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Seidu S, Barrat J, Khunti K. Clinical update: The important role of dual kidney function testing (ACR and eGFR) in primary care: Identification of risk and management in type 2 diabetes. Prim Care Diabetes 2020; 14:370-375. [PMID: 32139245 DOI: 10.1016/j.pcd.2020.02.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 02/03/2020] [Accepted: 02/24/2020] [Indexed: 12/24/2022]
Abstract
Diabetic kidney disease (DKD) is common complication of type 1 and type 2 diabetes and may lead to progressive kidney dysfunction culminating in end-stage kidney disease. Kidney function is evaluated less frequently than other care procedures in patients with diabetes, even though the opportunity to identify DKD early and slow or even halt renal damage early in the disease progression represents a potentially important clinical opportunity for early intervention. The following review provides an overview of the under-recognised importance of kidney function in T2D and current best-practice to support the identification of DKD as part of primary care T2D management.
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52
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Kang MW, Tangri N, Kim YC, An JN, Lee J, Li L, Oh YK, Kim DK, Joo KW, Kim YS, Lim CS, Lee JP. An independent validation of the kidney failure risk equation in an Asian population. Sci Rep 2020; 10:12920. [PMID: 32737361 PMCID: PMC7395750 DOI: 10.1038/s41598-020-69715-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 07/19/2020] [Indexed: 11/09/2022] Open
Abstract
Predicting the risk of end-stage renal disease (ESRD) progression facilitates appropriate nephrology care of patients with chronic kidney disease (CKD). Previously, the kidney failure risk equations (KFREs) were developed and validated in several cohorts. The purpose of this study is to validate the KFREs in a Korean population and to recalibrate the equations. A total of 38,905 adult patients, including 13,244 patients with CKD stages G3–G5, who were referred to nephrology were recruited. Using the original KFREs (4-, 6- and 8-variable equations) and recalibration equations, we predicted the risk of 2- and 5-year ESRD progression. All analyses were conducted in CKD stages G3-G5 patients as well as the total population. In CKD stages G3–G5 patients, All the original 4-, 6- and 8-variable equations showed excellent areas under the receiver operating characteristic curve of 0.87 and 0.83 for the 2- and 5-year risk of ESRD, respectively. The results of net reclassification improvement, integrated discrimination index and Brier score showed that recalibration improved the prediction models in some cases. The original KFREs showed high discrimination in both CKD stages G3–G5 patients and the total population referred to nephrology in this large Korean cohort. KFREs can be implemented in Korean health systems and can guide nephrology referrals and other CKD-related treatment decisions.
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Affiliation(s)
- Min Woo Kang
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Navdeep Tangri
- Department of Internal Medicine, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
| | - Yong Chul Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jung Nam An
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Jeonghwan Lee
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Lilin Li
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.,Department of Intensive Care Unit, Yanbian University Hospital, Jilin, China
| | - Yun Kyu Oh
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Dong Ki Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Kwon Wook Joo
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Yon Su Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Chun Soo Lim
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jung Pyo Lee
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea. .,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
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Glazyrin YE, Veprintsev DV, Ler IA, Rossovskaya ML, Varygina SA, Glizer SL, Zamay TN, Petrova MM, Minic Z, Berezovski MV, Kichkailo AS. Proteomics-Based Machine Learning Approach as an Alternative to Conventional Biomarkers for Differential Diagnosis of Chronic Kidney Diseases. Int J Mol Sci 2020; 21:ijms21134802. [PMID: 32645927 PMCID: PMC7369970 DOI: 10.3390/ijms21134802] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 07/04/2020] [Accepted: 07/06/2020] [Indexed: 11/16/2022] Open
Abstract
Diabetic nephropathy, hypertension, and glomerulonephritis are the most common causes of chronic kidney diseases (CKD). Since CKD of various origins may not become apparent until kidney function is significantly impaired, a differential diagnosis and an appropriate treatment are needed at the very early stages. Conventional biomarkers may not have sufficient separation capabilities, while a full-proteomic approach may be used for these purposes. In the current study, several machine learning algorithms were examined for the differential diagnosis of CKD of three origins. The tested dataset was based on whole proteomic data obtained after the mass spectrometric analysis of plasma and urine samples of 34 CKD patients and the use of label-free quantification approach. The k-nearest-neighbors algorithm showed the possibility of separation of a healthy group from renal patients in general by proteomics data of plasma with high confidence (97.8%). This algorithm has also be proven to be the best of the three tested for distinguishing the groups of patients with diabetic nephropathy and glomerulonephritis according to proteomics data of plasma (96.3% of correct decisions). The group of hypertensive nephropathy could not be reliably separated according to plasma data, whereas analysis of entire proteomics data of urine did not allow differentiating the three diseases. Nevertheless, the group of hypertensive nephropathy was reliably separated from all other renal patients using the k-nearest-neighbors classifier “one against all” with 100% of accuracy by urine proteome data. The tested algorithms show good abilities to differentiate the various groups across proteomic data sets, which may help to avoid invasive intervention for the verification of the glomerulonephritis subtypes, as well as to differentiate hypertensive and diabetic nephropathy in the early stages based not on individual biomarkers, but on the whole proteomic composition of urine and blood.
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Affiliation(s)
- Yury E. Glazyrin
- Laboratory for Biomolecular and Medical Technologies, Krasnoyarsk State Medical University Named after Prof. V.F. Voyno-Yasenetsky, 660022 Krasnoyarsk, Russia; (T.N.Z.); (A.S.K.)
