6301
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Liu H, Yu J, Chen F, Wang J, Chen S, Wang F, Hu D. Does Obesity Attenuate the Effect of Metabolic Syndrome on Chronic Kidney Disease in Patients With Coronary Artery Disease? Report From China Heart Survey. Circ J 2010; 74:462-7. [DOI: 10.1253/circj.cj-09-0771] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Hao Liu
- Institute of Clinical Epidemiology, School of Public Health, Fudan University
| | - Jinming Yu
- Institute of Clinical Epidemiology, School of Public Health, Fudan University
| | - Fang Chen
- Department of Preventive Medicine, Medical College, Tongji University
| | - Jinsong Wang
- Department of Preventive Medicine, Medical College, Tongji University
| | - Shengbao Chen
- Department of Preventive Medicine, Medical College, Tongji University
| | - Fang Wang
- Department of Preventive Medicine, Medical College, Tongji University
| | - Dayi Hu
- Department of Cardiology, People's Hospital, Peking University
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6302
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Yang X, Ma RCW, So WY, Ko GTC, Kong APS, Zhao H, Xu G, Tong PCY, Chan JCN. White blood cell count and renin-angiotensin system inhibitors for the risk of cancer in type 2 diabetes. Diabetes Res Clin Pract 2010; 87:117-25. [PMID: 19932519 DOI: 10.1016/j.diabres.2009.10.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2009] [Revised: 10/14/2009] [Accepted: 10/22/2009] [Indexed: 11/22/2022]
Abstract
BACKGROUND High white blood cell (WBC) predicted cancer-associated mortality and renin-angiotensin system (RAS) inhibitors have immunomodulating effects. We hypothesize that RAS inhibitors may reduce cancer risk associated with high WBC in type 2 diabetes mellitus (T2DM). METHODS A prospective cohort of 4570 Chinese T2DM patients, free of cancer at enrolment, were analyzed. Biological interaction between WBC groups and use of RAS inhibitors was estimated using relative excess risk due to interaction (RERI), attributable proportion due to interaction (AP) and synergy index (S). RERI>0, AP>0 or S>1 indicates biological interaction. RESULTS During 4.89 years of follow-up, 205 (4.49%) patients developed cancer. WBC > or = 8.2 x 10(9) counts/L plus non-use of RAS inhibitors was associated with elevated cancer risks in multivariable models. The RERI and AP for interaction between WBC > or = 8.2 x 10(9) counts/L and non-use of RAS inhibitors were, respectively, 1.26 (95% CI: 0.22-2.31) and 0.50 (0.23-0.78). In patients with WBC > or = 8.2 x 10(9) counts/L, use of RAS inhibitors was associated with 64% (31-81%) cancer risk reduction in multivariable analysis. CONCLUSIONS In T2DM, increased WBC predicts cancer while use of RAS inhibitors may reduce cancer risks associated with high WBC count.
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Affiliation(s)
- Xilin Yang
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong, SAR, China.
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6303
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Ingsathit A, Thakkinstian A, Chaiprasert A, Sangthawan P, Gojaseni P, Kiattisunthorn K, Ongaiyooth L, Vanavanan S, Sirivongs D, Thirakhupt P, Mittal B, Singh AK. Prevalence and risk factors of chronic kidney disease in the Thai adult population: Thai SEEK study. Nephrol Dial Transplant 2009; 25:1567-75. [DOI: 10.1093/ndt/gfp669] [Citation(s) in RCA: 112] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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6304
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Dong J, Li Y, Yang Z, Luo J. Low dietary sodium intake increases the death risk in peritoneal dialysis. Clin J Am Soc Nephrol 2009; 5:240-7. [PMID: 20019116 DOI: 10.2215/cjn.05410709] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES To explore the correlation between dietary sodium intake and cardiovascular and overall mortality, and then determine whether this correlation can be explained by protein and energy intake paralleled with sodium intake in dialysis patients. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS This single-center retrospective cohort study enrolled 305 incident patients who started peritoneal dialysis in our unit from July 2002 to February 2007. All patients were followed until death or until being censored in February 2008. Demographic data were collected at baseline. Biochemical, dietary, and nutrition data were examined at baseline and thereafter at regular intervals to calculate the average values throughout the study. RESULTS Participants with the highest average sodium intake were more likely to be younger, male, and overweight. Patients in the high tertile of average sodium intake had higher albumin, prealbumin, and lean body mass levels, and more nutrient intakes paralleling with sodium intake. Low average sodium intake independently predicted the increased risk for overall and cardiovascular death after adjusting for recognized confounders. Further adjustment for dietary protein, energy, and other nutrient intakes individually had minimal impact on the association between average sodium intake and overall death, with hazard ratios varying between 0.35 and 0.44, and cardiovascular death, with hazard ratios varying between 0.06 and 0.11. CONCLUSIONS This study revealed that low dietary sodium intake independently predicts the high overall and cardiovascular mortality in dialysis patients. This correlation could not be entirely explained by deficient protein and energy intake.
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Affiliation(s)
- Jie Dong
- Renal Division, Department of Medicine, Peking University First Hospital, Institute of Nephrology, Peking University, Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, People's Republic of China.
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6305
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Teo BW, Ng ZY, Li J, Saw S, Sethi S, Lee EJC. The choice of estimating equations for glomerular filtration rate significantly affects the prevalence of chronic kidney disease in a multi-ethnic population during health screening. Nephrology (Carlton) 2009; 14:588-96. [PMID: 19712259 DOI: 10.1111/j.1440-1797.2009.01122.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Patients present to the National University Hospital of Singapore and select one of several health screening packages after counselling. The prevalence of chronic kidney disease (CKD) in this population when different glomerular filtration rate (GFR) estimating equations are used has not been examined. METHODS Demographic data and urinalyses of patients from 2000 to 2005 were extracted from laboratory computer databases and analysed. CKD was classified into stages according to the US National Kidney Foundation guidelines by eGFR (mL/min per 1.73 m(2)) using the four-variable Modification of Diet in Renal Disease equation. GFR of ethnic Chinese was also estimated using Ma's equation 8 (cGFR). Stage 1 and normal (eGFR or cGFR > 90) was discriminated by urinary microscopy or dipstick for proteinuria, albuminuria, hematuria or leukocyturia. RESULTS There were 3979 screenings (55.9% males, 61.9% Chinese). Means: age = 47.0 +/- 12.3 years, creatinine = 80.1 +/- 26.5 micromol/L, eGFR = 89.6 +/- 19.7, cGFR = 110.8 +/- 23.8 and (eGFR + cGFR) = 102.5 +/- 24.9. By eGFR in all patients, the prevalence of CKD was 45.7%, 50.6%, 3.3%, 0.3% and 0.08% for stages normal or 1, 2, 3, 4 and 5, respectively. For Chinese patients only, eGFR and cGFR resulted in a different distribution (eGFR%/cGFR%): 24.9/50.5, 15.2/29.3, 56.8/19.7, 3/0.8, 0.2/0.2, 0/0 for stages 'Normal', 1, 2, 3, 4 and 5, respectively (P < 0.001). CONCLUSION The prevalence of moderate to severe CKD (stage 3 to 5) in patients presenting for health screening in Singapore was 3.7%. Notably, the prevalence of mild to moderate CKD (stages 1, 2 and 3) in Chinese patients was affected significantly by the choice of GFR estimating equation.
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Affiliation(s)
- Boon W Teo
- Department of Medicine, Yong Loo Lin School of Medicine, Singapore.
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6306
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Mathew A, Eliasziw M, Devereaux PJ, Merino JG, Barnett HJM, Garg AX. Carotid endarterectomy benefits patients with CKD and symptomatic high-grade stenosis. J Am Soc Nephrol 2009; 21:145-52. [PMID: 20007752 DOI: 10.1681/asn.2009030287] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Endarterectomy is generally recommended for symptomatic high-grade (70 to 99%) stenosis of the internal carotid artery, but whether this procedure is beneficial among patients with chronic kidney disease (CKD) is unknown. In this re-analysis of data from the North American Symptomatic Carotid Endarterectomy Trial, we included patients with symptomatic stenosis and either stage 3 CKD (n = 524) or preserved kidney function (n = 966; estimated GFR > or = 60). For medically treated patients with high-grade stenosis, risk for ipsilateral stroke at 2 yr was significantly higher in patients with CKD than in those with preserved renal function (31.6 versus 19.3%; P = 0.042); carotid endarterectomy significantly reduced this risk by 82 and 51%, respectively. To prevent one ipsilateral stroke, the number needed to treat by endarterectomy was four for patients with CKD and 10 for patients with preserved renal function. Compared with patients with preserved renal function, those with CKD had similar rates of perioperative stroke and death but higher rates of cardiac events. In conclusion, patients with stage 3 CKD and symptomatic high-grade carotid stenosis gain a large benefit in stroke risk reduction after endarterectomy.
