, Wenzhou Medical University, Wenzhou 325035, China; Institute of Bioscaffold Transplantation and Immunology, Wenzhou Medical University, Wenzhou 325035, China; Institute of Neuroscience, Wenzhou Medical University, Wenzhou 325035, China.
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5764
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Li Y, Chen Y, Liu X, Liang Y, Shao X, Zhang Y, Wang H, Wang X, Li B, Deng K, Liu Q, Holthöfer H, Liu H, Zou H. Metabolic syndrome and chronic kidney disease in a Southern Chinese population. Nephrology (Carlton) 2014; 19:325-31. [PMID: 24548104 DOI: 10.1111/nep.12219] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2014] [Indexed: 02/06/2023]
Affiliation(s)
- Yongqiang Li
- Department of Nephronology; Institute of Nephronology and Urology; The Third Affiliated Hospital of Southern Medical University; Guangzhou China
| | - Youming Chen
- Clinical Laboratory; The Third Affiliated Hospital of Southern Medical University; Guangzhou China
| | - Xinyu Liu
- Department of Nephronology; Institute of Nephronology and Urology; The Third Affiliated Hospital of Southern Medical University; Guangzhou China
| | - Yan Liang
- Department of Nephronology; Institute of Nephronology and Urology; The Third Affiliated Hospital of Southern Medical University; Guangzhou China
| | - Xiaofei Shao
- Department of Nephronology; Institute of Nephronology and Urology; The Third Affiliated Hospital of Southern Medical University; Guangzhou China
| | - Ying Zhang
- Department of Nephronology; Institute of Nephronology and Urology; The Third Affiliated Hospital of Southern Medical University; Guangzhou China
| | - Honglei Wang
- Department of Nephronology; Institute of Nephronology and Urology; The Third Affiliated Hospital of Southern Medical University; Guangzhou China
| | - Xiaohong Wang
- Department of Nephronology; Institute of Nephronology and Urology; The Third Affiliated Hospital of Southern Medical University; Guangzhou China
| | - Bin Li
- Department of Nephronology; Institute of Nephronology and Urology; The Third Affiliated Hospital of Southern Medical University; Guangzhou China
| | - Kangping Deng
- Department of Nephronology; Institute of Nephronology and Urology; The Third Affiliated Hospital of Southern Medical University; Guangzhou China
| | - Qin Liu
- Department of Nephronology; Institute of Nephronology and Urology; The Third Affiliated Hospital of Southern Medical University; Guangzhou China
| | - Harry Holthöfer
- National Centre for Sensor Research/BioAnalytical Sciences; Dublin City University; Dublin Ireland
| | - Hongmei Liu
- Department of Ultrasound; The Third Affiliated Hospital of Southern Medical University; Guangzhou China
| | - Hequn Zou
- Department of Nephronology; Institute of Nephronology and Urology; The Third Affiliated Hospital of Southern Medical University; Guangzhou China
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5765
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Soveri I, Berg UB, Björk J, Elinder CG, Grubb A, Mejare I, Sterner G, Bäck SE. Measuring GFR: a systematic review. Am J Kidney Dis 2014; 64:411-24. [PMID: 24840668 DOI: 10.1053/j.ajkd.2014.04.010] [Citation(s) in RCA: 363] [Impact Index Per Article: 36.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2013] [Accepted: 04/04/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND No comprehensive systematic review of the accuracy of glomerular filtration rate (GFR) measurement methods using renal inulin clearance as reference has been published. STUDY DESIGN Systematic review with meta-analysis of cross-sectional diagnostic studies. SETTING & POPULATION Published original studies and systematic reviews in any population. SELECTION CRITERIA FOR STUDIES Index and reference measurements conducted within 48 hours; at least 15 participants studied; GFR markers measured in plasma or urine; plasma clearance calculation algorithm verified in another study; tubular secretion of creatinine had not been blocked by medicines. INDEX TESTS Endogenous creatinine clearance; renal or plasma clearance of chromium 51-labeled ethylenediaminetetraacetic acid (51Cr-EDTA), diethylenetriaminepentaacetic acid (DTPA), iohexol, and iothalamate; and plasma clearance of inulin. REFERENCE TEST Renal inulin clearance measured under continuous inulin infusion and urine collection. RESULTS Mean bias <10%, median bias <5%, the proportion of errors in the index measurements that did not exceed 30% (P30) ≥80%, and P10 ≥50% were set as requirements for sufficient accuracy. Based on the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach, the quality of evidence across studies was rated for each index method. Renal clearance of iothalamate measured GFR with sufficient accuracy (strong evidence). Renal and plasma clearance of 51Cr-EDTA and plasma clearance of iohexol were sufficiently accurate to measure GFR (moderately strong evidence). Renal clearance of DTPA, renal clearance of iohexol, and plasma clearance of inulin had sufficient accuracy (limited evidence). Endogenous creatinine clearance was an inaccurate method (strong evidence), as was plasma clearance of DTPA (limited evidence). The evidence to determine the accuracy of plasma iothalamate clearance was insufficient. With the exception of plasma clearance of inulin, only renal clearance methods had P30 >90%. LIMITATIONS The included studies were few and most were old and small, which may limit generalizability. Requirements for sufficient accuracy may depend on clinical setting. CONCLUSIONS At least moderately strong evidence suggests that renal clearance of 51Cr-EDTA or iothalamate and plasma clearance of 51Cr-EDTA or iohexol are sufficiently accurate methods to measure GFR.
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Affiliation(s)
- Inga Soveri
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
| | - Ulla B Berg
- Department of Clinical Science, Intervention and Technology, Division of Pediatrics, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Jonas Björk
- Department of Occupational and Environmental Medicine, Lund University, Lund, Sweden
| | - Carl-Gustaf Elinder
- Department of Clinical Science, Intervention and Technology, Division of Renal Medicine, Karolinska Institutet, Stockholm County Council, Stockholm, Sweden
| | - Anders Grubb
- Department of Clinical Chemistry, Lund University Hospital, Lund, Sweden
| | - Ingegerd Mejare
- Swedish Council on Health Technology Assessment, Stockholm, Sweden
| | - Gunnar Sterner
- Department of Nephrology, Skåne University Hospital Malmö, Malmö, Sweden
| | - Sten-Erik Bäck
- Department of Clinical Chemistry, Lund University Hospital, Lund, Sweden
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5766
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Stefoni S, Cianciolo G, Baraldi O, Iorio M, Angelini ML. Emerging drugs for chronic kidney disease. Expert Opin Emerg Drugs 2014; 19:183-99. [PMID: 24836744 DOI: 10.1517/14728214.2014.900044] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Chronic kidney disease (CKD) is a worldwide health problem. Despite remarkable headway in slowing the progression of kidney diseases, the incidence of end-stage renal disease (ESRD) is increasing in all countries with a severe impact on patients and society. The high incidence of diabetes and hypertension, along with the aging population, may partially explain this growth. Currently, the mainstay of pharmacological treatment for CKD, aiming to slow progression to ESRD are ACE inhibitors and angiotensin II receptor blockers for their hemodynamic/antihypertensive and anti-inflammatory/antifibrotic action. However, novel drugs would be highly desirable to effectively slow the progressive renal function loss. AREAS COVERED Through the search engines, PubMed and ClinicalTrial.gov, the scientific literature was reviewed in search of emerging drugs in Phase II or III trials, which appear to be the most promising for CKD treatment. EXPERT OPINION The great expectations for new drugs for the management of CKD over the last decade have unfortunately not been met. Encouraging results from preliminary studies with specific agents need to be tempered with caution, given the absence of consistent and adequate data. To date, several agents that showed great promise in animal studies have been less effective in humans.
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Affiliation(s)
- Sergio Stefoni
- S.Orsola University Hospital, Department of Experimental, Diagnostic and Speciality Medicine, Dialysis, Nephrology and Trasplantation Unit , Via Massarenti, 9, Bologna, 40138 , Italy
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5767
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Risks of decreased renal function and increased albuminuria for glycemic status and metabolic syndrome components: Taichung Community Health study. BIOMED RESEARCH INTERNATIONAL 2014; 2014:841497. [PMID: 24900991 PMCID: PMC4037121 DOI: 10.1155/2014/841497] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Revised: 04/16/2014] [Accepted: 04/21/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND The objective of this study was to assess the association of glycemic status and decreased renal function as determined by estimated glomerular filtration rate (eGFR) and albuminuria in an adult Taiwanese metropolitan population. METHODS We did a cross-sectional survey in a representative sample of 2,350 Taiwanese adults aged 40 years and over living in a metropolitan city in Taiwan from 2004 to 2005. Glycemic status was classified as normal glycemia, hyperglycemia, and type 2 diabetes (T2D). Renal function was assessed with eGFR using modified Modification of Diet in Renal Disease Study equation for Chinese. Albuminuria was determined by the urinary albumin-creatinine ratio. Decreased renal function was defined as eGFR <60 mL/min/1.73 m(2) and albuminuria as the albumin-creatinine ratio >30 mg g(-1) creatinine. RESULTS 593 (25.23%) had hyperglycemia and 287 (12.21%) had T2D. As glycemia level increased, the prevalence of albuminuria and decreased eGFR increased. After adjustment, T2D was associated with an OR of 2.93 (95% CI: 2.11-4.07) for albuminuria, and an OR of 2.05 (95% CI: 1.18-3.58) for decreased eGFR. CONCLUSIONS In a representative sample from a metropolitan city in Taiwan, T2D was associated with albuminuria and decreased eGFR.