- Laboratory for Digital Controlled Drugs and Theranostics, Federal Research Center “Krasnoyarsk Science Center of the Siberian Branch of the Russian Academy of Science”, 660036 Krasnoyarsk, Russia;
- Correspondence:
| | - Dmitry V. Veprintsev
- Laboratory for Digital Controlled Drugs and Theranostics, Federal Research Center “Krasnoyarsk Science Center of the Siberian Branch of the Russian Academy of Science”, 660036 Krasnoyarsk, Russia;
| | - Irina A. Ler
- Department of Nephrology, Krasnoyarsk Interdistrict Clinical Hospital of Emergency Medical Care Named after N.S. Karpovich, 660062 Krasnoyarsk, Russia; (I.A.L.); (M.L.R.); (S.A.V.); (S.L.G.)
| | - Maria L. Rossovskaya
- Department of Nephrology, Krasnoyarsk Interdistrict Clinical Hospital of Emergency Medical Care Named after N.S. Karpovich, 660062 Krasnoyarsk, Russia; (I.A.L.); (M.L.R.); (S.A.V.); (S.L.G.)
| | - Svetlana A. Varygina
- Department of Nephrology, Krasnoyarsk Interdistrict Clinical Hospital of Emergency Medical Care Named after N.S. Karpovich, 660062 Krasnoyarsk, Russia; (I.A.L.); (M.L.R.); (S.A.V.); (S.L.G.)
| | - Sofia L. Glizer
- Department of Nephrology, Krasnoyarsk Interdistrict Clinical Hospital of Emergency Medical Care Named after N.S. Karpovich, 660062 Krasnoyarsk, Russia; (I.A.L.); (M.L.R.); (S.A.V.); (S.L.G.)
- Faculty of Medicine, Krasnoyarsk State Medical University Named after Prof. V.F. Voyno-Yasenetsky, 660022 Krasnoyarsk, Russia;
| | - Tatiana N. Zamay
- Laboratory for Biomolecular and Medical Technologies, Krasnoyarsk State Medical University Named after Prof. V.F. Voyno-Yasenetsky, 660022 Krasnoyarsk, Russia; (T.N.Z.); (A.S.K.)
| | - Marina M. Petrova
- Faculty of Medicine, Krasnoyarsk State Medical University Named after Prof. V.F. Voyno-Yasenetsky, 660022 Krasnoyarsk, Russia;
| | - Zoran Minic
- Department of Chemistry and Biomolecular Sciences, University of Ottawa, Ottawa, ON K1N6N5, Canada; (Z.M.); (M.V.B.)
| | - Maxim V. Berezovski
- Department of Chemistry and Biomolecular Sciences, University of Ottawa, Ottawa, ON K1N6N5, Canada; (Z.M.); (M.V.B.)
| | - Anna S. Kichkailo
- Laboratory for Biomolecular and Medical Technologies, Krasnoyarsk State Medical University Named after Prof. V.F. Voyno-Yasenetsky, 660022 Krasnoyarsk, Russia; (T.N.Z.); (A.S.K.)
- Laboratory for Digital Controlled Drugs and Theranostics, Federal Research Center “Krasnoyarsk Science Center of the Siberian Branch of the Russian Academy of Science”, 660036 Krasnoyarsk, Russia;
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54
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Kim SH, Yi SW, Yi JJ, Kim YM, Won YJ. Chronic Kidney Disease Increases the Risk of Hip Fracture: A Prospective Cohort Study in Korean Adults. J Bone Miner Res 2020; 35:1313-1321. [PMID: 32119747 DOI: 10.1002/jbmr.3997] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 02/09/2020] [Accepted: 02/27/2020] [Indexed: 12/16/2022]
Abstract
This study was conducted to examine the association between renal function and hip fracture. We followed up 352,624 Korean adults, who participated in health examinations during 2009-2010 until 2013. Kidney function was assessed by creatinine-based estimated glomerular filtration rate (eGFR) and albuminuria using urine reagent strip results. The incidence of hip fracture was examined by hospital discharge records. Hazard ratios (HRs) for hip fracture were calculated using Cox proportional hazard models after adjusting for multiple confounders. During a mean follow-up of 4.0 years, 1177 participants suffered a hip fracture. Lower eGFR and more severe albuminuria were associated with a higher risk of hip fracture. The HRs for hip fracture were 1.89 (95% confidence interval [CI] 1.47-2.43) and 3.75 (95% CI 2.30-6.11) among participants with eGFRs of 30 to 44 and 15 to 29 mL/min/1.73m2 relative to those with an eGFR ≥60 mL/min/1.73m2 , respectively. The HRs were 1.30 (95% CI 1.02-1.65) for moderate albuminuria and 1.58 (95% CI 1.07-2.35) for severe albuminuria (p for trend = 0.002). Participants with albuminuria had a higher risk of hip fracture than those without albuminuria, even when they belonged to the same eGFR category (HR = 1.75 versus 3.30 for an eGFR of 30 to 44 mL/min/1.73m2 ; HR = 2.72 versus 7.84 for an eGFR of 15 to 29 mL/min/1.73m2 ). The effects of each 10 mL/min/1.73m2 decrease in eGFR were stronger with advancing albuminuria severity (pinteraction = 0.016). In conclusion, both low eGFR and albuminuria were risk factors for incident hip fracture in Korean adults. Moreover, these factors exerted a synergistic effect on the risk of hip fracture. © 2020 American Society for Bone and Mineral Research.