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Affiliation(s)
- Anna Mathew
- University of Western Ontario, London, Ontario, Canada
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6307
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Prodjosudjadi W, Suhardjono, Suwitra K, Pranawa, Widiana IGR, Loekman JS, Nainggolan G, Prasanto H, Wijayanti Y, Dharmeizar, Sja'bani M, Nasution MY, Basuki W, Aditiawardana, Harris DCH, Pugsley DJ. Detection and prevention of chronic kidney disease in Indonesia: initial community screening. Nephrology (Carlton) 2009; 14:669-74. [PMID: 19796026 DOI: 10.1111/j.1440-1797.2009.01137.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
AIM This survey evaluated the prevalence of chronic kidney disease (CKD if estimated glomerular filtration rate (eGFR) <60 mL/min per 1.73 m(2)) and its risk factors amongst subjects from urban and semi-urban areas. METHODS History of hypertension, diabetes mellitus, kidney disease, cardio- and cerebrovascular diseases of subjects and their families was recorded. Blood pressure was determined as the mean of three readings in the sitting position and hypertension classified according to the Joint National Committee VII. Urinalysis was assessed using Combi 10R dipstick test. Random blood glucose and serum creatinine were measured in subjects with either hypertension, proteinuria, glycosuria and/or a history of diabetes. eGFR was calculated according Cockcroft-Gault (CG) adjusted by body surface area (BSA), Modification of Diet in Renal Disease (MDRD) and Chinese MDRD equations. RESULTS Of 9412 subjects recruited, 64.1% were female. Persistent proteinuria was found in almost 3%. Systolic and diastolic hypertension was found in 10%, isolated systolic hypertension in 4.8% and isolated diastolic hypertension in 4.6%. CKD was found in 12.5% (CG), 8.6% (MDRD) or 7.5% (Chinese MDRD) of subjects with either hypertension, proteinuria and/or diabetes. Proteinuria, systolic blood pressure and a history of diabetes mellitus were independent predictors of impaired eGFR. Obesity and smoking history were found in 32.5% and 19.8%, respectively. CONCLUSION The present study showed a high prevalence of CKD in representative urban and semi-urban areas and argues for screening and treatment of all Indonesians, particularly those at an increased risk of CKD.
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6308
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Beaulieu M, Levin A. Analysis of multidisciplinary care models and interface with primary care in management of chronic kidney disease. Semin Nephrol 2009; 29:467-74. [PMID: 19751891 DOI: 10.1016/j.semnephrol.2009.06.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Public policy efforts and education have led to an increased appreciation of the prevalence of chronic kidney disease (CKD) in general outpatient populations. The complexity of the care of individuals with established CKD has led to the development of multidisciplinary care models, which have been shown to improve the clinical outcomes of those with CKD. The interface between specialty and primary care in various systems remains necessary and desired, albeit a continuing challenge. This overview reviews various models of specialty care for CKD patients, including those that emphasize multidisciplinary team approaches, and highlight the essential role(s) of primary care physicians. Importantly, there is a need for improved definition of CKD populations and individuals, review and refinement of proposed care pathways, and the need to define essential elements of care for the patient. Models of care often are not subject to the same rigor that other interventions applied to this population are; nonetheless, we offer here a framework for establishing and evaluating care models for the CKD populations at various stages of disease and with various comorbidities.
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Affiliation(s)
- Monica Beaulieu
- Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada.
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6309
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Bao Y, Zuo L. Effect of repeated freeze-thaw cycles on urinary albumin-to-creatinine ratio. Scand J Clin Lab Invest 2009; 69:886-8. [PMID: 19929272 DOI: 10.3109/00365510903323209] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Urinary albumin-to-creatinine ratio (UACR) is widely used for diagnosis of chronic kidney disease in population investigation surveys. It is recommended that urinary albumin should be measured as soon as possible after urine is collected. It is not clear whether freezing and thawing affect the value of UACR and it is very inconvenient to measure UACR quickly in a population survey. The current study tries to determine the effect of repeated freezing and thawing on UACR to explore the possibility of freezing urine samples. METHODS Fifty-three urine samples with abnormal urinary albumin (ranging from 22.9 mg/L to 891.9 mg/L) were selected. The albumin and creatinine were measured before freezing, then all sample were stored at -30 degrees C. After being thawed at room temperature, the albumin and creatinine concentrations were measured again. The samples were frozen and thawed for five times, and albumin and creatinine were measured after each thawing. The measurements of albumin, creatinine, and UACR after each thawing were calculated and compared with its initial values using multiple comparisons of one-way ANOVA. RESULTS Compared with its initial value, urine albumin, creatinine and UACR all did not show any significant differences (p > 0.05). CONCLUSIONS It is feasible to freeze urine samples for future measurement of UACR. Urine samples can be safely frozen and thawed at least five times.
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Affiliation(s)
- Yunfei Bao
- Institute of Nephrology, Peking University First Hospital, Beijing, China
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6310
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Kuo CF, See LC, Luo SF, Ko YS, Lin YS, Hwang JS, Lin CM, Chen HW, Yu KH. Gout: an independent risk factor for all-cause and cardiovascular mortality. Rheumatology (Oxford) 2009; 49:141-6. [PMID: 19933595 DOI: 10.1093/rheumatology/kep364] [Citation(s) in RCA: 154] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE The relation of gout and hyperuricaemia to cardiovascular diseases has been well documented. This study investigates the survival impact of both gout and hyperuricaemia. METHODS The subjects of this study comprised participants of a health screening programme conducted by the Chang Gung Memorial Hospital in Taiwan from 2000 to 2006. The status and causes of death were ascertained by the Taiwan National Death Registry 2000-07. Cox proportional hazard model was performed to examine the association. RESULTS Among 61 527 subjects, 1383 deaths (198 cardiovascular deaths) were identified, corresponding to a crude mortality rate of 4.86 deaths per 1000 person-years. Crude mortality rates were 4.50, 5.61 and 10.46 deaths per 1000 person-years for subjects with normouricaemia, hyperuricaemia and gout, respectively. Compared with subjects with normouricaemia, the hazard ratios (HRs) of all-cause mortality were 1.46 (95% CI 1.12, 1.91) for individuals with gout and 1.07 (95% CI 0.94, 1.22) for those with hyperuricaemia, respectively, after adjustments were made for age, sex, component number of metabolic syndrome and proteinuria. The adjusted HRs of cardiovascular mortality were 1.97 (95% CI 1.08, 3.59) for individuals with gout and 1.08 (95% CI 0.78, 1.51) for those with hyperuricaemia. Moreover, the risk of all-cause or cardiovascular mortality for gout remained unchanged when limiting the data to those with an estimated glomerular filtration of >60 ml/min/1.73 m(2). CONCLUSION This study demonstrates a link of gout, not hyperuricaemia, with a higher risk of death from all causes and cardiovascular diseases.
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Affiliation(s)
- Chang-Fu Kuo
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Kwei-Shan Tao-Yuan, Taiwan
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6311
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Soares AA, Eyff TF, Campani RB, Ritter L, Camargo JL, Silveiro SP. Glomerular filtration rate measurement and prediction equations. Clin Chem Lab Med 2009; 47:1023-32. [PMID: 19728843 DOI: 10.1515/cclm.2009.263] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Chronic kidney disease (CKD) is defined as the presence of kidney damage or a glomerular filtration rate (GFR) <60 mL/min/1.73 m(2) for three or more months. Measurement of serum creatinine is the most commonly used method to evaluated kidney function, but it must be included in formulas to estimate GFR, adjusting for age, gender and ethnicity, such as the Modification of Diet in Renal Disease (MDRD) study equation. The performance of this equation is acceptable for patients with CKD but appears to under-estimate GFR in populations with unknown kidney status. A new formula has been developed recently. The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation appears to perform better than the MDRD equation. Cystatin C has been widely evaluated as a marker for GFR and seems to be more sensitive than creatinine. The aim of this review is to discuss the recommendations for detecting CKD, emphasizing the characteristics and limitations of GFR estimating equations and pitfalls in the evaluation of urinary albumin excretion.