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5768
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Cumulative effects of variants identified by genome-wide association studies in IgA nephropathy. Sci Rep 2014; 4:4904. [PMID: 24811838 PMCID: PMC4014895 DOI: 10.1038/srep04904] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Accepted: 04/11/2014] [Indexed: 11/09/2022] Open
Abstract
The effect of genetic markers associated with IgA nephropathy on risk of disease in sub-phenotype and progression is uncertain. Data from 2096 Chinese patients were used to create both un-weighted (uw) and weighted (w) genetic risk score (GRS). The association between GRS with disease susceptibility and clinical parameters were assessed. All nine selected single nucleotide polymorphisms (SNPs) were associated with susceptibility to IgAN. uwGRS and wGRS showed a similar fit in disease associations. With every 1-unit increase in the uwGRS, the disease risk increased by approximately 20%; whereas every one standard deviation increase in the wGRS, disease risk increased by approximately 40% ~ 60%. Association between rs3803800 and serum IgA was replicated, and risk groups in GRSs were associated with increased IgA/IgA1 levels. uwGRS9 ≥ 16 was an independent predictor for end stage renal disease (ESRD) in IgAN, with a relative risk of 2.52 (p = 6.68 × 10−3). In conclusion, we observed that GRSs comprising nine SNPs identified in a GWAS of IgAN were strongly associated with susceptibility to IgAN. The high risk GRS9 group had a high risk of ESRD in follow-up.
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5769
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Lo CH, Huang WY, Chao HL, Lin KT, Jen YM. Novel application of stereotactic ablative radiotherapy using CyberKnife ® for early-stage renal cell carcinoma in patients with pre-existing chronic kidney disease: Initial clinical experiences. Oncol Lett 2014; 8:355-360. [PMID: 24959276 PMCID: PMC4063570 DOI: 10.3892/ol.2014.2129] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Accepted: 04/24/2014] [Indexed: 12/25/2022] Open
Abstract
The treatment of renal cell carcinoma (RCC) in patients diagnosed with chronic kidney disease (CKD) requires particular care in order to preserve the remaining renal function. The present study aimed to investigate the potential of a novel nephron-sparing treatment, which is capable of targeting tumors embedded deep within tissues. The present study analyzed three patients, with pre-existing CKD and multiple comorbidities, who were successfully treated for stage I RCC using the CyberKnife® stereotactic ablative radiotherapy (SABR) system. The total prescribed dose was 40 Gy in five fractions administered over five consecutive days. Treatment efficiency was determined using computed tomography scans of the tumors and periodic measurements of the glomerular filtration rate over a period of 12–40 months. Local control, defined as a radiologically stable condition, was achieved in all patients. Lung metastasis was observed in one patient nine months after SABR; however, the side-effects were generally mild and self-limiting. One patient developed renal failure 26 months after SABR, while the severity of CKD was only marginally altered in the other two patients and renal failure did not occur. In conclusion, in the present study, SABR with CyberKnife® was observed to be well tolerated in the patients, with an acceptable acute toxicity effect. Therefore, it may represent a potential therapeutic option for patients with early-stage RCC who have previously been diagnosed with CKD, but for whom other nephron-sparing treatments are contraindicated.
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Affiliation(s)
- Cheng-Hsiang Lo
- Department of Radiation Oncology, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan, R.O.C
| | - Wen-Yen Huang
- Department of Radiation Oncology, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan, R.O.C
| | - Hsing-Lung Chao
- Department of Radiation Oncology, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan, R.O.C
| | - Kuen-Tze Lin
- Department of Radiation Oncology, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan, R.O.C
| | - Yee-Min Jen
- Department of Radiation Oncology, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan, R.O.C
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5770
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Chen J, Chen Y, Luo Y, Gui D, Huang J, He D. Astragaloside IV ameliorates diabetic nephropathy involving protection of podocytes in streptozotocin induced diabetic rats. Eur J Pharmacol 2014; 736:86-94. [PMID: 24809932 DOI: 10.1016/j.ejphar.2014.04.037] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Revised: 04/23/2014] [Accepted: 04/24/2014] [Indexed: 12/21/2022]
Abstract
Podocyte loss and dysfunction play key role during the development of diabetic nephropathy (DN). The aim of this study was to observe the protective effects of astragaloside IV on podocyte in diabetic rats and explore its mechanisms preliminary. Healthy male Sprague-Dawley (SD) rats were randomized into normal control group, diabetic nephropathy group and diabetic nephropathy with AS-IV treatment group. DN was induced by intraperitoneal injection of streptozotocin (STZ). AS-IV treatment started 2 weeks before STZ injection and lasted 14 weeks. 24h Urinary proteins were measured 4, 8 and 12 weeks after STZ injection. Body weight, blood glucose, blood urea nitrogen (BUN), creatinine (Cr), alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were measured 12 weeks after STZ injection. Renal pathology, podocyte morphological changes, podocyte density, protein and mRNA expression of integrin α3, integrin β1 and integrin-linked kinase (ILK) were detected by histopathology, electron microscopy, immunohistochemistry, western blot and real-time PCR, respectively. Hyperglycemia, proteinuria, mesangial expansion and podocyte loss, increased protein expression of ILK and decreased protein expression of integrin α3 and integrin β1 were detected in diabetic rats. AS-IV treatment ameliorated podocyte loss, renal histopathology and podocyte foot process effacement, decreased proteinuria, partially restored protein expression of integrin α3, integrin β1 and ILK. These findings suggested that AS-IV may protect podocyte and ameliorate diabetic nephropathy by inhibiting the expression of ILK and restoring the expression of integrin α3β1 in diabetic rats.
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Affiliation(s)
- Jianguo Chen
- Department of Nephrology, ZheJiang Hospital, HangZhou, PR China.
| | - Yifang Chen
- Department of Nephrology, ZheJiang Hospital, HangZhou, PR China
| | - Yunling Luo
- Department of Nephrology, ZheJiang Hospital, HangZhou, PR China
| | - Dingkun Gui
- Department of Nephrology, Shanghai Sixth People׳s Hospital, Shanghai, PR China
| | - Jianhua Huang
- Institute of Integrated Chinese and Western Medicine, Huashan Hospital, Fudan University, Shanghai, PR China
| | - Dongyuan He
- Department of Nephrology, ZheJiang Hospital, HangZhou, PR China.
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5771
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Survival rates and risk factors for mortality in systemic lupus erythematosus patients in a Chinese center. Clin Rheumatol 2014; 33:947-53. [PMID: 24794488 DOI: 10.1007/s10067-014-2596-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Revised: 12/31/2013] [Accepted: 03/26/2014] [Indexed: 10/25/2022]
Abstract
This paper aims to study the survival and risk factors affecting the long-term prognosis of Chinese patients with systemic lupus erythematosus (SLE). We collected clinical data of 1,072 SLE patients at the time of diagnosis. The Kaplan-Meier method was used to estimate the survival rate, and the Cox proportional hazard regression model for the risk factors affecting prognosis. Of the original 1,072 recruited SLE patients, 665 (570 females and 95 males) were successfully followed up. Mean follow-up was 5.47 ± 4.62 years. Mean age of onset was 29.4 ± 13.4 years. Eighty-one patients did not survive during follow-up; infection, followed by cardiovascular disease, renal failure and SLE disease activity were the leading causes of death. The 5- and 10-year survival rates were 91.2 and 79.6 %, respectively. Moreover, the 5-year survival rates of female and male patients were 92.6 and 81.6 % respectively, and the 10-year survival rates were 80.8 and 62.3 %, respectively. Univariate analyses indicated that male gender, older age of onset, hypertension, increased blood creatinine levels, and high-density lipoprotein cholesterol at the time of diagnosis of SLE were risk factors for all-cause mortality. After adjusting for potential confounders by multivariate analysis, male gender, older age of onset, and high SLEDAI scores at the time of diagnosis were independent risk factors for all-cause mortality in SLE patients. The long-term survival of Chinese SLE patients is comparable to that of other countries. Older age of onset, high disease activity, and decline in renal function are independent risk factors for mortality in patients with SLE.
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5772
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Chu R, Li C, Wang S, Zou W, Liu G, Yang L. Assessment of KDIGO definitions in patients with histopathologic evidence of acute renal disease. Clin J Am Soc Nephrol 2014; 9:1175-82. [PMID: 24789552 DOI: 10.2215/cjn.06150613] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND OBJECTIVES AKI is a clinical syndrome with various causes involving glomerular, interstitial, tubular, and vascular compartments of the kidney. Acute kidney disease (AKD) is a new concept that includes both AKI and the conditions associated with subacute decreases in GFR (AKD/non-AKI). This study aimed to investigate the correlation between AKI/AKD defined by clinical presentation and diffuse histologic criteria for acute abnormalities based on renal biopsy. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS All 303 patients who were histologically diagnosed as having acute tubular necrosis (ATN), acute tubulointerstitial nephritis, cellular crescentic GN, acute thrombotic microangiopathy, or complex lesions on renal biopsy from January 2009 to December 2011 were enrolled in the study. The 2012 Kidney Disease Improving Global Outcomes AKD/AKI definitions were applied to classify patients as follows: AKI, AKD/non-AKI, non-AKD, or unclassified. RESULTS A total of 273 patients (90.1%) met the AKD criteria; 198 patients (65.3%) were classified as having AKI according to serum creatinine (SCr) and urine output criteria. The urine output criteria added 4.3% to the SCr criteria and reclassified 6.7% of the AKI cases into higher stages. Of patients with ATN on pathology, 79.2% met AKI criteria; this was a higher percentage than for those who had other individual pathologic lesions (50%-64%). The major cause of not being defined as having AKI was a slower SCr increase than that required by the definition of AKI (98, 93.3%). Patients with AKI had more severe clinical conditions and worse short-term renal outcome than those in the non-AKI group. CONCLUSIONS Diffuse, acute abnormality defined by renal biopsy and AKI defined by clinical presentation are two different entities. Most patients who have diffuse acute histologic findings met the criteria for AKD, whereas only two thirds met the definition of AKI.