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Affiliation(s)
- Se Hwa Kim
- Department of Internal Medicine, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Republic of Korea.,Institute for Clinical and Translational Research, Catholic Kwandong University College of Medicine, Gangneung, Republic of Korea
| | - Sang-Wook Yi
- Institute for Clinical and Translational Research, Catholic Kwandong University College of Medicine, Gangneung, Republic of Korea.,Department of Preventive Medicine and Public Health, Catholic Kwandong University College of Medicine, Gangneung, Republic of Korea
| | - Jee-Jeon Yi
- Institute for Occupational and Environmental Health, Catholic Kwandong University, Gangneung, Republic of Korea
| | - Yoo Mee Kim
- Department of Internal Medicine, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Republic of Korea.,Institute for Clinical and Translational Research, Catholic Kwandong University College of Medicine, Gangneung, Republic of Korea
| | - Young Jun Won
- Department of Internal Medicine, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Republic of Korea.,Institute for Bio-Medical Convergence, Catholic Kwandong University College of Medicine, Gangneung, Republic of Korea
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55
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Lam NN, Lloyd A, Lentine KL, Quinn RR, Ravani P, Hemmelgarn BR, Klarenbach S, Garg AX. Changes in kidney function follow living donor nephrectomy. Kidney Int 2020; 98:176-186. [PMID: 32571482 DOI: 10.1016/j.kint.2020.03.034] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 02/10/2020] [Accepted: 03/13/2020] [Indexed: 01/28/2023]
Abstract
Better understanding of kidney function after living donor nephrectomy and how it differs by donor characteristics can inform patient selection, counselling, and follow-up care. To evaluate this, we conducted a retrospective matched cohort study of living kidney donors in Alberta, Canada between 2002-2016, using linked healthcare administrative databases. We matched 604 donors to 2,414 healthy non-donors from the general population based on age, sex, year of cohort entry, urban residence and the estimated glomerular filtration rate (eGFR) before cohort entry (nephrectomy date for donors and randomly assigned date for non-donors). The primary outcome was the rate of eGFR change over time (median follow-up seven years; maximum 15 years). The median age of the cohort was 43 years, 64% women, and the baseline (pre-donation) eGFR was 100 mL/min/1.73 m2. Overall, from six weeks onwards, the eGFR increased by +0.35 mL/min/1.73 m2 per year (95% confidence interval +0.21 to +0.48) in donors and significantly decreased by -0.85 mL/min/1.73 m2 per year (-0.94 to -0.75) in the matched healthy non-donors. The change in eGFR between six weeks to two years, two to five years, and over five years among donors was +1.06, +0.64, and -0.06 mL/min/1.73 m2 per year, respectively. In contrast to the steady age-related decline in kidney function in non-donors, post-donation kidney function on average initially increased by 1 mL/min/1.73 m2 per year attributable to glomerular hyperfiltration, which began to plateau by five years post-donation. Thus, the average change in eGFR over time is significantly different between donors and non-donors.
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Affiliation(s)
- Ngan N Lam
- Department of Medicine, Division of Nephrology, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
| | - Anita Lloyd
- Department of Medicine, Division of Nephrology, University of Alberta, Edmonton, Alberta, Canada
| | - Krista L Lentine
- Department of Medicine, Center for Abdominal Transplantation, Saint Louis University, St. Louis, Missouri, USA
| | - Robert R Quinn
- Department of Medicine, Division of Nephrology, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Pietro Ravani
- Department of Medicine, Division of Nephrology, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Brenda R Hemmelgarn
- Department of Medicine, Division of Nephrology, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Scott Klarenbach
- Department of Medicine, Division of Nephrology, University of Alberta, Edmonton, Alberta, Canada
| | - Amit X Garg
- Department of Medicine, Division of Nephrology, Western University, London, Ontario, Canada; Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada; Institute for Clinical Evaluative Sciences (ICES), Ontario, Canada
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56
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Weaver RG, James MT, Ravani P, Weaver CGW, Lamb EJ, Tonelli M, Manns BJ, Quinn RR, Jun M, Hemmelgarn BR. Estimating Urine Albumin-to-Creatinine Ratio from Protein-to-Creatinine Ratio: Development of Equations using Same-Day Measurements. J Am Soc Nephrol 2020; 31:591-601. [PMID: 32024663 PMCID: PMC7062208 DOI: 10.1681/asn.2019060605] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 11/22/2019] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Urine albumin-to-creatinine ratio (ACR) and protein-to-creatinine ratio (PCR) are used to measure urine protein. Recent guidelines endorse ACR use, and equations have been developed incorporating ACR to predict risk of kidney failure. For situations in which PCR only is available, having a method to estimate ACR from PCR as accurately as possible would be useful. METHODS We used data from a population-based cohort of 47,714 adults in Alberta, Canada, who had simultaneous assessments of urine ACR and PCR. After log-transforming ACR and PCR, we used cubic splines and quantile regression to estimate the median ACR from a PCR, allowing for modification by specified covariates. On the basis of the cubic splines, we created models using linear splines to develop equations to estimate ACR from PCR. In a subcohort with eGFR<60 ml/min per 1.73 m2, we then used the kidney failure risk equation to compare kidney failure risk using measured ACR as well as estimated ACR that had been derived from PCR. RESULTS We found a nonlinear association between log(ACR) and log(PCR), with the implied albumin-to-protein ratio increasing from <30% in normal to mild proteinuria to about 70% in severe proteinuria, and with wider prediction intervals at lower levels. Sex was the most important modifier of the relationship between ACR and PCR, with men generally having a higher albumin-to-protein ratio. Estimates of kidney failure risk were similar using measured ACR and ACR estimated from PCR. CONCLUSIONS We developed equations to estimate the median ACR from a PCR, optionally including specified covariates. These equations may prove useful in certain retrospective clinical or research applications where only PCR is available.