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Affiliation(s)
- Ariana Aguiar Soares
- Programa de Pós-Graduação em Ciências Médicas: Endocrinologia, Universidade Federal do Rio Grande do Sul (UFRGS), Brazil
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6312
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Retinal arteriolar narrowing increases the likelihood of chronic kidney disease in hypertension. J Hypertens 2009; 27:2209-17. [DOI: 10.1097/hjh.0b013e328330141d] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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6313
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Prevalence of chronic kidney disease in Thai adults: a national health survey. BMC Nephrol 2009; 10:35. [PMID: 19878577 PMCID: PMC2781792 DOI: 10.1186/1471-2369-10-35] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2009] [Accepted: 10/31/2009] [Indexed: 11/11/2022] Open
Abstract
Background The prevalence of patients with end stage renal disease (ESRD) who need dialysis and/or transplantation has more than doubled in Thailand during the past two decades. It has been suggested that therapeutic strategies to reduce the risk of ESRD and other complications in CKD are now available, thus the early recognition and the institution of proven therapeutic strategies are important and beneficial. We, therefore, aimed to determine the prevalence of CKD in Thai adults from the National Health Examination Survey of 2004. Methods Data from a nationally representative sample of 3,117 individuals aged 15 years and older was collected using questionnaires, physical examination and blood samples. Serum creatinine was measured by Jaffé method. GFR was estimated using the Chinese modified Modification of Diet in Renal Disease Study equation. Chronic kidney Disease (CKD) stages were classified based on Kidney Disease Outcome Quality Initiative (K/DOQI). Results The prevalence of CKD in Thai adults weighted to the 2004 Thai population by stage was 8.1% for stage 3, 0.2% and 0.15% for stage 4 and 5 respectively. Compared to non-CKD, individuals with CKD were older, had a higher level of cholesterol, and higher blood pressure. Those with cardiovascular risk factors were more likely to have CKD (stage 3-5) than those without, including hypertension (OR 1.6, 95%CI 1.1, 3.4), diabetes (OR 1.87, 95%CI 1.0, 3.4). CKD was more common in northeast (OR 2.1, 95%CI 1.3, 3.3) compared to central region. Urinalysis was not performed, therefore, we could not have data on CKD stage 1 and 2. We have no specific GFR formula for Thai population. Conclusion The identification of CKD patients should be evaluated and monitored for appropriate intervention for progression to kidney disease from this screening.
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6314
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Tzamaloukas AH, Murata GH, Piraino B, Raj DSC, VanderJagt DJ, Bernardini J, Servilla KS, Sun Y, Glew RH, Oreopoulos DG. Sources of variation in estimates of lean body mass by creatinine kinetics and by methods based on body water or body mass index in patients on continuous peritoneal dialysis. J Ren Nutr 2009; 20:91-100. [PMID: 19853476 DOI: 10.1053/j.jrn.2009.08.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2008] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE We identified factors that account for differences between lean body mass computed from creatinine kinetics (LBM(cr)) and from either body water (LBM(V)) or body mass index (LBM(BMI)) in patients on continuous peritoneal dialysis (CPD). DESIGN We compared the LBM(cr) and LBM(V) or LBM(BMI) in hypothetical subjects and actual CPD patients. PATIENTS We studied 439 CPD patients in Albuquerque, Pittsburgh, and Toronto, with 925 clearance studies. INTERVENTION Creatinine production was estimated using formulas derived in CPD patients. Body water (V) was estimated from anthropometric formulas. We calculated LBM(BMI) from a formula that estimates body composition based on body mass index. In hypothetical subjects, LBM values were calculated by varying the determinants of body composition (gender, diabetic status, age, weight, and height) one at a time, while the other determinants were kept constant. In actual CPD patients, multiple linear regression and logistic regression were used to identify factors associated with differences in the estimates of LBM (LBM(cr)<LBM(V), or LBM(cr)<LBM(BMI)). MAIN OUTCOME MEASURE We sought predictors of the differences LBM(V) - LBM(cr) and LBM(BMI) - LBM(cr). RESULTS Both LBM(V) (regardless of formula used to estimate V) and LBM(BMI) exceeded LBM(cr) in hypothetical subjects with average body compositions. The sources of differences between LBM estimates in this group involved differences in the coefficients assigned to gender, age, height, weight, presence or absence of diabetes, and serum creatinine concentration. In CPD patients, mean LBM(V) or LBM(BMI) exceeded mean LBM(cr) by 6.2 to 6.9 kg. For example, the LBM(V) obtained from one anthropometric formula was 50.4+/-10.4 kg and the LBM(cr) was 44.1+/-13.6 kg (P < .001), whereas among the 925 clearance studies, only 216 (23.3%) had LBM(cr)>LBM(V). The differences in determinants of body composition between groups with high versus low LBM(cr) were similar in hypothetical and actual CPD patients. Multivariate analysis in actual CPD patients identified serum creatinine, height, age, gender, weight, and body mass index as predictors of the differences LBM(V)-LBM(cr) and LBM(BMI)-LBM(cr). CONCLUSIONS Overhydration is not the sole factor accounting for the differences between LBM(cr) and either LBM(V) or LBM(BMI) in CPD patients. These differences also stem from the coefficients assigned to major determinants of body composition by the formulas estimating LBM.
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Affiliation(s)
- Antonios H Tzamaloukas
- Nephrology Section, Raymond G Murphy Veterans Administration Medical Center and University of New Mexico, Albuquerque, New Mexico 87108, USA
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6315
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Abstract
Clinical assessment of kidney function is central to the practice of medicine. GFR is widely accepted as the best index of kidney function in health and disease, and accurate values are required for optimal decision making. Estimated GFR based on serum creatinine is now widely reported by clinical laboratories, and in most circumstances, estimated GFR is sufficient for clinical decision making. GFR estimates may be inaccurate in the non-steady state and in people in whom non-GFR determinants differ greatly from those in whom the estimating equation was developed. If GFR estimates are likely inaccurate or if decisions based on inaccurate estimates may have adverse consequences, a measured GFR is an important confirmatory test. Endogenous creatinine clearance is the most common method used to measure GFR in clinical practice but may be difficult to obtain or fraught with error. We review methods for GFR measurement using urinary and plasma clearance of exogenous filtration markers and focus on urinary clearance of iothalamate and plasma clearance of iohexol compared with inulin clearance. We suggest plasma clearance of nonradioactive markers be more widely implemented in clinical settings. Further research is necessary on the impact of the use of measured GFR as a confirmatory test.
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6316
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Hallan SI. Chronic kidney disease: a new opportunity for better cardiovascular risk stratification. J Intern Med 2009; 266:414-7. [PMID: 19765183 DOI: 10.1111/j.1365-2796.2009.02147.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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6317
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Yang X, So WY, Ma RCW, Ko GTC, Kong APS, Zhao H, Luk AOY, Lam CWK, Ho CS, Tong PCY, Chan JCN. Low LDL cholesterol, albuminuria, and statins for the risk of cancer in type 2 diabetes: the Hong Kong diabetes registry. Diabetes Care 2009; 32:1826-32. [PMID: 19592629 PMCID: PMC2752941 DOI: 10.2337/dc09-0725] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE LDL cholesterol <2.80 mmol/l was associated with increased cancer risk in type 2 diabetes. We explored the 1) interaction between low LDL cholesterol and albuminuria and 2) interaction between copresence of these two risk factors and statin use for cancer in type 2 diabetes. RESEARCH DESIGN AND METHODS We analyzed prospective data for 3,793 Chinese type 2 diabetic patients who remained naive for statin treatment and 1,483 patients in whom statin treatment was initiated during a median follow-up period of 5.24 years. All patients were free of cancer at baseline. Biological interactions were estimated using relative excess risk due to interaction (RERI), attributable proportion due to interaction (AP), and synergy index (S). RERI > 0, AP > 0, or S > 1 indicates biological interaction. RESULTS In 3,793 statin-naive type 2 diabetic patients, copresence of low LDL cholesterol and albuminuria increased cancer risk by 2.8-fold (hazard ratio 2.77 [95% CI 1.78-4.31]) with significant biological interactions (RERI 1.05 [0.04-2.06]; AP 0.38 [0.09-0.66]). In the whole cohort of 5,276 type 2 diabetic patients, there was interaction between nonuse of statins and copresence of low LDL cholesterol and albuminuria with increased cancer risk (RERI 2.87 [0.64-5.09] and AP 0.60 [0.29-0.90]). Statin nonusers with LDL cholesterol <2.80 mmol/l and albumunuria had a 4.9-fold risk of cancer compared with statin users with or without both risk factors. CONCLUSIONS In type 2 diabetes, there was interaction between low LDL cholesterol and albuminuria with increased cancer risks. The latter was attenuated in the presence of statin treatment.
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Affiliation(s)
- Xilin Yang
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China.