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Affiliation(s)
- Rong Chu
- Renal Division, Department of Medicine, Peking University First Hospital; Peking University Institute of Nephrology; Key Laboratory of Renal Disease, Ministry of Health of China; and Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing, China
| | - Cui Li
- Renal Division, Department of Medicine, Peking University First Hospital; Peking University Institute of Nephrology; Key Laboratory of Renal Disease, Ministry of Health of China; and Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing, China
| | - Suxia Wang
- Renal Division, Department of Medicine, Peking University First Hospital; Peking University Institute of Nephrology; Key Laboratory of Renal Disease, Ministry of Health of China; and Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing, China
| | - Wanzhong Zou
- Renal Division, Department of Medicine, Peking University First Hospital; Peking University Institute of Nephrology; Key Laboratory of Renal Disease, Ministry of Health of China; and Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing, China
| | - Gang Liu
- Renal Division, Department of Medicine, Peking University First Hospital; Peking University Institute of Nephrology; Key Laboratory of Renal Disease, Ministry of Health of China; and Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing, China
| | - Li Yang
- Renal Division, Department of Medicine, Peking University First Hospital; Peking University Institute of Nephrology; Key Laboratory of Renal Disease, Ministry of Health of China; and Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing, China
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5773
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Abstract
Chronic kidney disease (CKD) is becoming a worldwide epidemic, driven largely by the dramatic rise in the prevalence of diabetes and obesity. Novel targets and treatments for CKD are, therefore, desperately needed-to both mitigate the burden of this disease in the general population and reduce the necessity for renal replacement therapy in individual patients. This Review highlights new insights into the mechanisms that contribute to CKD, and approaches that might facilitate the development of disease-arresting therapies for CKD. Particular focus is given to therapeutic approaches using antifibrotic agents that target the transforming growth factor β superfamily. In addition, we discuss new insights regarding the roles of vascular calcification, the NADPH oxidase family, and inflammation in the pathogenesis of CKD. We also highlight a new understanding regarding kidney energy sensing pathways (AMPK, sirtuins, and mTOR) in a variety of kidney diseases and how they are linked to inflammation and fibrosis. Finally, exciting new insights have been made into the role of mitochondrial function and mitochondrial biogenesis in relation to progressive kidney disease. Prospective therapeutics based on these findings will hopefully renew hope for clinicians and patients in the near future.
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Affiliation(s)
- Anne-Emilie Declèves
- Laboratory of Experimental Nephrology, Faculty of Medicine, Université Libre de Bruxelles (ULB), CP603, 808 Route de Lennik, 1070 Brussels, Belgium
| | - Kumar Sharma
- Center for Renal Translational Medicine, University of California, San Diego and Veterans Affairs San Diego Healthcare System, Stein Clinical Research Building, 4th Floor, 9500 Gilman Drive, La Jolla, CA 92093-0711, USA
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5774
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Wilkie M. Investigating Hyponatremia, Exit-Site Management and Discharge Planning. Perit Dial Int 2014; 34:251-2. [DOI: 10.3747/pdi.2014.00114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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5775
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Modesti PA, Agostoni P, Agyemang C, Basu S, Benetos A, Cappuccio FP, Ceriello A, Del Prato S, Kalyesubula R, O’Brien E, Kilama MO, Perlini S, Picano E, Reboldi G, Remuzzi G, Stuckler D, Twagirumukiza M, Van Bortel LM, Watfa G, Zhao D, Parati G. Cardiovascular risk assessment in low-resource settings: a consensus document of the European Society of Hypertension Working Group on Hypertension and Cardiovascular Risk in Low Resource Settings. J Hypertens 2014; 32:951-60. [PMID: 24577410 PMCID: PMC3979828 DOI: 10.1097/hjh.0000000000000125] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2013] [Revised: 01/09/2014] [Accepted: 01/09/2014] [Indexed: 02/06/2023]
Abstract
The Global Burden of Diseases, Injuries, and Risk Factors Study 2010 confirms ischemic heart disease and stroke as the leading cause of death and that hypertension is the main associated risk factor worldwide. How best to respond to the rising prevalence of hypertension in resource-deprived settings is a topic of ongoing public-health debate and discussion. In low-income and middle-income countries, socioeconomic inequality and cultural factors play a role both in the development of risk factors and in the access to care. In Europe, cultural barriers and poor communication between health systems and migrants may limit migrants from receiving appropriate prevention, diagnosis, and treatment. To use more efficiently resources available and to make treatment cost-effective at the patient level, cardiovascular risk approach is now recommended. In 2011, The European Society of Hypertension established a Working Group on 'Hypertension and Cardiovascular risk in low resource settings', which brought together cardiologists, diabetologists, nephrologists, clinical trialists, epidemiologists, economists, and other stakeholders to review current strategies for cardiovascular risk assessment in population studies in low-income and middle-income countries, their limitations, possible improvements, and future interests in screening programs. This report summarizes current evidence and presents highlights of unmet needs.
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Affiliation(s)
- Pietro A. Modesti
- Department of Clinical and Experimental Medicine, University of Florence, Florence
| | | | - Charles Agyemang
- Department of Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Sanjay Basu
- University of California, San Francisco, California, USA
| | - Athanase Benetos
- INSERM UMR S1116, Université de Lorraine, Vandoeuvre-les-Nancy, Nancy, France
| | - Francesco P. Cappuccio
- University of Warwick, Warwick Medical School, and University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
| | - Antonio Ceriello
- Institut d’Investigacions Biomèdiques August Pi i Sunyer IDIBAPS, and Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, Spain
| | - Stefano Del Prato
- Section of Metabolic Diseases and Diabetes, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Eoin O’Brien
- The Conway Institute, University College Dublin, Dublin, Ireland
| | | | | | | | | | - Giuseppe Remuzzi
- IRCCS-Istituto di Ricerche Farmacologiche ‘Mario Negri’, Bergamo, Italy
| | - David Stuckler
- Department of Sociology, University of Oxford, Oxford, UK
| | - Marc Twagirumukiza
- Faculty of Medicine and Health Sciences, Heymans Institute of Pharmacology, Ghent University, Ghent, Belgium
| | - Luc M. Van Bortel
- Faculty of Medicine and Health Sciences, Heymans Institute of Pharmacology, Ghent University, Ghent, Belgium
| | | | - Dong Zhao
- Beijing Institute of Heart, Lung and Blood Vessel Diseases, Capital Medical University, Beijing Anzhen Hospital, Beijing, China
| | - Gianfranco Parati
- Department of Health Sciences, University of Milano-Bicocca
- Department of Cardiology, S. Luca Hospital, IRCCS Istituto Auxologico Italiano, Milan, Italy
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5776
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5777
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Jessani S, Jafar TH. In Reply to ‘Validating GFR Estimating Samples With Clinical Outcomes’. Am J Kidney Dis 2014; 63:859-60. [DOI: 10.1053/j.ajkd.2014.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 02/18/2014] [Indexed: 11/11/2022]
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5778
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Haynes R, Lewis D, Emberson J, Reith C, Agodoa L, Cass A, Craig JC, de Zeeuw D, Feldt-Rasmussen B, Fellström B, Levin A, Wheeler DC, Walker R, Herrington WG, Baigent C, Landray MJ. Effects of lowering LDL cholesterol on progression of kidney disease. J Am Soc Nephrol 2014; 25:1825-33. [PMID: 24790178 DOI: 10.1681/asn.2013090965] [Citation(s) in RCA: 111] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Lowering LDL cholesterol reduces the risk of developing atherosclerotic events in CKD, but the effects of such treatment on progression of kidney disease remain uncertain. Here, 6245 participants with CKD (not on dialysis) were randomly assigned to simvastatin (20 mg) plus ezetimibe (10 mg) daily or matching placebo. The main prespecified renal outcome was ESRD (defined as the initiation of maintenance dialysis or kidney transplantation). During 4.8 years of follow-up, allocation to simvastatin plus ezetimibe resulted in an average LDL cholesterol difference (SEM) of 0.96 (0.02) mmol/L compared with placebo. There was a nonsignificant 3% reduction in the incidence of ESRD (1057 [33.9%] cases with simvastatin plus ezetimibe versus 1084 [34.6%] cases with placebo; rate ratio, 0.97; 95% confidence interval [95% CI], 0.89 to 1.05; P=0.41). Similarly, allocation to simvastatin plus ezetimibe had no significant effect on the prespecified tertiary outcomes of ESRD or death (1477 [47.4%] events with treatment versus 1513 [48.3%] events with placebo; rate ratio, 0.97; 95% CI, 0.90 to 1.04; P=0.34) or ESRD or doubling of baseline creatinine (1189 [38.2%] events with treatment versus 1257 [40.2%] events with placebo; rate ratio, 0.93; 95% CI, 0.86 to 1.01; P=0.09). Exploratory analyses also showed no significant effect on the rate of change in eGFR. Lowering LDL cholesterol by 1 mmol/L did not slow kidney disease progression within 5 years in a wide range of patients with CKD.