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Affiliation(s)
| | - Matthew T James
- Departments of Medicine and
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Pietro Ravani
- Departments of Medicine and
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Colin G W Weaver
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Edmund J Lamb
- Pathology Department, Clinical Biochemistry, East Kent Hospitals University National Health Service Trust, Canterbury, Kent, United Kingdom; and
| | | | - Braden J Manns
- Departments of Medicine and
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Min Jun
- The George Institute for Global Health, University of New South Wales Sydney, Sydney, Australia
| | - Brenda R Hemmelgarn
- Departments of Medicine and
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Kamińska J, Dymicka-Piekarska V, Tomaszewska J, Matowicka-Karna J, Koper-Lenkiewicz OM. Diagnostic utility of protein to creatinine ratio (P/C ratio) in spot urine sample within routine clinical practice. Crit Rev Clin Lab Sci 2020; 57:345-364. [PMID: 32058809 DOI: 10.1080/10408363.2020.1723487] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The spot (random) urine protein to creatinine ratio (P/C ratio) is an alternative, fast and simple method of detecting and estimating the quantitative assessment of proteinuria. The aim of the work was to review the literature concerning the usefulness of spot urine P/C ratio evaluation in the diagnosis of proteinuria in the course of kidney disease, hypertension, gestational hypertension, preeclampsia, immunological diseases, diabetes mellitus, and multiple myeloma, and in the diagnosis of proteinuria in children. We searched the PubMed and Google Scholar databases using the following keywords: proteinuria, spot urine protein to creatinine ratio, spot urine P/C ratio, protein creatinine index, PCR (protein to creatinine ratio), P/C ratio and methods, Jaffe versus enzymatic creatinine methods, urine protein methods, spot urine protein to creatinine ratio versus ACR (albumin to creatinine ratio), proteinuria versus albuminuria, limitations of the P/C ratio. More weight was given to the articles published in the last 10-20 years. A spot urine P/C ratio >20 mg/mmol (0.2 mg/mg) is the most commonly reported cutoff value for detecting proteinuria, while a P/C ratio value >350 mg/mmol (3.5 mg/mg) confirms nephrotic proteinuria. The International Society for the Study of Hypertension in Pregnancy recommends a P/C ratio of 30 mg/mmol (0.3 mg/mg) for the classification of proteinuria in pregnant women at risk of preeclampsia. A high degree of correlation was observed between P/C ratio values and the protein concentration in 24-h urine collections. The spot urine P/C ratio is a quick and reliable test that can eliminate the need for a daily 24-h urine collection. However, in doubtful situations, it is still recommended to assess proteinuria in a 24-h urine collection. The literature review indicates the usefulness of the spot P/C ratio in various disease states; therefore, this test should be available in every laboratory. However, the challenge for the primary care physician is to know the limitations of the methods used to determine the protein and creatinine concentrations that are used to calculate the P/C ratio. Moreover, the P/C ratio cutoff used should be determined in individual laboratories because it depends on the patient population and the laboratory methodologies.
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Affiliation(s)
- Joanna Kamińska
- Department of Clinical Laboratory Diagnostics, Medical University of Białystok, Białystok, Poland
| | | | - Justyna Tomaszewska
- Scientific Student's Club at the Department of Clinical Laboratory Diagnostics, Medical University of Białystok, Białystok, Poland
| | - Joanna Matowicka-Karna
- Department of Clinical Laboratory Diagnostics, Medical University of Białystok, Białystok, Poland
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de Souza ABC, Arantes MF, Zatz R, Elias RM, Lopes RI, Macedo E. Influence of low free thyroxine on progression of chronic kidney disease. BMC Nephrol 2020; 21:36. [PMID: 32000713 PMCID: PMC6993384 DOI: 10.1186/s12882-019-1677-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 12/30/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hypothyroidism is highly prevalent in patients with chronic kidney disease (CKD) and has been associated with poorer clinical outcomes, including faster decline of kidney function. However, there is no consensus whether low free thyroxin (LFT) affects the rate of estimated glomerular filtration rate (eGFR) decline and how the presence of proteinuria influences the progression of renal dysfunction in hypothyroidism. METHODS We assessed thyroid status, proteinuria, and progression of eGFR by Modification of Diet in Renal Disease equation and CKD-EPI equation in a cohort of CKD patients followed in general nephrology clinics. We estimated the association of LFT levels, and the degree of proteinuria on progression of eGFR. We adjusted for other covariables: age, gender, body mass index, diabetes, hypertension, HbA1c, uric acid, cholesterol, and triglycerides levels.. RESULTS One thousand six hundred ten patients (64 ± 15 years, 46.8% men, 25.3% diabetic) were included. At beggnining of follow up eGFR was between 45 and 60, 30-45 and 15-30 ml/min/1.73m2 in 479 (29.8%), 551(34.2%), and 580(36.0%) patients, respectively. LFT levels were available at initial evaluation in 288(17.9%) patients and 735(48.5%) had assessment of proteinuria (19.6% with LFT vs. 15.4% without LFT, p = 0.032). Median follow-up time was of 21 months, and 1223(76%) had at least 1 year of follow up. Overall, eGFR decline per month was - 0.05(- 0.26, 0.23) ml/min/1.73m2, reaching 1.7(1.3, 2.4) ml/min/1.73m2 by the end of study period. Similar results were obtained using CKD-EPI. Multivariable mixed linear analysis showed that proteinuria and age were independently associated with eGFR decline, with no effect of LFT, and no interaction between proteinuria and LFT. In patients without proteinuria, there was an improvement of eGFR despite the presence of LFT. CONCLUSIONS We confirmed a faster rate of eGFR declined in patients with proteinuria. However, despite the pathophysiological rational that hypothyroidism can lead to increased rate of CKD progression, we failed to demonstrate an association between LFT and rate of CKD progression. We conclude that the benefit of hypothyroidism treatment in CKD patients needs to be evaluate in prospective studies.
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Affiliation(s)
| | - Marcia Fernanda Arantes
- Nephrology Service, Hospital das Clinicas HCFMUSP, Universidade de São Paulo, São Paulo, Brazil.
| | - Roberto Zatz
- Nephrology Service, Hospital das Clinicas HCFMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Rosilene Motta Elias
- Nephrology Service, Hospital das Clinicas HCFMUSP, Universidade de São Paulo, São Paulo, Brazil
- Universidade Nove de Julho, UNINOVE, São Paulo, Brazil
| | - Roberto Iglesias Lopes
- Urology Service Hospital das Clinicas HCFMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Etienne Macedo
- Nephrology Division, Department of Medicine, University of California San Diego, San Diego, California, USA
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Oh HJ, Kim CT, Ryu DR. Effect of Renin-Angiotensin System Blockade on Mortality in Korean Hypertensive Patients with Proteinuria. Electrolyte Blood Press 2020; 17:25-35. [PMID: 31969921 PMCID: PMC6962440 DOI: 10.5049/ebp.2019.17.2.25] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 10/10/2019] [Accepted: 10/28/2019] [Indexed: 01/13/2023] Open
Abstract
Background Although renin-angiotensin system (RAS) blockade is recommended for hypertensive patients with proteinuria, the effect of RAS blockade on Korean hypertensive patients has not been investigated. Methods Among individuals who underwent a National Health Examination between 2002 and 2003 in Korea, hypertensive patients with proteinuria (defined as a dipstick test result ≥2+) were enrolled in this study. We investigated the outcomes of two groups stratified by RAS blockade prescription (with RAS blockade vs. without RAS blockade). Moreover, Cox proportional hazard regression and Kaplan-Meier analyses were performed to examine the effects of RAS blockade on mortality and end-stage renal disease (ESRD). Results A total of 8,460 patients were enrolled in this study, of whom 6,236 (73.7%) were prescribed with RAS blockade. The mean follow-up period was 129 months. A total of 1,003 (11.9%) patients died, of whom 273 (3.2%) died of cardiovascular (CV) events. The Kaplan-Meier curves for all-cause or CV mortality showed that the survival probability was significantly higher in the RAS blockade group than in the non-RAS blockade group. Multivariate Cox analysis also revealed RAS blockade significantly reduced the all-cause and CV mortality rates by 39.1% and 33.7%, respectively, compared with non-RAS blockade, even after adjusting for age, sex, and comorbid diseases; however, ESRD was not affected. Conclusion In this study, we found that RAS blockade was significantly associated with a reduction in mortality but not in the incidence of ESRD. However, 26.3% of the enrolled patients did not use RAS blockade. Physicians need to consider the usefulness of RAS blockade in hypertensive patients with proteinuria.