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6318
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Chin HJ, Ahn JM, Na KY, Chae DW, Lee TW, Heo NJ, Kim S. The effect of the World Kidney Day campaign on the awareness of chronic kidney disease and the status of risk factors for cardiovascular disease and renal progression. Nephrol Dial Transplant 2009; 25:413-9. [PMID: 19783595 DOI: 10.1093/ndt/gfp512] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) is a worldwide problem. We describe the trends in CKD awareness before and after the World Kidney Day (WKD) campaign and the impact of the WKD campaign in increasing awareness and appropriate management of the risk factors for cardiovascular disease and renal progression. METHODS We selected 57 718 people who had undergone a routine health check-up. RESULTS The average CKD awareness was 3.1% (95% CI: 2.6-3.7%) and was increased with progressing CKD stage. The awareness was increased from 1.1% before the WKD campaign to 5.8% after the campaign (P < 0.001). CKD awareness in the post-WKD period was increased in CKD stages 2 (OR 4.535: 95% CI: 2.044-10.062) and 3 (OR 6.614: 95% CI: 4.282-10.217) and profoundly increased in stage 4 (OR 13.800: 95% CI: 2.127-89.524), compared to the pre-WKD period. In the CKD-aware group compared to the CKD-unaware group, the awareness of diabetes mellitus (90.0% versus 54.2%, P < 0.001) and hypertension (87.2% versus 64.7%, P < 0.001) was higher and the levels of systolic blood pressure (116.9 +/- 1.0 versus 120.1 +/- 0.2, P < 0.01) and serum cholesterol (198.3 +/- 2.7 versus 205.0 +/- 0.5, P < 0.05) were lower by covariance analysis. CONCLUSIONS The WKD campaign had a positive impact on the awareness and control of risk factors in CKD subjects but the absolute frequency of CKD awareness still remains undesirable in Korea. We need new campaign strategies to publicize the importance of early diagnosis and appropriate management of CKD.
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Affiliation(s)
- Ho Jun Chin
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
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6319
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Nyman U, Grubb A, Sterner G, Björk J. Different equations to combine creatinine and cystatin C to predict GFR. Arithmetic mean of existing equations performs as well as complex combinations. Scand J Clin Lab Invest 2009; 69:619-27. [DOI: 10.1080/00365510902946992] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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6320
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Zhang W, Sun K, Yang Y, Zhang H, Hu FB, Hui R. Plasma uric acid and hypertension in a Chinese community: prospective study and metaanalysis. Clin Chem 2009; 55:2026-34. [PMID: 19729471 DOI: 10.1373/clinchem.2009.124891] [Citation(s) in RCA: 84] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Hyperuricemia has been positively associated with hypertension, but whether this association is independent of adiposity and other cardiovascular risk factors remains a matter of debate. METHODS We conducted a community-based prospective cohort study comprising 7220 participants (mean age 37 years; 73.8% men) in the Qingdao Port Health and Nutrition Examination Survey in China, who were free from hypertension at study entry in 1999-2000. During 4-year follow-up, 1370 men (19.0%) and 208 women (11.0%) had developed hypertension. RESULTS After adjustment for age, body mass index, and other covariates, the relative risks (RRs) of developing hypertension comparing the highest and lowest uric acid quartiles were 1.55 (95% CI 1.10-2.19; P for trend <0.001) for men and 1.91 (1.12-3.25; P for trend <0.001) for women. After additional adjustment for abdominal obesity, the RRs comparing the participants in the highest and lowest quartiles of uric acid were 1.39 (1.16-1.68; P for trend 0.003) for men and 1.85 (1.06-3.24; P for trend 0.006) for women. In joint analysis, compared with those in the lowest uric acid quartile and without abdominal obesity, participants who were in the highest quartile and also had abdominal obesity had a 3.0- and 3.4-fold greater risk of incident hypertension (1.56-3.97 for men and 2.10-3.81 for women, respectively). CONCLUSIONS These data suggest a positive association between plasma uric acid and incidence of hypertension during short-term follow-up in a Chinese population. The association between hyperuricemia and hypertension was partly mediated by abdominal obesity.
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Affiliation(s)
- Weili Zhang
- The Key Laboratory for Clinical Cardiovascular Genetics, Cardiovascular Institute and FuWai Hospital, Peking Union Medical College, Beijing 100037, China
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6321
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SZETO CHEUKCHUN, CHOW KAIMING, POON PETERYAMKAU, KWAN BONNIECHINGHA, LI PHILIPKAMTAO. Association of interleukin-18 promoter polymorphism and atherosclerotic diseases in Chinese patients with diabetic nephropathy. Nephrology (Carlton) 2009; 14:606-612. [DOI: 10.1111/j.1440-1797.2008.01075.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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6322
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Zhang L, Wang H. Chronic Kidney Disease Epidemic: Cost and Health Care Implications in China. Semin Nephrol 2009; 29:483-6. [DOI: 10.1016/j.semnephrol.2009.06.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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6323
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Tseng GY, Fang CT, Lin HJ, Yang HB, Tseng GC, Wang PC, Liao PC, Cheng YT, Huang CH. Efficacy of an intravenous proton pump inhibitor after endoscopic therapy with epinephrine injection for peptic ulcer bleeding in patients with uraemia: a case-control study. Aliment Pharmacol Ther 2009; 30:406-13. [PMID: 19485981 DOI: 10.1111/j.1365-2036.2009.04049.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Patients with peptic ulcer bleeding and uraemia are prone to re-bleeding. AIM To compare the efficacy of an intravenous proton pump inhibitor in treating peptic ulcer bleeding in patients with uraemia and those without uraemia. METHODS High-risk peptic ulcer bleeding patients received endoscopic therapy with epinephrine (adrenaline) injection plus intravenous omeprazole (40 mg bolus followed by 40 mg infusion every 12 h) for 3 days. Re-bleeding, volume of blood transfusion, hospital stay, need for surgery, and mortality were analysed. RESULTS The uraemic group had similar 7-day re-bleeding rate (6/42, 14.29% vs. 6/46, 13.04%, P = 0.865) to that of non-uraemic patients, but more re-bleeding episodes beyond 7 days (4/42, 9.52% vs. 0/46, 0%, P = 0.032, OR [95% CI] = 1.105 [1.002-1.219]) and all-cause mortality (4/42 vs. 0/46 P = 0.032, OR [95% CI] = 1.105 [1.002-1.219]). The uraemic group also had more units of blood transfusion after endoscopic therapy (mean +/- s.d. 4.33 +/- 3.35 units vs. 2.15 +/- 1.65 units, P < 0.001), longer hospital stay (mean +/- s.d. 8.55 +/- 8.12 days vs. 4.11 +/- 1.60 days, P < 0.001) and complications during hospitalization (9/42 vs. 0/46, P = 0.001, OR [95% CI] = 1.273 [1.087-1.490]). CONCLUSION Endoscopic therapy with epinephrine injection plus an intravenous proton pump inhibitor can offer protection against early re-bleeding in uraemic patients with peptic ulcer bleeding, but has a limited role beyond 7 days.
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Affiliation(s)
- G-Y Tseng
- Division of Gastroenterology, Department of Medicine, Ton-Yen General Hospital, Hsin-Chu, Taiwan
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6324
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Song XY, Lee SY, Ma RCW, So WY, Cai JH, Tam C, Lam V, Ying W, Ng MCY, Chan JCN. Phenotype-genotype interactions on renal function in type 2 diabetes: an analysis using structural equation modelling. Diabetologia 2009; 52:1543-53. [PMID: 19479237 DOI: 10.1007/s00125-009-1400-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2008] [Accepted: 04/02/2009] [Indexed: 01/22/2023]
Abstract
AIMS/HYPOTHESIS Cardiovascular and renal diseases share common risk factors. We used structural equation modelling (SEM) to evaluate the independent and combined effects of phenotypes and genotypes implicated in cardiovascular diseases on renal function in type 2 diabetes. METHODS 1,188 type 2 diabetic patients were stratified into high-risk and low-risk groups according to bimodal distributions of the logarithmically transformed (log(e)) urinary albumin:creatinine ratio and plasma creatinine levels. Models for these groups, comprising continuous and non-ranking categorical data, were developed separately to evaluate the inter-relationships among measured variables and latent factors using non-linear SEMs, Bayesian estimation and model selection as assessed by a goodness-of-fit statistic. RESULTS Inter-correlated measured variables (obesity, glycaemia, lipid, blood pressure) and variants of the genes encoding endothelial nitric oxide synthase (NOS), beta-adrenergic receptor (ADRB), components of the renin-angiotensin system (RAS) and lipid metabolism were loaded onto their respective latent factors of phenotypes and genotypes. In addition to direct and indirect effects, latent factors of obesity, lipid and BP interacted with latent factors of ADRB and RAS genotypes to influence renal function. Together with variants of the genes encoding peroxisome proliferator-activated receptor gamma, atrial natriuretic peptide, adducin, G protein beta(3) subunit, epithelial sodium channel alpha subunit and matrix metallopeptidase 3, these parameters explained 39-80% of the variance in renal function in the high-risk and low-risk models. CONCLUSIONS/INTERPRETATION SEM is a useful tool for confirming and quantifying multiple interactions of biological pathways with genetic determinants. The combined and interactive effects of blood pressure, lipid and obesity on renal function may have therapeutic implications, especially in type 2 diabetic individuals with genetic risk factors.