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Affiliation(s)
- Richard Haynes
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - David Lewis
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Jonathan Emberson
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Christina Reith
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Lawrence Agodoa
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Alan Cass
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Jonathan C Craig
- Sydney School of Public Health, Children's Hospital at Westmead, University of Sydney, Sydney, New South Wales, Australia
| | - Dick de Zeeuw
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | | | | | - Adeera Levin
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Rob Walker
- Dunedin School of Medicine, University of Otago, Otago, New Zealand
| | - William G Herrington
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Colin Baigent
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Martin J Landray
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom;
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5779
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5780
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Lau YC, Lip GYH. Management of Atrial Fibrillation in Patients With Kidney Disease. J Atr Fibrillation 2014; 6:989. [PMID: 27957055 DOI: 10.4022/jafib.989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Revised: 03/27/2014] [Accepted: 03/27/2014] [Indexed: 11/10/2022]
Abstract
The increasing burden of Chronic Kidney Disease (CKD) is highly relevant to cardiologists, as cardiovascular mortality is 10-30 times higher amongst people with End-stage Renal Disease (ESRD), comparing with general population. One of the commonest associations is the increased frequency of atrial fibrillation (AF) amongst those experiencing CKD. Overall, we know that AF is the most common cardiac arrhythmia. AF leads to a substantial risk of mortality and morbidity, from stroke and thromboembolism, heart failure, reduced cognitive function and impaired quality of life. However, most clinical trials in AF (for example, for stroke prevention in AF with anticoagulation therapy) have largely excluded patients with significant renal impairment. In this review article, we will focus on stroke prevention in AF, and the clinical impact of CKD and its implications for management.
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Affiliation(s)
- Yee C Lau
- University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom
| | - Gregory Y H Lip
- University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom
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5781
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Tsai YW, Ho CI, Chen JY, Chang KC, Weng YM, Chen SY, Li WC. Impact of body composition on estimated glomerular filtration rate in relatively healthy adults in Taiwan. Eur J Clin Nutr 2014; 69:34-9. [PMID: 24781688 DOI: 10.1038/ejcn.2014.66] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Revised: 12/21/2013] [Accepted: 02/21/2014] [Indexed: 01/10/2023]
Abstract
BACKGROUND/OBJECTIVES Chronic kidney diseases are associated with changes in cardiometabolic risk (CMR) factors in which body composition parameters have been used as sensitive predictors. This study aimed to explore the associations of anthropometric indicators, body fat (BF), body mass index (BMI) and waist circumference (WC) with estimated glomerular filtration rate (eGFR) in an adult healthy Chinese population. SUBJECTS/METHODS A cross-sectional study was conducted for the subjects undergoing annual health examinations. The associations of subjects with body composition parameters were analyzed using the cutoff values of BMI, BF and WC in accordance with the criteria for Asian or Taiwanese population by gender. RESULTS A total of 3473 subjects, aged 30-45 years, who received physical examinations in 2007 were analyzed. The levels of CMR factors were significantly higher in males than in females. eGFR was negatively associated with BMI but positively related to BF. The additional roles of BMI and WC were observed in the subjects who were categorized according to BF. Females with normal weight obese were associated with increased eGFR, whereas a higher eGFR was found in males with low/normal BF and BMI or normal WC. CONCLUSIONS Our data provided evidence that anthropometric parameters were associated with changes of eGFR in relatively healthy adults. Higher eGFR was observed in females with normal weight obese in whom hyperfiltration may be suspected, and this finding deserves further studies.
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Affiliation(s)
- Y-W Tsai
- Department of Family Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - C-I Ho
- Department of Family Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - J-Y Chen
- Department of Family Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - K-C Chang
- Department of Family Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Y-M Weng
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - S-Y Chen
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - W-C Li
- Department of Occupation Medicine, Chang-Gung Memorial Hospital, Chiayi, Taiwan
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5782
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Ding ZH, Xu LM, Wang SZ, Kou JQ, Xu YL, Chen CX, Yu HP, Qin ZH, Xie Y. Ameliorating Adriamycin-Induced Chronic Kidney Disease in Rats by Orally Administrated Cardiotoxin from Naja naja atra Venom. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2014; 2014:621756. [PMID: 24876873 PMCID: PMC4021839 DOI: 10.1155/2014/621756] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Revised: 04/11/2014] [Accepted: 04/12/2014] [Indexed: 01/27/2023]
Abstract
Previous studies reported the oral administration of Naja naja atra venom (NNAV) reduced adriamycin-induced chronic kidney damage. This study investigated the effects of intragastric administrated cardiotoxin from Naja naja atra venom on chronic kidney disease in rats. Wistar rats were injected with adriamycin (ADR; 6 mg/kg body weight) via the tail vein to induce chronic kidney disease. The cardiotoxin was administrated daily by intragastric injection at doses of 45, 90, and 180 μ g/kg body weight until the end of the protocol. The rats were placed in metabolic cages for 24 hours to collect urine, for determination of proteinuria, once a week. After 6 weeks, the rats were sacrificed to determine serum profiles relevant to chronic kidney disease, including albumin, total cholesterol, phosphorus, blood urea nitrogen, and serum creatinine. Kidney histology was examined with hematoxylin and eosin, periodic acid-Schiff, and Masson's trichrome staining. The levels of kidney podocin were analyzed by Western blot analysis and immunofluorescence. We found that cardiotoxin reduced proteinuria and can improve biological parameters in the adriamycin-induced kidney disease model. Cardiotoxin also reduced adriamycin-induced kidney pathology, suggesting that cardiotoxin is an active component of NNAV for ameliorating adriamycin-induced kidney damage and may have a potential therapeutic value on chronic kidney disease.
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Affiliation(s)
- Zhi-Hui Ding
- The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, China
| | - Li-Min Xu
- The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, China
| | - Shu-Zhi Wang
- Department of Pharmacology and Laboratory of Aging and Nervous Diseases, Soochow University School of Medicine, Suzhou 215123, Jiangsu, China
| | - Jian-Qun Kou
- Department of Pharmacology and Laboratory of Aging and Nervous Diseases, Soochow University School of Medicine, Suzhou 215123, Jiangsu, China
| | - Yin-Li Xu
- Department of Pharmacology and Laboratory of Aging and Nervous Diseases, Soochow University School of Medicine, Suzhou 215123, Jiangsu, China
| | - Cao-Xin Chen
- Department of Pharmacology and Laboratory of Aging and Nervous Diseases, Soochow University School of Medicine, Suzhou 215123, Jiangsu, China
| | - Hong-Pei Yu
- The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215004, China
| | - Zheng-Hong Qin
- Department of Pharmacology and Laboratory of Aging and Nervous Diseases, Soochow University School of Medicine, Suzhou 215123, Jiangsu, China
| | - Yan Xie
- The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, China
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5783
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Wahafu W, Ma X, Li HZ, Ding Q, Wang BJ, Shi TP, Zheng T, Dong J, Cai W, Zhang X. Evolving renorrhaphy technique for retroperitoneal laparoscopic partial nephrectomy: single-surgeon series. Int J Urol 2014; 21:865-73. [PMID: 24780100 DOI: 10.1111/iju.12470] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Accepted: 03/19/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To evaluate renorrhaphy techniques and to analyze surgical outcomes in retroperitoneal laparoscopic partial nephrectomy. METHODS A retrospective study from January 2008 to December 2011 analyzed 526 patients with renal tumors in whom renorrhaphy was changed from one layer, interrupted, figure-of-eight (n = 228) suture to two layers, continuous, unknotted (n = 298) suture. All procedures were carried out by the same laparoscopic surgeon (XZ). Patient demographics, tumor characteristics, operative outcomes and perioperative renal function were compared. RESULTS Median follow up for one layer, interrupted, figure-of-eight suture and two layers, continuous, unknotted suture was 31 and 28 months, respectively. The two layers, continuous, unknotted suture group had shorter warm ischemia time (P = 0.021), faster removal of Jackson-Pratt drains (P = 0.029) and shorter hospital stay (P = 0.037) than the one layer, interrupted, figure-of-eight suture group. There was a trend towards a better preservation of glomerular filtration rates in the two layers, continuous, unknotted suture group (P = 0.045). In a multivariable model, the two layers, continuous, unknotted suture technique was a statistically significant independent predictor of warm ischemia time (P = 0.01), hospital stay (P = 0.001) and estimated glomerular filtration rates (P = 0.043). CONCLUSIONS Two layers, continuous, unknotted suture renorrhaphy allows better outcomes than one layer, interrupted, figure-of-eight suture renorrhaphy in retroperitoneal laparoscopic partial nephrectomy. A longer clinical follow-up evaluation is warranted.
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Affiliation(s)
- Wasilijiang Wahafu
- Department of Urology, Military Postgraduate Medical College, Chinese People's Liberation Army General Hospital, Beijing, China
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5784
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Comparison of CKD-EPI Cystatin C and Creatinine Glomerular Filtration Rate Estimation Equations in Asian Indians. Int J Nephrol 2014; 2014:746497. [PMID: 24868463 PMCID: PMC4020461 DOI: 10.1155/2014/746497] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 03/11/2014] [Indexed: 11/18/2022] Open
Abstract
Background. Chronic kidney disease (CKD) is identified in the general population using estimated glomerular filtration rates (eGFR) calculated from a serum creatinine-based equation, the chronic kidney disease-epidemiology collaboration (CKD-EPI) equation. Using serum cystatin C in combination may improve eGFR accuracy. We evaluated the new CKD-EPI equations incorporating cystatin C in a population of Asian Indians in classifying CKD across body mass index, diabetes, and hypertension status. Methods. We retrieved standardized serum creatinine and serum cystatin C data from a cohort of 2877 Asian Indians aged 40–80 years from the Singapore Indian Eye Study and calculated eGFR (in mL/min/1.73 m2) with the new CKD-EPI equations and serum creatinine only equation. Results. The creatinine only equation mean eGFR (88 ± 17) was similar to using spline Log cystatin C (88 ± 22). The lowest mean eGFR (81 ± 21) was obtained with the spline Log cystatin C—age, sex, and weight equation. The creatinine only equation had the fewest participants (7.1%) with eGFR <60 and spline Log cystatin C—age, sex, and weight equation had the most (16.1%). Conclusions. Using serum cystatin C resulted in widely varying eGFR which significantly affected the classification of chronic kidney disease.