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Affiliation(s)
- Hyung Jung Oh
- Ewha Institute of Convergence Medicine, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - Clara Tammy Kim
- Institute of Life and Death Studies, Hallym University, Chuncheon, Korea
| | - Dong-Ryeol Ryu
- School of Medicine, Ewha Womans University, Seoul, Korea.,Tissue Injury Defense Research Center, Ewha Womans University, Seoul, Korea
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Liu L, Gao B, Wang J, Yang C, Wu S, Wu Y, Chen S, Li Q, Zhang H, Wang G, Chen M, Zhao MH, Zhang L. Reduction in Serum High-Sensitivity C-Reactive Protein Favors Kidney Outcomes in Patients with Impaired Fasting Glucose or Diabetes. J Diabetes Res 2020; 2020:2720905. [PMID: 32587865 PMCID: PMC7303740 DOI: 10.1155/2020/2720905] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 05/22/2020] [Accepted: 05/27/2020] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE We aimed to evaluate whether the reduction in serum high-sensitivity C-reactive protein (hs-CRP) favors kidney outcomes. METHODS This study was a subanalysis including patients with impaired fasting glucose or diabetes of the Kailuan cohort study. The predictor was based on two consecutive visits of hs-CRP levels in 2006 and 2008. A total of 3924 patients with hs-CRP ≥ 3 mg/L in 2006 were divided into two groups according to whether the levels of hs-CRP were reduced in 2008: Group 1: no reduction: hs-CRP ≥ 3 mg/L in 2008; Group 2: reduction: hs-CRP < 3 mg/L in 2008. Kidney outcomes include kidney function decline and development and progression of proteinuria and were followed up until the end of 2015. RESULTS There were 3905, 2049, and 493 patients included into our analysis for the outcomes of kidney function decline and the development and progression of proteinuria, respectively. A total of 398, 297, and 47 events occurred after 5 years of follow-up, respectively. Cox regression revealed that patients with reduction in hs-CRP have lower risk of kidney function decline (HR 0.71, 95% CI 0.57-0.89, and P = 0.002) and development of proteinuria (0.77, 0.61-0.99, and P = 0.038) after controlling for potential confounders as compared to those with no reduction in hs-CRP levels. CONCLUSIONS Reduction in serum hs-CRP levels favors kidney outcomes in patients with impaired fasting glucose or diabetes.
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Affiliation(s)
- Lili 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, Key Laboratory of Chronic Kidney Disease Prevention and Treatment, Ministry of Education, Beijing 100034, China
| | - Bixia Gao
- Renal Division, Department of Medicine, Peking University First Hospital, Peking University Institute of Nephrology, Key Laboratory of Renal Disease, Ministry of Health of China, Key Laboratory of Chronic Kidney Disease Prevention and Treatment, Ministry of Education, Beijing 100034, China
| | - Jinwei 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, Key Laboratory of Chronic Kidney Disease Prevention and Treatment, Ministry of Education, Beijing 100034, China
| | - Chao 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, Key Laboratory of Chronic Kidney Disease Prevention and Treatment, Ministry of Education, Beijing 100034, China
| | - Shouling Wu
- Department of Cardiology, Kailuan General Hospital, Tangshan 063001, China
| | - Yuntao Wu
- Department of Cardiology, Kailuan General Hospital, Tangshan 063001, China
| | - Shuohua Chen
- Department of Health Care Center, Kailuan General Hospital, Tangshan 063001, China
| | - Qiuyun Li
- Department of Endocrinology, Kailuan General Hospital, Tangshan 063001, China
| | - Huifen Zhang
- Department of Laboratory, Kailuan General Hospital, Tangshan 063001, China
| | - Guodong Wang
- Department of Cardiology, Kailuan General Hospital, Tangshan 063001, China
| | - Min Chen
- Renal Division, Department of Medicine, Peking University First Hospital, Peking University Institute of Nephrology, Key Laboratory of Renal Disease, Ministry of Health of China, Key Laboratory of Chronic Kidney Disease Prevention and Treatment, Ministry of Education, Beijing 100034, China
| | - Ming-hui Zhao
- Renal Division, Department of Medicine, Peking University First Hospital, Peking University Institute of Nephrology, Key Laboratory of Renal Disease, Ministry of Health of China, Key Laboratory of Chronic Kidney Disease Prevention and Treatment, Ministry of Education, Beijing 100034, China
- Peking-Tsinghua Center for Life Sciences, Beijing 100034, China
| | - Luxia Zhang
- Renal Division, Department of Medicine, Peking University First Hospital, Peking University Institute of Nephrology, Key Laboratory of Renal Disease, Ministry of Health of China, Key Laboratory of Chronic Kidney Disease Prevention and Treatment, Ministry of Education, Beijing 100034, China
- National Institute of Health Data Science at Peking University, Beijing 100191, China