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Affiliation(s)
- X Y Song
- Department of Statistics, The Chinese University of Hong Kong, Shatin, Hong Kong, SAR, People's Republic of China
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6325
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Zhao WY, Zeng L, Zhu YH, Wang LM, Zhou MS, Han S, Zhang L. A comparison of prediction equations for estimating glomerular filtration rate in Chinese potential living kidney donors. Clin Transplant 2009; 23:469-75. [DOI: 10.1111/j.1399-0012.2009.01027.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Yang YH, He XJ, Chen SR, Wang L, Li EM, Xu LY. Changes of serum and urine neutrophil gelatinase-associated lipocalin in type-2 diabetic patients with nephropathy: one year observational follow-up study. Endocrine 2009; 36:45-51. [PMID: 19390997 DOI: 10.1007/s12020-009-9187-x] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2009] [Revised: 03/10/2009] [Accepted: 03/27/2009] [Indexed: 02/05/2023]
Abstract
We initiated the present work to explore whether neutrophil gelatinase-associated lipocalin (NGAL) could be used to predict the progression of diabetic nephropathy in type-2 diabetic patients. Seventy-four type-2 diabetic patients were divided into normo-, micro- and macro-albuminuria groups according to their 24 h-urinary albumin excreting rate. Serum and urine NGAL, and other clinical parameters were detected. Patients were followed and measurements were repeated 1 year later. An increased tendency of urine NGAL and a decreased tendency of serum NGAL were detected, from normo-albuminuria group to macro-albuminuria group. Serum NGAL was found to rise after follow-up. Moreover, urine NGAL was found to be correlated positively with cystatin C, urea nitrogen, and serum creatinine (SCr), and inversely with glomerular filtration rate (GFR), while serum NGAL correlated negatively with cystatin C and urea nitrogen, at both baseline and follow-up levels. The results indicate that NGAL correlates closely with renal function. Both serum and urine NGAL are sensitive for predicting the progression of type-2 diabetic nephropathy but they may change differently. Serum NGAL may be more useful in early detection and urine NGAL may be more meaningful in renal function assessment.
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Affiliation(s)
- Yi-Hua Yang
- Department of Endocrinology and Metabolism of the Second Affiliated Hospital, Shantou University Medical College, Shantou, 515041, Guangdong, China
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6328
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Abstract
With its rising incidence and prevalence, chronic kidney disease (CKD) is a major public health concern, both in the United States and worldwide. Recent worldwide initiatives have attempted to garner attention for CKD by emphasizing that the condition is "common, harmful, and treatable." In the United States, as many as 26 million adults may have CKD, an increase from approximately 10% of the US adult population between 1988 and 1994 to >13% just one decade later. Similar rates have been seen worldwide, with a CKD prevalence of 13% in Beijing, China and 16% in Australia. In the United States, the dramatic rise in the prevalence of CKD likely reflects similar increases in obesity and its sequelae-namely, diabetes, hypertension, and cardiovascular disease. The prevalence of CKD, as well as its associated costs, is expected to continue to increase.
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6329
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Central or peripheral systolic or pulse pressure: which best relates to target organs and future mortality? J Hypertens 2009; 27:461-7. [PMID: 19330899 DOI: 10.1097/hjh.0b013e3283220ea4] [Citation(s) in RCA: 311] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine the relationship between brachial and central carotid pressures and target organ indices at baseline and their association with future mortality. METHODS We examined, cross-sectionally and longitudinally, the relations of baseline systolic and pulse pressures in central (calibrated tonometric carotid pulse) and peripheral (brachial, mercury sphygmomanometer) arteries to baseline left ventricular mass, carotid intima-media thickness, estimated glomerular filtration rate, and 10-year all-cause and cardiovascular mortality in 1272 participants (47% women aged 30-79 years) from a community of homogeneous Chinese. RESULTS Left ventricular mass was more strongly related to central and peripheral systolic pressures than pulse pressures. Intima-media thickness and glomerular filtration rate were more strongly related to central pressures than peripheral pressures. A total of 130 participants died, 37 from cardiovascular causes. In univariate analysis, all four blood pressure variables significantly predicted all-cause and cardiovascular mortality. Each blood pressure variable was entered into the multivariate models, both individually and jointly with another blood pressure variable. After adjustment for age, sex, heart rate, BMI, current smoking, glucose, ratio of total cholesterol to high-density lipoprotein cholesterol, carotid-femoral pulse wave velocity, left ventricular mass, intima-media thickness, and glomerular filtration rate, only central systolic pressure consistently and independently predicted cardiovascular mortality (hazards ratio, 1.30 per 10 mmHg). No significant sex interactions were observed in all analyses. CONCLUSION Systolic and pulse pressures relate differently to different target organs. Central systolic pressure is more valuable than other blood pressure variables in predicting cardiovascular mortality.
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6330
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Wu VC, Chueh SC, Chang HW, Lin LY, Liu KL, Lin YH, Ho YL, Lin WC, Wang SM, Huang KH, Hung KY, Kao TW, Lin SL, Yen RF, Chen YM, Hsieh BS, Wu KD. Association of kidney function with residual hypertension after treatment of aldosterone-producing adenoma. Am J Kidney Dis 2009; 54:665-73. [PMID: 19628318 DOI: 10.1053/j.ajkd.2009.06.014] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2008] [Accepted: 06/02/2009] [Indexed: 12/14/2022]
Abstract
BACKGROUND Autonomous secretion of aldosterone in patients with primary aldosteronism increases glomerular filtration rate and causes kidney damage. The influence of a mild decrease in kidney function on residual hypertension after adrenalectomy is unexplored. STUDY DESIGN Nonconcurrent prospective study. SETTING & PARTICIPANTS The study was based on the Taiwan Primary Aldosteronism Investigation (TAIPAI) database. 150 patients (61 men; overall mean age, 47.2 +/- 11.6 years) with a diagnosis of aldosterone-producing adenoma had undergone unilateral adrenalectomy at National Taiwan University Hospital from July 1999 to January 2007. PREDICTOR Presurgery estimated glomerular filtration rate (eGFR). OUTCOMES & MEASUREMENTS Residual hypertension after adrenalectomy, defined either as less than 75% of recorded blood pressure measurements with systolic blood pressure less than 140 mm Hg and diastolic blood pressure less than 90 mm Hg or requiring antihypertensive medications during the first year after surgery. RESULTS Before surgery, 27 (18%), 72 (48%), and 51 (34%) patients had moderately to severely decreased (<60 mL/min/1.73 m(2)), mildly decreased (60 <or= eGFR < 90 mL/min/1.73 m(2)), or nondecreased eGFR (>or=90 mL/min/1.73 m(2)), respectively. After surgery, 16 (59.3%), 29 (40.3%), and 10 (19.3%) patients in each category had postsurgery residual hypertension. Compared with patients without decreased eGFR before surgery, adjusted odds ratios for postsurgery residual hypertension were 2.7 (95% confidence interval, 1.03 to 7.0; P = 0.04) and 2.8 (95% confidence interval, 1.05 to 9.3) for mildly and moderately to severely decreased eGFR, respectively. LIMITATIONS Arbitrary definition for residual hypertension. CONCLUSIONS Two-thirds of patients with aldosterone-producing adenoma were cured of hypertension by means of unilateral adrenalectomy. Kidney function impairment, even mild, appears to be associated with a high incidence of postsurgery residual hypertension.