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5785
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Comparison of CKD-EPI Cystatin C and Creatinine Glomerular Filtration Rate Estimation Equations in Asian Indians. Int J Nephrol 2014. [PMID: 24868463 DOI: 10.1155/746497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background. Chronic kidney disease (CKD) is identified in the general population using estimated glomerular filtration rates (eGFR) calculated from a serum creatinine-based equation, the chronic kidney disease-epidemiology collaboration (CKD-EPI) equation. Using serum cystatin C in combination may improve eGFR accuracy. We evaluated the new CKD-EPI equations incorporating cystatin C in a population of Asian Indians in classifying CKD across body mass index, diabetes, and hypertension status. Methods. We retrieved standardized serum creatinine and serum cystatin C data from a cohort of 2877 Asian Indians aged 40-80 years from the Singapore Indian Eye Study and calculated eGFR (in mL/min/1.73 m(2)) with the new CKD-EPI equations and serum creatinine only equation. Results. The creatinine only equation mean eGFR (88 ± 17) was similar to using spline Log cystatin C (88 ± 22). The lowest mean eGFR (81 ± 21) was obtained with the spline Log cystatin C-age, sex, and weight equation. The creatinine only equation had the fewest participants (7.1%) with eGFR <60 and spline Log cystatin C-age, sex, and weight equation had the most (16.1%). Conclusions. Using serum cystatin C resulted in widely varying eGFR which significantly affected the classification of chronic kidney disease.
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5786
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Abstract
Vascular calcification in chronic kidney disease (CKD) patients is associated to increased mortality. Osteoprotegerin (OPG) is a soluble tumor necrosis factor (TNF) superfamily receptor that inhibits the actions of the cytokines receptor activator of nuclear factor kappa-B ligand (RANKL) and TNF-related apoptosis-inducing ligand (TRAIL) by preventing their binding to signaling receptors in the cell membrane. OPG-deficient mice display vascular calcification while OPG prevented calcification of cultured vascular smooth muscle cells and protected kidney cells from TRAIL-induced death. OPG may be a biomarker in patients with kidney disease. Circulating OPG is increased in predialysis, dialysis and transplant CKD patients and may predict vascular calcification progression and patient survival. By contrast, circulating OPG is decreased in nephrotic syndrome. In addition, free and exosome-bound urinary OPG is increased in human kidney disease. Increased urinary OPG has been associated with lupus nephritis activity. Despite the association of high OPG levels with disease, experimental functional information available suggests that OPG might be protective in kidney disease and in vascular injury in the context of uremia. Thus, tissue injury results in increased OPG, while OPG may protect from tissue injury. Recombinant OPG was safe in phase I randomized controlled trials. Further research is needed to fully define the therapeutic and biomarker potential of OPG in patients with kidney disease.
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5787
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Wang L, Xia P, Lv K, Han J, Dai Q, Li XM, Chen LM, Jiang YX. Assessment of renal tissue elasticity by acoustic radiation force impulse quantification with histopathological correlation: preliminary experience in chronic kidney disease. Eur Radiol 2014; 24:1694-9. [PMID: 24744199 DOI: 10.1007/s00330-014-3162-5] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Accepted: 03/21/2014] [Indexed: 01/01/2023]
Abstract
OBJECTIVES Chronic kidney disease (CKD), a progressive and irreversible pathological syndrome, is the major cause of renal failure. Renal fibrosis is the principal process underlying the progression of CKD. Acoustic radiation force impulse (ARFI) quantification is a promising noninvasive method for assessing tissue stiffness. We evaluated whether the technique could reveal renal tissue fibrosis in CKD patients. METHODS ARFI assessments were performed in 45 patients with CKD referred for renal biopsies to measure cortical shear wave velocity (SWV). During measurement, a standardized method was employed, which aimed to minimize the potential impact of variation of transducer force, sampling error of non-cortical tissue and structural anisotropy of the kidney. Then SWV was compared to patients' CKD stage and pathological fibrosis indicators. RESULTS ARFI could not predict the different stages of CKD. Spearman correlation analysis showed that SWV did not correlate with any pathological indicators of fibrosis. CONCLUSION ARFI assesses tissue stiffness of CKD kidneys by measuring cortical SWV. However, SWV did not show significant correlations with CKD stage and fibrosis indicators despite using standardized measurement methods. We therefore suggest that it would be necessary to evaluate the effect of pathological complexity and tissue perfusion of the kidney on stiffness assessment in future studies. KEY POINTS • Acoustic radiation force impulse (ARFI) can quantify tissue elasticity of CKD kidney. • Despite standardized measurement, ARFI-estimated elasticity did not correlate with renal fibrosis. • Effects of pathological complexity and tissue perfusion on renal stiffness warrant further study.
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Affiliation(s)
- Liang Wang
- Department of Ultrasound, Chinese Academy of Medical Sciences & Peking Union Medical College Hospital, 1 Shuaifuyuan Wangfujing, Beijing, 100730, China
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5788
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Significance of white-coat and masked hypertension in chronic kidney disease and end-stage renal disease. Hypertens Res 2014; 37:882-9. [PMID: 24739541 DOI: 10.1038/hr.2014.82] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Revised: 02/17/2014] [Accepted: 02/18/2014] [Indexed: 11/08/2022]
Abstract
Hypertension is a frequent and modifiable cardiovascular risk factor with a cyclic relationship with chronic kidney disease (CKD). The diagnosis, treatment, monitoring and control of high blood pressure are all mandatory not only in CKD but also in end-stage renal disease (ESRD). As demonstrated by studies using population and hypertensive patients, white-coat hypertension (WCHT) and masked hypertension (MHT) carry a particular degree of risk. The advantages of ambulatory techniques in the management and prognostic stratification of patients with CKD and ESRD have also been recognized. However, most of the evidence underlines the importance of nocturnal hypertension and neglects WCHT and MHT. The absence of specific reports involving untreated and treated patients hinders the ability to significantly discriminate WCHT from the white-coat effect and MHT from masked uncontrolled hypertension. The heterogeneous definitions that are used add additional difficulty in translating experimental evidence into clinical practice. Reaching a consensus in definitions is mandatory for designing future research. Cross-sectional studies underscore the frequency of misdiagnosis, potentially leading to undertreatment (MHT) and overtreatment (WCHT) in renal disease. The divergent prevalence of WCHT and MHT reported in CKD could be related to the diverse definitions of hypertension and the heterogeneity of the pathologies pooled under the CKD definition. Even in the absence of randomized clinical trials specifically addressing this issue, the scarce longitudinal studies confirm that WCHT carries a risk close to that of sustained normotension, whereas MHT is associated with a risk close or identical to that of sustained hypertension.
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5789
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Nanayakkara S, Senevirathna STMLD, Abeysekera T, Chandrajith R, Ratnatunga N, Gunarathne EDL, Yan J, Hitomi T, Muso E, Komiya T, Harada KH, Liu W, Kobayashi H, Okuda H, Sawatari H, Matsuda F, Yamada R, Watanabe T, Miyataka H, Himeno S, Koizumi A. An Integrative Study of the Genetic, Social and Environmental Determinants of Chronic Kidney Disease Characterized by Tubulointerstitial Damages in the North Central Region of Sri Lanka. J Occup Health 2014; 56:28-38. [DOI: 10.1539/joh.13-0172-oa] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Shanika Nanayakkara
- Department of Health and Environmental SciencesGraduate School of Medicine, Kyoto UniversityJapan
- Institute of Dental Research, Westmead Centre for Oral Health, Faculty of DentistryThe University of SydneyAustralia
| | - STMLD Senevirathna
- Department of Health and Environmental SciencesGraduate School of Medicine, Kyoto UniversityJapan
- School of Computing, Engineering and Mathematics, University of Western SydneyAustralia
| | - Tilak Abeysekera
- Department of Pharmacology, Faculty of MedicineUniversity of PeradeniyaSri Lanka
| | - Rohana Chandrajith
- Department of Geology, Faculty of ScienceUniversity of PeradeniyaSri Lanka
| | | | | | - Junxia Yan
- Department of Health and Environmental SciencesGraduate School of Medicine, Kyoto UniversityJapan
| | - Toshiaki Hitomi
- Department of Health and Environmental SciencesGraduate School of Medicine, Kyoto UniversityJapan
| | - Eri Muso
- Department of Nephrology and DialysisTazuke Kofukai Medical Research Institute, Kitano HospitalJapan
| | - Toshiyuki Komiya
- Department of Nephrology and DialysisTazuke Kofukai Medical Research Institute, Kitano HospitalJapan
| | - Kouji H. Harada
- Department of Health and Environmental SciencesGraduate School of Medicine, Kyoto UniversityJapan
| | - Wanyang Liu
- Department of Health and Environmental SciencesGraduate School of Medicine, Kyoto UniversityJapan
| | - Hatasu Kobayashi
- Department of Health and Environmental SciencesGraduate School of Medicine, Kyoto UniversityJapan
| | - Hiroko Okuda
- Department of Health and Environmental SciencesGraduate School of Medicine, Kyoto UniversityJapan
| | | | - Fumihiko Matsuda
- Center for Genomic Medicine, Graduate School of Medicine, Kyoto UniversityJapan
| | - Ryo Yamada
- Center for Genomic Medicine, Graduate School of Medicine, Kyoto UniversityJapan
| | | | - Hideki Miyataka
- Laboratory of Molecular Nutrition and Toxicology, Faculty of Pharmaceutical SciencesTokushima Bunri UniversityJapan
| | - Seiichiro Himeno
- Laboratory of Molecular Nutrition and Toxicology, Faculty of Pharmaceutical SciencesTokushima Bunri UniversityJapan
| | - Akio Koizumi
- Department of Health and Environmental SciencesGraduate School of Medicine, Kyoto UniversityJapan
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5790
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Li Y, Xie D, Qin X, Tang G, Xing H, Li Z, Xu X, Xu X, Hou F. Metabolic syndrome, but not insulin resistance, is associated with an increased risk of renal function decline. Clin Nutr 2014; 34:269-75. [PMID: 24792685 DOI: 10.1016/j.clnu.2014.04.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2013] [Revised: 03/19/2014] [Accepted: 04/01/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND & AIMS The purpose of this study was to evaluate the effect of metabolic syndrome (Mets) and insulin resistance (IR) on the risk of renal function decline (RFD) in a rural Chinese cohort. METHODS A total of 2696 subjects aged 40-71 years with normal renal function were followed-up for 7 years. RFD was defined using the Kidney Disease: Improving Global Outcome definition, i.e., a drop in estimated glomerular filtration rate (eGFR) category accompanied by a 25% or greater drop in eGFR from baseline or a sustained decline in eGFR of more than 5 mL/min/1.73 m(2)/year. RESULTS During the 7-year follow-up, 9.0% of the subjects developed RFD. Subjects with Mets at baseline had an increased risk of RFD with an adjusted odds ratio (OR) of 1.77 (95%CI: 1.25-2.52), and there was a graded relationship between the numbers of Mets components and the risk for RFD. Exclusion of the subjects with hypertension (1.65; 0.99-2.75) or diabetes (1.86; 1.30-2.67) at baseline or further adjustment for IR (1.72; 1.15-2.57) did not substantially change the association between Mets and the risk of RFD. Moreover, the ORs of Mets status for RFD in the older group (≥55 years) were 2.14 (1.06-4.33) times of that in the younger group (<55 years) and 2.26 (1.07-4.78) times in hypercholesterolemia group (≥5.2 mmol/L) of that in the normal (<5.2 mmol/L) group. The baseline IR was not associated with the risk for RFD. CONCLUSIONS Mets, but not IR, was associated with an increased risk for RFD. And there was a detrimental interaction of Mets with older age and hypercholesterolemia on the risk of RFD.