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Wang Y, Nguyen FNHL, Allen JC, Lew JQL, Tan NC, Jafar TH. Validation of the kidney failure risk equation for end-stage kidney disease in Southeast Asia. BMC Nephrol 2019; 20:451. [PMID: 31801468 PMCID: PMC6894117 DOI: 10.1186/s12882-019-1643-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 11/25/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Patients with chronic kidney disease (CKD) are at high risk of end-stage kidney disease (ESKD). The Kidney Failure Risk Equation (KFRE), which predicts ESKD risk among patients with CKD, has not been validated in primary care clinics in Southeast Asia (SEA). Therefore, we aimed to (1) evaluate the performance of existing KFRE equations, (2) recalibrate KFRE for better predictive precision, and (3) identify optimally feasible KFRE thresholds for nephrologist referral and dialysis planning in SEA. METHODS All patients with CKD visiting nine primary care clinics from 2010 to 2013 in Singapore were included and applied 4-variable KFRE equations incorporating age, sex, estimated glomerular filtration rate (eGFR), and albumin-to-creatinine ratio (ACR). ESKD onset within two and five years were acquired via linkage to the Singapore Renal Registry. A weighted Brier score (the squared difference between observed vs predicted ESKD risks), bias (the median difference between observed vs predicted ESKD risks) and precision (the interquartile range of the bias) were used to select the best-calibrated KFRE equation. RESULTS The recalibrated KFRE (named Recalibrated Pooled KFRE SEA) performed better than existing and other recalibrated KFRE equations in terms of having a smaller Brier score (square root: 2.8% vs. 4.0-9.3% at 5 years; 2.0% vs. 6.1-9.1% at 2 years), less bias (2.5% vs. 3.3-5.2% at 5 years; 1.8% vs. 3.2-3.6% at 2 years), and improved precision (0.5% vs. 1.7-5.2% at 5 years; 0.5% vs. 3.8-4.2% at 2 years). Area under ROC curve for the Recalibrated Pooled KFRE SEA equations were 0.94 (95% confidence interval [CI]: 0.93 to 0.95) at 5 years and 0.96 (95% CI: 0.95 to 0.97) at 2 years. The optimally feasible KFRE thresholds were > 10-16% for 5-year nephrologist referral and > 45% for 2-year dialysis planning. Using the Recalibrated Pooled KFRE SEA, an estimated 82 and 89% ESKD events were included among 10% of subjects at highest estimated risk of ESKD at 5-year and 2-year, respectively. CONCLUSIONS The Recalibrated Pooled KFRE SEA performs better than existing KFREs and warrants implementation in primary care settings in SEA.
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Affiliation(s)
- Yeli Wang
- Program in Health Services and Systems Research, Duke-NUS Medical School, 8 College Road, Singapore, Singapore
| | | | - John C Allen
- Center for Quantitative Medicine, Office of Clinical Sciences, Duke-NUS Medical School, Singapore, Singapore
| | | | - Ngiap Chuan Tan
- Health Services Research Centre, SingHealth, Singapore, Singapore.,SingHealth Polyclinics, Singapore, Singapore.,SingHealth-Duke NUS Family Academic Clinical Program, Singapore, Singapore
| | - Tazeen H Jafar
- Program in Health Services and Systems Research, Duke-NUS Medical School, 8 College Road, Singapore, Singapore. .,Health Services Research Centre, SingHealth, Singapore, Singapore. .,Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore. .,Duke Global Health Institute, Duke University, Durham, NC, USA.
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A Portable System to Monitor Saliva Conductivity for Dehydration Diagnosis and Kidney Healthcare. Sci Rep 2019; 9:14771. [PMID: 31611585 PMCID: PMC6791883 DOI: 10.1038/s41598-019-51463-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 09/28/2019] [Indexed: 12/13/2022] Open
Abstract
Chronic kidney disease (CKD) has become a major issue in long-term healthcare. It is caused by recurrent kidney injury, which is possible induced by dehydration and heat stress. Therefore, it is important to access the dehydration diagnosis on fields. Conventional instruments for assessing dehydration from blood and urine samples are expensive and time-consuming. These disadvantages limit their applications in high-risk groups susceptible to kidney disease. To address this unmet need, this study presents a portable miniaturized device for dehydration diagnosis with clinical saliva samples. With co-plane coating-free gold electrodes, the dehydration diagnosis was achieved with a saliva specimen at low volumes (50–500 μL). To examine the characteristics, the developed device was assessed by using standard conductivity solutions and the examined variation was <5%. To validate the use for field applications, saliva samples were measured by the developed device and the measured results were compared with standard markers of serum osmolality (N = 30). These data indicate that the measured saliva conductivity is consistent with serum osmolality. And it shows significant difference between healthy adults and healthy farmers (p < 0.05), who typically suffer high risks of CKD. Based on this work, the proposed device and measurement offer a useful method to diagnosis dehydrations and indicate possible potential for CKD.