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Affiliation(s)
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- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
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6331
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Jia W, Gao X, Pang C, Hou X, Bao Y, Liu W, Wang W, Zuo Y, Gu H, Xiang K. Prevalence and risk factors of albuminuria and chronic kidney disease in Chinese population with type 2 diabetes and impaired glucose regulation: Shanghai diabetic complications study (SHDCS). Nephrol Dial Transplant 2009; 24:3724-31. [PMID: 19617258 DOI: 10.1093/ndt/gfp349] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Diabetes is a major risk factor for the development of kidney disease. We aimed to determine the prevalence of albuminuria and chronic kidney disease (CKD) in Chinese subjects with diabetes and pre-diabetes and the risk factors for kidney disease. METHODS An urban community-based sample of 3714 adults in Shanghai was classified into normal glucose tolerance (NGT), impaired glucose regulation (IGR) and diabetes. The estimated glomerular filtration rate (eGFR) and the urinary albumin-to-creatinine ratio (ACR) were applied to designate renal function and albuminuria, respectively. Binary logistic regression was performed to analyse the contribution of risk factors to CKD. Polynominal regression was used to determine the trends of eGFR with the increment of ACR. RESULTS The prevalence of microalbuminuria, macroalbuminuria and CKD in subjects with diabetes was 22.8%, 3.4% and 29.6%, respectively, which was significantly higher than that in non-diabetes subjects. After adjustment for age, the odds ratio of hypertension for albuminuria and renal insufficiency (eGFR <60 mL/min/1.73 m(2,) stages 3-5 of CKD) were 1.23 (P = 0.000) and 2.55 (P = 0.000). Diabetes and cardiovascular disease (CVD) both increased the risk for albuminuria significantly, with the odds ratio of 1.22 (P = 0.04) and 1.36 (P = 0.006), respectively. Diabetes and CVD were not independent risk factor for renal insufficiency. Although the worsening trends of eGFR are similar in diabetes and IGR subjects, IGR was not a significant risk factor for albuminuria and renal insufficiency. CONCLUSION Screening for albuminuria and eGFR is highly recommended for older patients with diabetes, hypertension and CVD to prevent end-stage kidney disease.
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Affiliation(s)
- Weiping Jia
- Department of Endocrinology and Metabolism, Shanghai Clinical Center of Diabetes, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, China.
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6332
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Mok VCT, Lau AYL, Wong A, Lam WWM, Chan A, Leung H, Wong E, Soo Y, Leung T, Wong LKS. Long-term prognosis of Chinese patients with a lacunar infarct associated with small vessel disease: a five-year longitudinal study. Int J Stroke 2009; 4:81-8. [PMID: 19383047 DOI: 10.1111/j.1747-4949.2009.00262.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
RATIONALE Lacunar infarct associated with small vessel disease is a common stroke subtype in China and has a favorable short-term prognosis. Data on its long-term prognosis among Chinese patients are lacking. AIMS We aimed to study its long-term prognosis and predictors for poor outcomes. DESIGN We followed up to 75 consecutive Chinese stroke patients who had a lacunar infarct for a period of 5 years. Clinical outcomes with respect to mortality and recurrent stroke were noted. We evaluated baseline clinical and imaging predictors for such outcomes using the Cox regression analysis. STUDY OUTCOMES Sixteen (21.3%) patients died and 12 (16%) patients had recurrent stroke during follow-up. Twenty-one (28%) patients had combined events of either death and/or recurrent stroke. Univariate Cox regression analysis showed that age, literacy, National Institute of Health Stroke Scale, incident stroke/transient ischemic attack, and white matter lesion volume predicted survival, while, age, National Institute of Health Stroke Scale, systolic blood pressure, hyperhomocysteinemia, silent lacunes, microbleeds, and white matter lesion volume predicted recurrent stroke. Multivariate Cox regression analysis showed that National Institute of Health Stroke Scale (HR 1.25, 95% CI 1.05-1.48) and white matter lesion volume (HR 1.46, 95% CI 1.11-1.92) predicted combined events of mortality and/or recurrent stroke after age adjustment. CONCLUSION Approximately one in four patients either died and/or had recurrent stroke within 5 years after a lacunar infarct. Age, stroke severity, and volume of white matter lesion predict a poor long-term prognosis.
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Affiliation(s)
- Vincent C T Mok
- Department of Medicine and Therapeutics, Division of Neurology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China.
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6333
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Chang IH, Han JH, Myung SC, Kwak KW, Kim TH, Park SW, Choi NY, Chung WH, Ahn SH. Association between metabolic syndrome and chronic kidney disease in the Korean population. Nephrology (Carlton) 2009; 14:321-6. [PMID: 19444966 DOI: 10.1111/j.1440-1797.2009.01091.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM We performed a retrospective study to examine the association between the metabolic syndrome (MS)and risk for the development of chronic kidney disease (CKD). METHODS This cohort study included 60 921 healthy adults recruited from two health promotion centres.Anthropometric measures, blood pressure, fasting glucose, lipid profile and serum creatinine were evaluated. The glomerular filtration rate was estimated (eGFR) using the abbreviated equation developed by the Modification of Diet in Renal Disease (MDRD) formula. CKD was defined as an eGFR of <60 mL/min per 1.73 m2 or the presence of proteinuria. RESULTS The prevalence of MS and CKD was 19.0% and 7.2% respectively. Those with MS had a higher prevalence of CKD (11.0% vs 6.3%, P < 0.001) than those without MS. As the number of MS components increased, the prevalence of CKD increased and the eGFR decreased. The multiple linear analyses showed that each of the components of the MS was negatively correlated with the eGFR. Unadjusted and multivariate adjusted associations were identified between MS and CKD. Individuals with MS had a multivariate adjusted odds ratio of 1.680 (95% confidence interval, 0.566-1.801) for CKD compared with those without MS. CONCLUSION Our findings, which were obtained from a large Korean cohort, suggest that MS was associated with CKD.
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Affiliation(s)
- In Ho Chang
- Department of Urology, Chung-Ang University, College of Medicine, Seoul, Korea
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6334
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Clinical characteristics and outcomes of rural patients with ESRD in Guangxi, China: one dialysis center experience. Int Urol Nephrol 2009; 42:195-204. [PMID: 19597958 DOI: 10.1007/s11255-009-9609-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2009] [Accepted: 06/22/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVES End-stage renal disease (ESRD) is a serious public health problem in Guangxi, a province of south China. This prospective study evaluated the characteristics and outcome of rural patients with ESRD in a dialysis center of Guangxi, compared with urban patients in the same period. METHODS A total of 238 patients (96 rural and 142 urban) who enrolled in 2007 was included in this study and followed up for 1 year. Clinical data including patient basic information, clinical parameters, laboratory tests, data associated with dialysis and prognosis were evaluated and compared between rural and urban groups. RESULTS Glomerulonephritis was found to be the most common cause of ESRD in all the cohorts studied, with similar rates of 47.9 and 46.5% in the rural and urban patients, respectively. Compared to urban patients, the rural patients had significantly lower prevalence of diabetic nephropathy (8.3 vs. 24.6%, P < 0.001) and higher prevalence of obstructive uropathy (20.8 vs. 3.5%, P < 0.001); the rural patients were overall younger, with poorer financial supports, but with higher rates of late referrals, poorer renal functions as indicated by related laboratory tests including lower levels of GFR, serum hemoglobin, bicarbonate and Kt/V, but higher prevalence of very low GFR, severe metabolic acidosis, severe anemia and hyperkalemia, higher rate of not initiating dialysis, radial artery puncture and mortality. The cardiovascular events were found to be the most common cause of death in both rural and urban groups. CONCLUSIONS Glomerulonephritis was found to be the most common cause of ESRD in all the studied patients. The rural patients with ESRD in Guangxi had kidney disease in more advanced stage at the time of first visit to a nephrologist and higher rates of mortality after dialysis initiation, compared to urban patients.
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6335
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Ozmen S, Kaplan MA, Kaya H, Akin D, Danis R, Kizilkan B, Yazanel O. Role of lean body mass for estimation of glomerular filtration rate in patients with chronic kidney disease with various body mass indices. ACTA ACUST UNITED AC 2009; 43:171-6. [DOI: 10.1080/00365590802502228] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
| | | | - Halil Kaya
- Nuclear Medicine, Dicle University School of Medicine, Diyarbakir, Turkey
| | | | | | - Berfin Kizilkan
- Nuclear Medicine, Dicle University School of Medicine, Diyarbakir, Turkey
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6336
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Bi SH, Cheng LT, Wang T. A Survey of Chronic Kidney Disease in a Large Hospital in China. Ren Fail 2009; 30:541-5. [DOI: 10.1080/08860220802064796] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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6337
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Guo XH, Zhang PH, Zeng ZC, Wang W, Li C, Shi Y, Liu ZJ. Combination Patterns of Cardiovascular Risks and Sequelae at Different Stage of Hypertension in Natural Hypertensive Population in Beijing. Clin Exp Hypertens 2009; 31:142-55. [DOI: 10.1080/10641960802621309] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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6338
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Zhu L, Tang W, Li G, Lv J, Ding J, Yu L, Zhao M, Li Y, Zhang X, Shen Y, Zhang H, Wang H. Interaction between variants of two glycosyltransferase genes in IgA nephropathy. Kidney Int 2009; 76:190-8. [DOI: 10.1038/ki.2009.99] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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6339
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Greenberg E, Saad N, Abraham T, Balmir E. Drug Dosage Adjustment Using Renal Estimation Equations: A Review of the Literature. Hosp Pharm 2009. [DOI: 10.1310/hpj4407-577] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To examine the factors affecting drug clearance and the available evidence for drug dosing based on the Cockcroft-Gault (CG) equation and the abbreviated Modification of Diet in Renal Disease (abbrMDRD) equation. Factors that would distort the accuracy of these formulas and the affect of this distortion on the use of either formula in drug dosage adjustment were reviewed. Methods An updated review of the literature was performed that pertained to the accuracy of the CG and abbrMDRD equations and their use in drug dosage adjustment. MEDLINE was searched using the OVIDSP database, from the inception of the database (1950) through June 2008. Discussion To cover the major issues concerning the use of renal estimation equations in drug dosing adjustment, various areas were examined. Topics included the accuracy of the CG and abbrMDRD formulas, variability in these equations because of patient and laboratory factors, the isotope dilution-mass spectrometry standardization initiative, and the applicability of each formula to modifying medication doses. Conclusion Although the abbrMDRD equation has many advantages as compared with the CG equation, too little research has been completed at this time to recommend the clinical use of the abbrMDRD equation in pharmacy practice.