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Affiliation(s)
- Youbao Li
- Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Di Xie
- Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China; Guangdong Institute of Nephrology, Southern Medical University, Guangzhou, China
| | - Xianhui Qin
- Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China; Guangdong Institute of Nephrology, Southern Medical University, Guangzhou, China
| | - Genfu Tang
- Institute of Biomedicine, Anhui Medical University, Hefei, China
| | - Houxun Xing
- Institute of Biomedicine, Anhui Medical University, Hefei, China
| | - Zhiping Li
- Institute of Biomedicine, Anhui Medical University, Hefei, China
| | - Xiping Xu
- Guangdong Institute of Nephrology, Southern Medical University, Guangzhou, China
| | - Xin Xu
- Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China; Guangdong Institute of Nephrology, Southern Medical University, Guangzhou, China.
| | - Fanfan Hou
- Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China; Guangdong Institute of Nephrology, Southern Medical University, Guangzhou, China.
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5791
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Feehally J, Couser W, Dupuis S, Finkelstein F, Harden P, Harris D, Lameire N, Naicker S, Remuzzi G, Segantini L, Tonelli M. Nephrology in developing countries: the ISN's story. Lancet 2014; 383:1271-1272. [PMID: 24725563 DOI: 10.1016/s0140-6736(13)62711-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- John Feehally
- International Society of Nephrology, Brussels B-1000, Belgium.
| | - William Couser
- International Society of Nephrology, Brussels B-1000, Belgium
| | - Sophie Dupuis
- International Society of Nephrology, Brussels B-1000, Belgium
| | | | - Paul Harden
- International Society of Nephrology, Brussels B-1000, Belgium
| | - David Harris
- International Society of Nephrology, Brussels B-1000, Belgium
| | - Norbert Lameire
- International Society of Nephrology, Brussels B-1000, Belgium
| | - Sarala Naicker
- International Society of Nephrology, Brussels B-1000, Belgium
| | | | - Luca Segantini
- International Society of Nephrology, Brussels B-1000, Belgium
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5792
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Moustafa M, Lehrner L, Al-Saghir F, Smith M, Goyal S, Dillon M, Hunter J, Holmes-Farley R. A randomized, double-blind, placebo-controlled, dose-ranging study using Genz-644470 and sevelamer carbonate in hyperphosphatemic chronic kidney disease patients on hemodialysis. Int J Nephrol Renovasc Dis 2014; 7:141-52. [PMID: 24748812 PMCID: PMC3986335 DOI: 10.2147/ijnrd.s56217] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Genz-644470 is a new, nonabsorbed phosphate binding polymer. In an in vitro competitive phosphate binding assay, Genz-644470 bound significantly more phosphate per gram than sevelamer. As a consequence, this clinical study evaluated the ability of Genz-644470 to lower serum phosphorus in patients on hemodialysis and compared serum phosphorus lowering of Genz-644470 with sevelamer carbonate and placebo. Because three different fixed doses of Genz-644470 and sevelamer carbonate were used, phosphate-lowering dose-responses of each agent were also analyzed. Methods A randomized, double-blind, dose-ranging study was conducted. After a 2-week phosphate binder washout, 349 hyperphosphatemic (serum phosphorus >5.5 mg/dL) hemodialysis patients were randomized to one of seven fixed-dose groups: placebo, Genz-644470 2.4 g/day, Genz-644470 4.8 g/day, Genz-644470 7.2 g/day, sevelamer carbonate 2.4 g/day, sevelamer carbonate 4.8 g/day, or sevelamer carbonate 7.2 g/day. Indicated total daily doses were administered in fixed divided doses three times a day with meals for 3 weeks. The change in serum phosphorus during the treatment period and its dose-response patterns were assessed. Results Dose-dependent reductions in serum phosphorus were observed with both Genz-644470 and sevelamer carbonate. Serum phosphorus-lowering responses to fixed doses of sevelamer carbonate and Genz-644470 were enhanced in a roughly linear fashion with increasing doses over a threefold range after 3 weeks of treatment. Genz-644470 did not show any advantage in phosphorus lowering per gram of binder compared with sevelamer carbonate. Overall toler-ability was similar between active treatment groups. The tolerability of sevelamer carbonate was consistent with prior studies and with the established safety profile of sevelamer. Conclusion Both Genz-644470 and sevelamer carbonate effectively lowered serum phosphate levels in a dose-dependent fashion in patients with chronic kidney disease on hemodialysis. However, Genz-644470 did not provide any advantage over sevelamer carbonate in phosphate lowering in vivo, as had been demonstrated in vitro.
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Affiliation(s)
- Moustafa Moustafa
- South Carolina Nephrology and Hypertension Center Inc., Orangeburg, SC, USA
| | | | | | - Mark Smith
- Kidney Care Associates, LLC, Augusta, GA, USA
| | | | | | - John Hunter
- Genzyme, a Sanofi company, Cambridge, MA, USA
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5793
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Association of serum irisin with metabolic syndrome in obese Chinese adults. PLoS One 2014; 9:e94235. [PMID: 24709991 PMCID: PMC3978033 DOI: 10.1371/journal.pone.0094235] [Citation(s) in RCA: 111] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Accepted: 03/13/2014] [Indexed: 02/06/2023] Open
Abstract
Irisin, a recently identified novel myokine, drives brown-fat-like conversion of white adipose tissues and has been proposed to mediate beneficial effects of exercise on metabolism. Circulating irisin was significantly reduced in type 2 diabetes patients; however, no evidence is available about its association with metabolic syndrome (MetS) and effects of adiposity and muscle mass on circulating irisin have been controversial. Cross-sectional data on socio-demographic, lifestyle, clinical characteristics and serum irisin were collected for 1,115 community-living Chinese adults with central obesity. Associations of serum irisin with MetS (central obesity plus any two of the following four factors (raised blood pressure (BP), raised fasting plasma glucose (FPG), raised triglyceride (TG), and reduced HDL cholesterol) and each component of MetS were analyzed using multivariable logistic regression. Among the 1,115 obese Chinese adults with a mean age of 53.2(±7.2) years, serum irisin levels (log-transformed) were significantly reduced in subjects with MetS and raised FPG than their control groups (p = 0.034 and 0.041, respectively). After adjustment for potential confounders, serum irisin was significantly associated with reduced risks of MetS and raised FPG, with odds ratios (ORs) (95% CI) per standard deviation of log-transformed irisin of 0.796 (0.505–0.959, p = 0.027) and 0.873 (0.764–0.998, p = 0.046), respectively. Associations of irisin with raised BP, raised TG and reduced HDL were not statistically significant ((ORs) (95% CI): 0.733(0.454–1.182, p = 0.202), 0.954(0.838–1.086, p = 0.478) and 1.130(0.980–1.302, p = 0.092), respectively). Stepwise multivariable linear regression analysis showed that fasting insulin, HbA1c and albumin/globulin ratio were negatively associated with serum irisin level with statistical significance (all p-values <0.05) and waist circumference was negatively associated with serum risin with marginally statistical significance (p = 0.055). These results imply that irisin may play an important role in insulin resistance and MetS and should be confirmed in future prospective studies.