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Role of anemia and proteinuria in the development of subsequent renal function deterioration in a general population with preserved glomerular filtration rate: a community-based cohort study. J Nephrol 2019; 32:775-781. [DOI: 10.1007/s40620-019-00605-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 03/26/2019] [Indexed: 10/27/2022]
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64
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Hsu CY, Hsu RK, Liu KD, Yang J, Anderson A, Chen J, Chinchilli VM, Feldman HI, Garg AX, Hamm L, Himmelfarb J, Kaufman JS, Kusek JW, Parikh CR, Ricardo AC, Rosas SE, Saab G, Sha D, Siew ED, Sondheimer J, Taliercio JJ, Yang W, Go AS. Impact of AKI on Urinary Protein Excretion: Analysis of Two Prospective Cohorts. J Am Soc Nephrol 2019; 30:1271-1281. [PMID: 31235617 PMCID: PMC6622423 DOI: 10.1681/asn.2018101036] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 03/30/2019] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Prior studies of adverse renal consequences of AKI have almost exclusively focused on eGFR changes. Less is known about potential effects of AKI on proteinuria, although proteinuria is perhaps the strongest risk factor for future loss of renal function. METHODS We studied enrollees from the Assessment, Serial Evaluation, and Subsequent Sequelae of AKI (ASSESS-AKI) study and the subset of the Chronic Renal Insufficiency Cohort (CRIC) study enrollees recruited from Kaiser Permanente Northern California. Both prospective cohort studies included annual ascertainment of urine protein-to-creatinine ratio, eGFR, BP, and medication use. For hospitalized participants, we used inpatient serum creatinine measurements obtained as part of clinical care to define an episode of AKI (i.e., peak/nadir inpatient serum creatinine ≥1.5). We performed mixed effects regression to examine change in log-transformed urine protein-to-creatinine ratio after AKI, controlling for time-updated covariates. RESULTS At cohort entry, median eGFR was 62.9 ml/min per 1.73 m2 (interquartile range [IQR], 46.9-84.6) among 2048 eligible participants, and median urine protein-to-creatinine ratio was 0.12 g/g (IQR, 0.07-0.25). After enrollment, 324 participants experienced at least one episode of hospitalized AKI during 9271 person-years of follow-up; 50.3% of first AKI episodes were Kidney Disease Improving Global Outcomes stage 1 in severity, 23.8% were stage 2, and 25.9% were stage 3. In multivariable analysis, an episode of hospitalized AKI was independently associated with a 9% increase in the urine protein-to-creatinine ratio. CONCLUSIONS Our analysis of data from two prospective cohort studies found that hospitalization for an AKI episode was independently associated with subsequent worsening of proteinuria.
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Affiliation(s)
- Chi-yuan Hsu
- Department of Medicine, University of California, San Francisco, San Francisco, California;,Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Raymond K. Hsu
- Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Kathleen D. Liu
- Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Jingrong Yang
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | | | - Jing Chen
- Medicine, Tulane University, New Orleans, Louisiana
| | - Vernon M. Chinchilli
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | | | - Amit X. Garg
- Department of Medicine, Western University, London, Ontario, Canada
| | - Lee Hamm
- Medicine, Tulane University, New Orleans, Louisiana
| | | | - James S. Kaufman
- Veterans Affairs New York Harbor Healthcare System, New York, New York;,Department of Medicine, New York University School of Medicine, New York, New York
| | | | - Chirag R. Parikh
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Ana C. Ricardo
- Department of Medicine, University of Illinois, Chicago, Illinois
| | - Sylvia E. Rosas
- Kidney and Hypertension Unit, Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts
| | - Georges Saab
- Case Western Reserve University and Metrohealth Medical Center, Cleveland, Ohio
| | - Daohang Sha
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Edward D. Siew
- Vanderbilt University Medical Center and Nashville Veterans Affairs Hospital, Nashville, Tennessee
| | - James Sondheimer
- Department of Medicine, Wayne State University School of Medicine, Detroit, Michigan; and
| | | | - Wei Yang
- Department of Biostatistics and Epidemiology, and
| | - Alan S. Go
- Department of Medicine, University of California, San Francisco, San Francisco, California;,Division of Research, Kaiser Permanente Northern California, Oakland, California
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65
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Guedes AM. Peritoneal Protein Loss, Leakage or Clearance in Peritoneal Dialysis, Where do we Stand? Perit Dial Int 2019; 39:201-209. [DOI: 10.3747/pdi.2018.00138] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 12/28/2018] [Indexed: 11/15/2022] Open
Abstract
Peritoneal protein loss (PPL) through peritoneal effluent has been a well-recognized detrimental result of peritoneal dialysis (PD) treatment since its inception. Investigation has focused mainly on PPL quantitative and qualitative determinations and evaluation of its prognostic value. A comprehensive review of the pathophysiology of PPL (3-pore model revisited), methods of quantification, dialysate protein composition, and impact on clinical outcomes is presented herein. The author summarizes a brief analysis of associated cardiovascular disease and nutritional consequences, exploring the controversial cause-effect on mortality and technique failure. Therapeutic modalities aiming to reduce PPL (angiotensin-converting enzyme inhibitors [ACEI]s and vitamin D therapies) were explored, although it is unclear whether PPL represents a valid therapeutic target or, on the other hand, is solely a manifestation of endothelial dysfunction.
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Affiliation(s)
- Anabela Malho Guedes
- Serviço de Nefrologia, Centro Hospitalar Universitário do Algarve, Faro, Portugal; Algarve Biomedical Center, Faro, Portugal
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66
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Yi SW, Moon SJ, Yi JJ. Low-normal hemoglobin levels and anemia are associated with increased risk of end-stage renal disease in general populations: A prospective cohort study. PLoS One 2019; 14:e0215920. [PMID: 31022266 PMCID: PMC6483202 DOI: 10.1371/journal.pone.0215920] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 04/10/2019] [Indexed: 11/18/2022] Open
Abstract
Background The impact of low-normal hemoglobin (Hb) levels and anemia on the risk of end-stage renal disease (ESRD) in general populations has rarely been examined. Methods 510,620 Korean adults aged 40–80 years without known chronic kidney disease (CKD) underwent health examinations during 2002–2003 and were followed-up until 2013. Incidence of ESRD was identified by hospital discharge and clinical visit records. Results During a mean follow-up of 10.5, 575 women and 1047 men were diagnosed with ESRD. Lower Hb levels were associated with an increased risk of ESRD at given severity of albuminuria and at given estimated glomerular filtration rate (eGFR). Hb 13–13.9 g/dL in men, Hb 11–11.9 g/dL in women, and trace albuminuria assessed by dipstick urinalysis were associated with more than doubled risk. The risk associated with lower Hb was stronger in older (≥60 years) than younger women. Among 349,993 participants with information on eGFR, the multivariable-adjusted HRs associated with 1 g/dL lower Hb in participants with eGFR values ≥60, 30–59, and <30 mL/min/1.73 m2 were 1.34 (95% CI, 1.17–1.54), 1.55 (1.38–1.74), and 1.75 (1.47–2.09), respectively (Pinteraction between eGFR groups = .06). Conclusions Low-normal Hb levels and anemia are risk factors for ESRD incidence in person without CKD and for CKD progression to ESRD. Lower Hb increases the risk of ESRD through synergistic biological interactions with lower eGFR and albuminuria. The impacts of lower Hb may be stronger in older than younger women. Proper management and screening at earlier stage of Hb decline and anemia might reduce the burden of CKD.