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Affiliation(s)
- Eric Greenberg
- New York Methodist Hospital, New York Methodist Hospital, Brooklyn, New York
| | - Nasser Saad
- Clinical Pharmacy, New York Methodist Hospital, Brooklyn, New York
| | - Teena Abraham
- Clinical Pharmacy and Residency Programs, New York Methodist Hospital, Brooklyn, New York
| | - Eric Balmir
- New York Methodist Hospital, Brooklyn, New York
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Chan J, So W, Ko G, Tong P, Yang X, Ma R, Kong A, Wong R, Le Coguiec F, Tamesis B, Wolthers T, Lyubomirsky G, Chow P. The Joint Asia Diabetes Evaluation (JADE) Program: a web-based program to translate evidence to clinical practice in Type 2 diabetes. Diabet Med 2009; 26:693-9. [PMID: 19573118 DOI: 10.1111/j.1464-5491.2009.02751.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIMS The Joint Asia Diabetes Evaluation (JADE) Program is the first web-based program incorporating a comprehensive risk engine, care protocols, clinical decision and self-management support to improve ambulatory diabetes care. The aim was to validate the risk stratification system of the JADE Program using a large prospective cohort. METHODS The JADE interactive risk engine stratifies patients into different risk levels using results from an annual comprehensive assessment of complications and risk factors. We used a prospective registry consisting of 7534 Type 2 diabetic patients [45.6% men, median (range) age 57 years (13-92)] to perform internal validation of the risk engine. RESULTS The JADE Risk Engine categorized patients into four risk levels (from low to high): level 1, n = 4520 (6%); level 2, n = 1468 (19.5%); level 3, n = 4476 (59.4%); and level 4, n = 1138 (15.1%). After a median follow-up period of 5.5 years (mean +/- sd 5.4 +/- 2.81 years), 763 (10.1%) died, 1129 (14.9%) developed cardiovascular disease (CVD), 282 (3.7%) developed end-stage renal disease and 1400 (18.6%) had at least one of these events. Compared with risk level 1, levels 2, 3 and 4 were associated with 2.8-, 4.7- and 8.6-fold increased risk of clinical end-points. Risk levels 3 and 4 were, respectively, associated with 2.2- and 3.9-fold increased risk for all-cause death and 4.8- and 12.1-fold increased CVD risks. CONCLUSION Based on results from a comprehensive assessment, the JADE Risk Engine successfully categorizes patients into different risk levels to guide clinical management.
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Affiliation(s)
- J Chan
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Shatin, Hong Kong.
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6341
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Rong S, Jin X, Ye C, Chen J, Mei C. Carotid vascular remodelling in patients with autosomal dominant polycystic kidney disease. Nephrology (Carlton) 2009; 14:113-7. [PMID: 19335845 DOI: 10.1111/j.1440-1797.2008.01049.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM To study carotid vascular wall remodelling in patients with autosomal dominant polycystic kidney disease (ADPKD) using integrated backscatter signal (IBS) analysis. METHODS Included in the study were: 60 ADPKD patients with preserved renal function, including 32 patient with hypertension and 28 with normotension; 25 patients with essential hypertension; and 30 healthy volunteers. Carotid intima-media thickness (IMT) was measured by 2-D conventional ultrasonography. Acoustic tissue characterization of the carotid wall was assessed by IBS analysis, and the percentage of regions considered as fibromatosis was calculated in all groups. RESULTS Carotid IMT in hypertensive ADPKD patients (0.8 +/- 0.05 vs 0.68 +/- 0.02 mm, P < 0.01 and 0.8 +/- 0.05 vs 0.56 +/- 0.04 mm, P < 0.01 respectively) and patients with essential hypertension (0.79 +/- 0.03 vs 0.68 +/- 0.02 mm, P < 0.01 and 0.79 +/- 0.03 vs 0.56 +/- 0.0 4 mm, P < 0.01 respectively) was significantly greater than that of normotensive patients and healthy subjects. Carotid IMT in normotensive ADPKD patients was also significantly greater than that in healthy subjects (0.68 +/- 0.02 vs 0.56 +/- 0.04 mm, P < 0.01). Calibrated IBS (C-IBS) in hypertensive ADPKD patients was significantly greater than that in patients with essential hypertension and normotensive ADPKD patients (-21.2 +/- 1.51 dB vs -23.1 +/- 1.61 dB, P < 0.05; -21.2 +/- 1.51 dB vs -24.5 +/- 1.34 dB, P < 0.01). C-IBS in normotensive ADPKD patients was significantly greater than that in healthy subjects (-24.5 +/- 1.34 dB vs -26.2 +/- 1.69 dB, P < 0.01). The percentage of regions that could be considered as fibromatosis in hypertensive ADPKD patients was significantly greater than that in patients with essential hypertension and normotensive ADPKD patients (30.0% vs 22.4%, P < 0.05; 30.0% vs 17.9%, P < 0.01). The percentage of regions that could be considered as fibromatosis in normotensive ADPKD patients was significantly greater than that in healthy subjects (15.2% vs 10.3%, P < 0.01). CONCLUSION Carotid remodelling occurs in the early stage of ADPKD and can be aggravated by hypertension. Fibrosis contributes to the vascular rearrangement.
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Affiliation(s)
- Shu Rong
- Nephrology Institute of CPLA, Second Millitary Medical University, Shanghai, China
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6342
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Rostoker G, Andrivet P, Pham I, Griuncelli M, Adnot S. Accuracy and limitations of equations for predicting the glomerular filtration rate during follow-up of patients with non-diabetic nephropathies. BMC Nephrol 2009; 10:16. [PMID: 19555481 PMCID: PMC2717960 DOI: 10.1186/1471-2369-10-16] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2009] [Accepted: 06/25/2009] [Indexed: 11/22/2022] Open
Affiliation(s)
- Guy Rostoker
- Service de Néphrologie et de Dialyse, Centre Hospitalier Privé Claude Galien, 91480 Quincy sous Sénart, France.
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6343
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Tsai SY, Tseng HF, Tan HF, Chien YS, Chang CC. End-stage renal disease in Taiwan: a case-control study. J Epidemiol 2009; 19:169-76. [PMID: 19542686 PMCID: PMC3924105 DOI: 10.2188/jea.je20080099] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background Taiwan has the highest incidence of end-stage renal disease (ESRD) in the world. The epidemiologic features of ESRD, however, have not been investigated. In this case–control study, we evaluated the risk of ESRD associated with a number of putative risk factors. Methods We studied 200 patients among whom ESRD had been newly diagnosed between 1 January 2005 and 31 December 2005; 200 controls were selected from among relatives of patients treated in the general surgery unit. Using a structured questionnaire, we collected information related to socioeconomic factors, history of disease, regular blood or urine screening, lifestyle, environmental exposure, consumption of vitamin supplements, and regular drug use at 5 years before disease onset. Results Our primary multivariate risk models indicated that low socioeconomic status was a strong predictor of ESRD (education: odds ratio [OR], 2.78; 95% confidence interval [CI], 1.49–5.19; income: OR, 2.86, 95% CI, 1.48–5.52), even after adjusting for other risk factors. Other significant predictors for ESRD were a history of hypertension (OR, 3.63–3.90), history of diabetes (OR, 3.85–5.50), and regular intake of folk remedies or over-the-counter Chinese herbs (OR, 10.84–12.51). Regular intake of a multivitamin supplement 5 years before diagnosis was associated with a decreased risk of ESRD (OR, 0.12–0.14). Conclusions Our findings indicate that low socioeconomic status, history of hypertension, diabetes, and regular use of folk remedies or over-the-counter Chinese herbs were significant risk factors for ESRD, while regular intake of a multivitamin supplement was associated with a decreased risk of ESRD.