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5794
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Harward DH, Bang H, Hu Y, Bomback AS, Kshirsagar AV. Evaluation of the Scored Questionnaire to Identify Individuals with Chronic Kidney Disease in a Community-based Screening Program in Rural North Carolina. ACTA ACUST UNITED AC 2014; 4:007. [PMID: 28680741 PMCID: PMC5495467 DOI: 10.4172/2161-0711.s2-007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Background Just over 10 percent of US adults over twenty years of age have chronic kidney disease (CKD). Early detection is essential to delay or halt CKD's progression, but screening and early detection of CKD in high risk populations is inconsistent, especially in rural and underserved communities. Objective The objective of this study was to evaluate the effectiveness of the Screening for Occult Renal Disease questionnaire as a simple, self-report tool to identify individuals with increased likelihood of prevalent CKD in a rural North Carolina setting. Methods Over an eight month period, in the context of the Kidney Education Outreach Program (KEOP), sixteen CKD screenings were conducted in two underserved, rural NC communities. For this study, the SCORED questionnaire was administered prior to the execution of the regular KEOP screening protocol. Results For 172 participants for whom both blood and urine specimens were collected, there were fifteen (8.7%) who demonstrated less than normal kidney function. The SCORED sensitivity and specificity were 100% and 42%, respectively. The positive predictive value was 14% and the negative predictive value was 100%. The positive likelihood ratio for low eGFR was 1.7 and conversely, the negative likelihood ratio for low eGFR was zero. Conclusion In this study, the SCORED performed comparably to previous settings in established datasets and cohort studies, with high sensitivity and negative predictive values that allow for ruling out the presence of disease. SCORED appears to provides a practical alternative to the administration of regular CKD screening protocols that can be difficult to organize and administer in rural settings. The need for further evaluation of SCORED in underserved, high-risk communities is recommended.
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Affiliation(s)
- Donna H Harward
- Director of Education and Outreach, University of North Carolina at Chapel Hill, USA
| | - Heejung Bang
- Professor, Clinical trials and observational studies, University of California Davis, USA
| | - Yichun Hu
- Director of Education and Outreach, University of North Carolina at Chapel Hill, USA
| | - Andrew S Bomback
- Assistant Professor of Clinical Medicine, Columbia University, USA
| | - Abhijit V Kshirsagar
- Director of Education and Outreach, University of North Carolina at Chapel Hill, USA
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5795
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Wu Q, Li X, Lai Y, Peng Z, Liao Y. Chronic kidney disease after autologous stem cell transplantation: analysis of a single center experience. Int Urol Nephrol 2014; 46:1403-10. [PMID: 24668138 DOI: 10.1007/s11255-014-0683-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Accepted: 02/24/2014] [Indexed: 11/24/2022]
Abstract
PURPOSE Chronic kidney disease (CKD) after allogeneic hematopoietic stem cell transplantation (HSCT) has increasingly been reported. However, CKD after autologous HSCT, especially changes in renal pathology, has rarely been reported. This study aimed to evaluate the frequency of CKD among patients who received autologous HSCT for hematological and nonhematological disorders, and analyze its clinical and pathological features. METHODS We performed a retrospective study to evaluate the frequency of CKD after autologous HSCT and analyzed clinical and pathological features of CKD. Clinical records of patients who underwent autologous HSCT at the First Affiliated Hospital of Guangxi Medical University between May 2000 and November 2010 were screened. Clinical data of those with kidney injury on presentation and follow-up were acquired from hospital records. RESULTS A total of 41 patients who received autologous HSCT were identified. CKD developed in six patients (14.6%). Among the six patients, all had various degrees of proteinuria and three patients had nephrotic syndrome. Impaired renal function occurred in three patients. Three patients with nephrotic syndrome received only prednisone. Two patients obtained complete remission, and one had partial remission. What is particularly worth mentioning is, in two patients who received renal biopsy in our study, the pathological changes were mesangial proliferative glomerulonephritis. CONCLUSIONS Mesangial proliferative glomerulonephritis may not be as uncommon as previously thought in CKD patients after autologous HSCT. Presentation of nephrotic syndrome is common in CKD after HSCT and prednisone alone are effective.
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Affiliation(s)
- QiaoYuan Wu
- Department of Nephrology, The First Affiliated Hospital, Guangxi Medical University, No. 22, Shuang Yong Lu, Nanning, 530021, Guangxi, China
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5796
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Borsting E, Patel SV, Declèves AE, Lee SJ, Rahman QM, Akira S, Satriano J, Sharma K, Vallon V, Cunard R. Tribbles homolog 3 attenuates mammalian target of rapamycin complex-2 signaling and inflammation in the diabetic kidney. J Am Soc Nephrol 2014; 25:2067-78. [PMID: 24676635 DOI: 10.1681/asn.2013070811] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The endoplasmic reticulum (ER) stress response is activated in the diabetic kidney and functions to reduce ER protein accumulation and improve cellular function. We previously showed that tribbles homolog 3 (TRB3), an ER stress-associated protein, is upregulated in the diabetic kidney. Here, we investigated whether absence of TRB3 alters outcomes in diabetic nephropathy. Type 1 diabetes was induced in TRB3 wild-type and knockout ((-/-)) mice by low-dose streptozotocin, and the mice were followed for 12 weeks. Diabetic TRB3(-/-) mice developed higher levels of albuminuria and increased expression of inflammatory cytokine and chemokine mRNA in renal cortices relative to wild-type littermates, despite similar hyperglycemia. Diabetic TRB3(-/-) mice also expressed higher levels of ER stress-associated molecules in both the renal cortices and glomeruli. This change was associated with higher renal cortical phosphorylation of AKT at serine 473 (Ser(473)), which is the AKT site phosphorylated by mammalian target of rapamycin complex-2 (mTORC2). We show in renal tubular cells that TRB3 binds to mTOR and the rapamycin-insensitive companion of mTOR (Rictor), a protein specific to mTORC2. Finally, we demonstrate in murine tubular cells that TRB3 can inhibit secretion of IL-6. Thus, TRB3 reduces albuminuria and inflammatory gene expression in diabetic kidney disease by a mechanism that may involve inhibition of the mTORC2/AKT pathway and may prove to be a novel therapeutic target.
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Affiliation(s)
- Emily Borsting
- Research Service and Division of Nephrology-Hypertension, Veterans Affairs San Diego Healthcare System, Veterans Medical Research Foundation, San Diego, California
| | - Shalin V Patel
- Research Service and Division of Nephrology-Hypertension, Veterans Affairs San Diego Healthcare System, Veterans Medical Research Foundation, San Diego, California
| | - Anne-Emilie Declèves
- Center for Renal Translational Medicine, Department of Medicine, University of California San Diego, La Jolla, California; and
| | - Sarah J Lee
- Research Service and Division of Nephrology-Hypertension, Veterans Affairs San Diego Healthcare System, Veterans Medical Research Foundation, San Diego, California
| | - Qazi M Rahman
- Research Service and Division of Nephrology-Hypertension, Veterans Affairs San Diego Healthcare System, Veterans Medical Research Foundation, San Diego, California
| | - Shizuo Akira
- Laboratory of Host Defense, WPI Immunology Frontier Research Center, Osaka University, Osaka, Japan
| | - Joe Satriano
- Research Service and Division of Nephrology-Hypertension, Veterans Affairs San Diego Healthcare System, Veterans Medical Research Foundation, San Diego, California; Center for Renal Translational Medicine, Department of Medicine, University of California San Diego, La Jolla, California; and
| | - Kumar Sharma
- Research Service and Division of Nephrology-Hypertension, Veterans Affairs San Diego Healthcare System, Veterans Medical Research Foundation, San Diego, California; Center for Renal Translational Medicine, Department of Medicine, University of California San Diego, La Jolla, California; and
| | - Volker Vallon
- Research Service and Division of Nephrology-Hypertension, Veterans Affairs San Diego Healthcare System, Veterans Medical Research Foundation, San Diego, California; Center for Renal Translational Medicine, Department of Medicine, University of California San Diego, La Jolla, California; and
| | - Robyn Cunard
- Research Service and Division of Nephrology-Hypertension, Veterans Affairs San Diego Healthcare System, Veterans Medical Research Foundation, San Diego, California; Center for Renal Translational Medicine, Department of Medicine, University of California San Diego, La Jolla, California; and
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5797
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Li Y, Zhou C, Shao X, Liu X, Guo J, Zhang Y, Wang H, Wang X, Li B, Deng K, Liu Q, Holthöfer H, Zou H. Hypertriglyceridemic waist phenotype and chronic kidney disease in a Chinese population aged 40 years and older. PLoS One 2014; 9:e92322. [PMID: 24663403 PMCID: PMC3963886 DOI: 10.1371/journal.pone.0092322] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2013] [Accepted: 02/20/2014] [Indexed: 12/22/2022] Open
Abstract
Objective To examine the relationship between the HW phenotype and risk for CKD in a community population aged 40 years and older. Methods A cross-sectional study was conducted in Zhuhai from June to October 2012. The participants were divided into three groups: Group 1, Waist circumference >90 cm in men or >85 cm in women and triglycerides ≥2 mmol/l; Group 3, Waist circumference ≤90 cm in men or ≤85 cm in women and triglycerides <2 mmol/l; Group 2, The remaining participants. The prevalence of the three subgroups and CKD were determined. The association between HW phenotype and CKD was then analyzed using SPSS (version 13.0). Results After adjusting for age and sex, Group 1 was associated with CKD (OR 3.08, 95% CI 2.01, 4.73, P<0.001), when compared with Group 3. Further adjustment for factors which were potential confounders and unlikely to be in the causal pathway between the HW phenotype and CKD, Group 1 was still significantly associated with CKD. The OR for CKD was 2.65 (95% CI 1.65, 4.26, P<0.001). When adjusted for diabetes and hypertension, the association of Group 1 and CKD was still significant (OR 2.09, 95% CI 1.26, 3.45, P = 0.004). Group 2 was associated with CKD (OR 1.81, 95% CI 1.29, 2.53, P = 0.001), when compared with Group 3. Further adjustment for factors which were potential confounders, Group 2 was still significantly associated with CKD. The OR for CKD was 1.75 (95% CI 1.22, 2.51, P = 0.002). When adjusted for diabetes and hypertension, the association between Group 2 and CKD still existed. The OR for CKD was 1.48 (95% CI 1.01, 2.16, P = 0.046). Conclusion Our results showed that HW phenotype was associated with CKD in the population aged 40 years and older.