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Affiliation(s)
- Su-Ying Tsai
- Department of Health Management, I-Shou University, Yanchao Township, Kaohsiung County, Taiwan (R.O.C.).
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See LC, Kuo CF, Chuang FH, Li HY, Chen YM, Chen HW, Yu KH. Serum uric acid is independently associated with metabolic syndrome in subjects with and without a low estimated glomerular filtration rate. J Rheumatol 2009; 36:1691-8. [PMID: 19531754 DOI: 10.3899/jrheum.081199] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE The relationship among serum uric acid (SUA), metabolic syndrome, and chronic kidney disease (CKD) is unclear. We examined whether SUA level is an independent risk factor for chronic kidney disease and whether the association between SUA and metabolic syndrome is affected by kidney function. METHODS We analyzed 28,745 subjects (17,478 men, 11,267 women, age 20-49 yrs) who underwent health examinations at this hospital between 2000 and 2007. Hyperuricemia was defined as SUA level > 7.7 mg/dl in men or > 6.6 mg/dl in women. Kidney function was assessed by estimated glomerular filtration rate (eGFR) using the Modification of Diet in Renal Disease Study equation modified for Chinese subjects. Impaired renal function with low GFR was defined as eGFR < 90 ml/min/1.73 m(2). The UA-low GFR groups were defined according to the observed combination of hyperuricemia and low GFR: Group A (absence of both hyperuricemia and low GFR); Group B (presence of low GFR but no hyperuricemia); Group C (presence of hyperuricemia but not low GFR); and Group D (presence of both hyperuricemia and low GFR). RESULTS The prevalence of hyperuricemia, metabolic syndrome, and impaired kidney function with low GFR was 20.3% (27.6% in men, 8.9% in women), 7.6% (10.6% in men, 3.0% in women), and 9.9% (11.6% in men, 7.1% in women), respectively. The Pearson correlation between SUA and eGFR was only -0.26 (-0.21 in men, -0.22 in women; p < 0.001). In men, the age-adjusted odds ratio (OR) of metabolic syndrome was 1.41 (Group B), 2.45 (Group C), and 2.58 (Group D) in comparison with Group A. In women, the age-adjusted OR of metabolic syndrome was 0.83 (Group B), 5.47 (Group C), and 3.31 (Group D) in comparison with Group A. CONCLUSION Hyperuricemia is prevalent in the Taiwan population. Hyperuricemia is only weakly associated with renal function, but is strongly associated with metabolic syndrome with or without a low eGFR.
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Affiliation(s)
- Lai-Chu See
- Department of Public Health, BiostatisticsConsulting Center, Chang Gung University, Tao-Yuan, Taiwan, Republic of China
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6345
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Rule AD, Teo BW. GFR estimation in Japan and China: what accounts for the difference? Am J Kidney Dis 2009; 53:932-5. [PMID: 19463761 DOI: 10.1053/j.ajkd.2009.02.011] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2009] [Accepted: 02/18/2009] [Indexed: 11/11/2022]
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6346
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Zhao X, Zuo L, Wang H. Reply. Nephrol Dial Transplant 2009. [DOI: 10.1093/ndt/gfp291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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6347
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Delanaye P, Cavalier E, Krzesinski JM. Low prevalence of chronic kidney disease in Far-East Asian populations: impact of the ethnicity factor? Nephrol Dial Transplant 2009; 24:2952-3; author reply 2953-4. [PMID: 19525517 DOI: 10.1093/ndt/gfp279] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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6348
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Imai E, Horio M, Watanabe T, Iseki K, Yamagata K, Hara S, Ura N, Kiyohara Y, Moriyama T, Ando Y, Fujimoto S, Konta T, Yokoyama H, Makino H, Hishida A, Matsuo S. Prevalence of chronic kidney disease in the Japanese general population. Clin Exp Nephrol 2009; 13:621-30. [PMID: 19513802 DOI: 10.1007/s10157-009-0199-x] [Citation(s) in RCA: 390] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2009] [Accepted: 04/28/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND We previously estimated the prevalence of chronic kidney disease (CKD) stages 3-5 at 19.1 million based on data from the Japanese annual health check program for 2000-2004 using the Modification of Diet in Renal Disease (MDRD) equation multiplied by the coefficient 0.881 for the Japanese population. However, this equation underestimates the GFR, particularly for glomerular filtration rates (GFRs) of over 60 ml/min/1.73 m(2). We did not classify the participants as CKD stages 1 and 2 because we did not obtain proteinuria data for all of the participants. We re-estimated the prevalence of CKD by measuring proteinuria using a dipstick test and by calculating the GFR using a new equation that estimates GFR based on data from the Japanese annual health check program in 2005. METHODS Data were obtained for 574,024 (male 240,594, female 333,430) participants over 20 years old taken from the general adult population, who were from 11 different prefectures in Japan (Hokkaido, Yamagata, Fukushima, Tochigi, Ibaraki, Tokyo, Kanazawa, Osaka, Fukuoka, Miyazaki and Okinawa) and took part in the annual health check program in 2005. The glomerular filtration rate (GFR) of each participant was computed from the serum creatinine value using a new equation: GFR (ml/min/1.73 m(2)) = 194 x Age(-0.287) x S-Cr(-1.094) (if female x 0.739). The CKD population nationwide was calculated using census data from 2005. We also recalculated the prevalence of CKD in Japan assuming that the age composition of the population was same as that in the USA. RESULTS The prevalence of CKD stages 1, 2, 3, and 4 + 5 were 0.6, 1.7, 10.4 and 0.2% in the study population, which resulted in predictions of 0.6, 1.7, 10.7 and 0.2 million patients, respectively, nationwide. The prevalence of low GFR was significantly higher in the hypertensive and proteinuric populations than it was in the populations without proteinuria or hypertension. The prevalence rate of CKD in Japan was similar to that in the USA when the Japanese general population was age adjusted to the US 2005 population estimate. CONCLUSION About 13% of the Japanese adult population-approximately 13.3 million people-were predicted to have CKD in 2005.
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Affiliation(s)
- Enyu Imai
- Department of Nephrology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
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6349
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Wang Y, Zhang L, Li X, Xu Y, Yang M, Qian J, Wang L, Chen N, Gu Y, Chen M, Xing C, Chen X, Hou F, Yu X, Cheng X, Guo L, Wei C, Huang G, Zhang Q, Wang R, Wang L, Mei C, Li Y, Liu Z, Zhao L, Wu Y, Wang HY. Improvement of awareness, treatment and control of hypertension among chronic kidney disease patients in China from 1999 to 2005. Hypertens Res 2009; 32:444-9. [DOI: 10.1038/hr.2009.38] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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6350
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Ma RCW, Yang X, Ko GTC, So WY, Kong APS, Ho CS, Lam CWK, Chow CC, Tong PCY, Chan JCN. Effects of systolic and diastolic blood pressures on incident coronary heart disease and all-cause death in Chinese women with Type 2 diabetes: the Hong Kong Diabetes Registry. J Diabetes 2009; 1:90-8. [PMID: 20929505 DOI: 10.1111/j.1753-0407.2009.00023.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Elevated blood pressure (BP) is an important risk factor for the development of coronary heart disease (CHD), although the threshold above which the risk increases has not been clearly defined. The aim of the present study was to examine the full-range association between BP and CHD. METHODS A prospective cohort of 3861 Chinese women with Type 2 diabetes mellitus (T2DM) was followed for a median of 5.61 years. Restricted cubic spline analysis was used to examine the relationship between BP and CHD. RESULTS Subjects who developed CHD were older, more likely to be smokers, had a significantly longer duration of diabetes, higher systolic BP (SBP), glycated hemoglobin, albuminuria, low-density lipoprotein-cholesterol, and triglycerides, and lower estimated glomerular filtration rate and high-density lipoprotein-cholesterol. Mortality was higher in those who developed CHD compared with those who did not, with all-cause death in 30.2% and 7.8% of patients, respectively. Over 21,641 and 22 049 person-years follow up, 4.4% of patients (n = 169) developed CHD and 8.8% (n = 340) died, respectively. The relative risk of SBP for CHD was constant up to 120 mmHg, after which it started to rise: from 130 mmHg, each 10-mmHg increase in SBP was associated with a 1.13-fold increased risk of CHD. CONCLUSIONS We identified 130 mmHg as the threshold of SBP for increased risk of CHD in Chinese female patients with T2DM. It appears that 67-77 mmHg is the optimal range for diastolic BP, within which the risk of CHD is lowest.
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Affiliation(s)
- Ronald Ching Wan Ma
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, SAR, China
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