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Affiliation(s)
- Yongqiang Li
- Department of Nephrology, Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Chaomin Zhou
- Department of Nephrology, Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Xiaofei Shao
- Department of Nephrology, Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Xinyu Liu
- Department of Nephrology, Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Jia Guo
- Department of Nephrology, Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Ying Zhang
- Department of Nephrology, Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Honglei Wang
- Department of Nephrology, Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Xiaohong Wang
- Department of Nephrology, Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Bin Li
- Department of Nephrology, Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Kangping Deng
- Department of Nephrology, Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Qin Liu
- Department of Nephrology, Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Harry Holthöfer
- National Centre for Sensor Research/BioAnalytical Sciences, Dublin City University, Dublin, Ireland
| | - Hequn Zou
- Department of Nephrology, Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
- * E-mail:
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5798
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Lack of association between TLR4 genetic polymorphisms and diabetic nephropathy in a Chinese population. BIOMED RESEARCH INTERNATIONAL 2014; 2014:704167. [PMID: 24779014 PMCID: PMC3980983 DOI: 10.1155/2014/704167] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Accepted: 02/28/2014] [Indexed: 12/02/2022]
Abstract
Objective. Toll-like receptor 4 (TLR4) plays a central role in innate immunity. Activation of innate immune response and subsequent chronic low-grade inflammation are thought to be involved in the pathogenesis of diabetic nephropathy. In this study, we aimed to investigate whether TLR4 variants are associated with diabetic nephropathy in the Chinese population. Methods. Seven tagging single nucleotide polymorphisms (SNPs) of TLR4 based on HapMap Chinese data were genotyped in 1,455 Chinese type 2 diabetic patients. Of these patients, 622 were diagnosed with diabetic nephropathy and 833 were patients with diabetes for over 5 years but without diabetic nephropathy. Results. None of the SNPs and haplotypes showed significant association to diabetic nephropathy in our study. No association between the SNPs and quantitative traits was observed either. Conclusion. We concluded that common variants within TLR4 genes were not associated with diabetic nephropathy in the Chinese type 2 diabetes patients.
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5799
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Chung HF, Long KZ, Hsu CC, Al Mamun A, Jhang HR, Shin SJ, Hwang SJ, Huang MC. Association of n-3 polyunsaturated fatty acids and inflammatory indicators with renal function decline in type 2 diabetes. Clin Nutr 2014; 34:229-34. [PMID: 24721145 DOI: 10.1016/j.clnu.2014.02.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2013] [Revised: 02/15/2014] [Accepted: 02/26/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND & AIMS The n-3 polyunsaturated fatty acids (PUFAs) and the inflammatory indicator, interleukin-6 (IL-6), have been implied in the development of renal dysfunction. This longitudinal study examined the effect of n-3 PUFAs and IL-6 on the risk of renal function decline and explored whether n-3 PUFAs modify the effect of inflammatory indicators on renal dysfunction risk in type 2 diabetes. METHODS Studying 676 type 2 diabetic patients, we analyzed erythrocyte fatty acids and inflammatory markers in 2008 and estimated glomerular filtration rate (eGFR) in 2008 and 2012. Renal function decline was defined as an eGFR decline of ≥25% over a 4-year period. RESULTS Multivariable logistic regression revealed erythrocyte total PUFAs, n-3 PUFAs, and n-3/n-6 PUFA ratio correlated negatively with risk of renal function decline (OR = 0.75, 0.78, and 0.61, respectively, all p < 0.01), while n-6 PUFAs did not. IL-6 independently predicted risk of renal dysfunction (OR = 1.18, p = 0.015). Stratifying erythrocyte PUFAs into low (<50(th) percentile) or high group (≥50(th) percentile), we found a positive association between IL-6 and risk of renal dysfunction only in the low n-3 PUFA (OR = 1.27, p = 0.035), low n-3/n-6 PUFA (OR = 1.27, p = 0.034), and low total PUFA groups (OR = 1.36, p = 0.005), but not in the high groups. CONCLUSIONS High PUFA concentrations, especially n-3 or higher n-3/n-6 PUFA ratio, may exert protective effects against renal function impairment in type 2 diabetic patients. Whether the effect is mediated via modification of inflammatory biomarker such as IL-6 by high n-3 PUFA status warrants further investigation.
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Affiliation(s)
- Hsin-Fang Chung
- School of Population Health, University of Queensland, Brisbane, Queensland, Australia
| | - Kurt Z Long
- School of Population Health, University of Queensland, Brisbane, Queensland, Australia
| | - Chih-Cheng Hsu
- Division of Preventive Medicine and Health Services Research, Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan
| | - Abdullah Al Mamun
- School of Population Health, University of Queensland, Brisbane, Queensland, Australia
| | - Huei-Ru Jhang
- Department of Nutrition and Dietetics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Shyi-Jang Shin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Shang-Jyh Hwang
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Meng-Chuan Huang
- Department of Nutrition and Dietetics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Public Health and Environmental Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
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5800
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Morishita Y, Numata A, Miki A, Okada M, Ishibashi K, Takemoto F, Ando Y, Muto S, Nagata D, Kusano E. Primary care physicians' own exercise habits influence exercise counseling for patients with chronic kidney disease: a cross-sectional study. BMC Nephrol 2014; 15:48. [PMID: 24641626 PMCID: PMC3994874 DOI: 10.1186/1471-2369-15-48] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Accepted: 03/12/2014] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The appropriate exercise counseling for chronic kidney disease (CKD) patients is crucial to improve their prognosis. There have been few studies about exercise counseling by primary care physicians for CKD patients. We investigated primary care physicians' exercise counseling practices for CKD patients, and the association of these physicians' own exercise habits with exercise counseling. METHODS The population of this cross-sectional study was 3310 medical doctors who graduated from Jichi Medical University from 1978 to 2012. The study instrument was a self-administered questionnaire that was mailed in August 2012 to investigate their age class, specialty, workplace, exercise habits, and practices of exercise counseling for CKD. RESULTS 581 (64.8%) medical doctors practiced the management of CKD among a total of 933 responses. These 581 medical doctors were defined as CKD primary care physicians and their answers were analyzed. CKD primary care physicians' own exercise habits (frequencies and intensities) were as follows: frequencies: daily, 71 (12.1%); ≥ 2-3 times/week, 154 (26.5%); ≥ 1 time/week, 146 (25.1%); and ≤ 1 time/month, 176 (30.2%); intensities: high (≥ 6 Mets), 175 (30.1%); moderate (4-6 Mets), 132 (22.7%); mild (3-4 Mets), 188 (32.3%); very mild (<3 Mets), 47 (8.1%); and none, 37 (6.4%). The CKD primary care physicians' exercise recommendation levels for CKD patients were as follows: high, 31 (5.3%); moderate, 176 (29.7%); low, 256 (44.0%); and none, 92 (15.8%). The CKD primary care physicians' exercise recommendations for CKD patients were significantly related to their own exercise frequency (p < 0.001), but they were not related to their age, specialty, workplace, or exercise intensity. CONCLUSIONS CKD primary care physicians' exercise recommendation level for CKD patients was limited. In addition, CKD primary care physicians' own exercise habits influenced the exercise counseling for CKD patients. The establishment of guidelines for exercise by CKD patients and their dissemination among primary care physicians are needed.(University Hospital Medical Information Network Clinical Trial Registry. number, UMIN000011803. Registration date, Sep/19/2013).
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Affiliation(s)
- Yoshiyuki Morishita
- Division of Nephrology, Department of Medicine, Jichi Medical University, 3311-1, Yakushiji, Shimotsuke-city, Tochigi 329-0498, Japan
| | - Akihiko Numata
- Division of Nephrology, Department of Medicine, Jichi Medical University, 3311-1, Yakushiji, Shimotsuke-city, Tochigi 329-0498, Japan
| | - Atushi Miki
- Division of Nephrology, Department of Medicine, Jichi Medical University, 3311-1, Yakushiji, Shimotsuke-city, Tochigi 329-0498, Japan
| | - Mari Okada
- Division of Nephrology, Department of Medicine, Jichi Medical University, 3311-1, Yakushiji, Shimotsuke-city, Tochigi 329-0498, Japan
| | - Kenichi Ishibashi
- Department of Medical Physiology, Meiji Pharmaceutical University, Kiyose, Japan
| | - Fumi Takemoto
- Division of Nephrology, Department of Medicine, Jichi Medical University, 3311-1, Yakushiji, Shimotsuke-city, Tochigi 329-0498, Japan
| | - Yasuhiro Ando
- Division of Nephrology, Department of Medicine, Jichi Medical University, 3311-1, Yakushiji, Shimotsuke-city, Tochigi 329-0498, Japan
| | - Shigeaki Muto
- Division of Nephrology, Department of Medicine, Jichi Medical University, 3311-1, Yakushiji, Shimotsuke-city, Tochigi 329-0498, Japan
| | - Daisuke Nagata
- Division of Nephrology, Department of Medicine, Jichi Medical University, 3311-1, Yakushiji, Shimotsuke-city, Tochigi 329-0498, Japan
| | - Eiji Kusano
- Department of Internal medicine, Ustunomiya Social Insurance Hospital, Ustunomiya, Japan
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