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Affiliation(s)
- Sang-Wook Yi
- Department of Preventive Medicine and Public Health, Catholic Kwandong University College of Medicine, Gangneung, Republic of Korea
- * E-mail:
| | - Sung Jin Moon
- Department of Internal Medicine, Catholic Kwandong University College of Medicine, International St. Mary's Hospital, Incheon, Republic of Korea
| | - Jee-Jeon Yi
- Institute for Occupational and Environmental Health, Catholic Kwandong University, Gangneung, Republic of Korea
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67
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Doi R. Maximizing the Accuracy of Continuous Quantification Measures Using Discrete PackTest Products with Deep Learning and Pseudocolor Imaging. JOURNAL OF ANALYTICAL METHODS IN CHEMISTRY 2019; 2019:1685382. [PMID: 31093418 PMCID: PMC6481099 DOI: 10.1155/2019/1685382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 01/31/2019] [Accepted: 02/14/2019] [Indexed: 06/09/2023]
Abstract
Using the standard colors provided in the instructions, PackTest products can approximate and quickly estimate the chemical characteristics of liquid samples. The combination of PackTest products and deep learning was examined for its accuracy and precision in quantifying chemical oxygen demand, ammonium ion, and phosphate ion using a pseudocolor imaging method. Each PackTest product underwent reactions with standard solutions. The generated color was scanner-read. From the color image, ten grayscale images representing the intensity values of red, green, blue, cyan, magenta, yellow, key black, and L ∗ , and the values of a ∗ and b ∗ were generated. Using the grayscale images representing the red, green, and blue intensity values, 73 other grayscale images were generated. The grayscale intensity values were used to prepare datasets for the ten and 83 (=10 + 73) images. For both datasets, chemical oxygen demand quantification was successful, resulting in values of normalized mean absolute error of less than 0.4% and coefficients of determination that were greater than 0.9996. However, the quantification of ammonium and phosphate ions commonly provided false positive results for the standard solution that contained no ammonium ion/phosphate ion. For ammonium ion, multiple regression markedly improved the accuracy using the pseudocolor method. Phosphate ion quantification was also improved by avoiding the use of an estimated value for the reference solution that contained no phosphate ion. Real details of the measurements and the perspectives were discussed.
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Affiliation(s)
- Ryoichi Doi
- Faculty of Social-Human Environmentology, Daito Bunka University, 1-9-1 Takashimadaira, Itabashi-ku, Tokyo 175-8571, Japan
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68
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James MT, Levey AS, Tonelli M, Tan Z, Barry R, Pannu N, Ravani P, Klarenbach SW, Manns BJ, Hemmelgarn BR. Incidence and Prognosis of Acute Kidney Diseases and Disorders Using an Integrated Approach to Laboratory Measurements in a Universal Health Care System. JAMA Netw Open 2019; 2:e191795. [PMID: 30951162 PMCID: PMC6450331 DOI: 10.1001/jamanetworkopen.2019.1795] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 02/18/2019] [Indexed: 12/29/2022] Open
Abstract
Importance Abnormal measurements of kidney function or structure may be identified that do not meet criteria for acute kidney injury (AKI) or chronic kidney disease (CKD) but nonetheless may require medical attention. The Kidney Disease: Improving Global Outcomes Clinical Practice Guideline for AKI proposed criteria for the definition of acute kidney diseases and disorders (AKD), which include AKI; however, the incidence and prognosis of AKD without AKI remain unknown. Objective To characterize the incidence and outcomes of AKD without AKI, with or without CKD. Design, Setting, and Participants Retrospective cohort study including all adult residents in a universal health care system in Alberta, Canada, without end-stage kidney disease (ESKD) and with at least 1 serum creatinine measurement between January 1 and December 31, 2008, in a community or hospital setting. Data analysis took place in 2018. Main Outcomes and Measures The Kidney Disease: Improving Global Outcomes guideline definitions for CKD, AKI, and AKD based on serum creatinine, estimated glomerular filtration rate, and albuminuria criteria were applied to estimate the proportion of patients with CKD, AKI, and AKD without AKI, and combinations of the conditions. Patients were followed up for up to 8 years (study end date, June 31, 2016) to characterize their risks of mortality, development of new CKD, progression of preexisting CKD, and ESKD. Results Among 1 109 099 Alberta residents included in the cohort, the mean (SD) age was 52.3 (17.6) years, and 43.0% were male. Findings showed that AKD without AKI was common (3.8 individuals without preexisting CKD and 0.6 with preexisting CKD per 100 population tested). In Cox proportional hazards and competing risks models over a median (interquartile range) of 6.0 (5.7-6.3) years of follow-up, AKD without AKI (compared with no kidney disease) was associated with higher risks of developing new CKD (37.4% vs 7.4%%; adjusted sub-hazard ratio [sHR], 3.17; 95% CI, 3.10-3.23), progression of preexisting CKD (49.5% vs 34.6%; adjusted sHR, 1.38; 95% CI, 1.33-1.44), ESKD (0.6% vs 0.1%; adjusted sHR, 8.56; 95% CI, 7.32-10.01), and death (25.8% vs 7.3%; adjusted hazard ratio, 1.42; 95% CI, 1.39-1.45). Conclusions and Relevance Criteria for AKD identified many patients who did not meet the criteria for CKD or AKI but had overall modestly increased risks of incident and progressive CKD, ESKD, and death. The clinical importance of AKD remains to be determined.
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Affiliation(s)
- Matthew T. James
- Department of Medicine, Cumming School of Medicine, University of Calgary, Alberta, Canada
- Libin Cardiovascular Institute of Alberta, Cumming School of Medicine, University of Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada
- O’Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | | | - Marcello Tonelli
- Department of Medicine, Cumming School of Medicine, University of Calgary, Alberta, Canada
- Libin Cardiovascular Institute of Alberta, Cumming School of Medicine, University of Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada
- O’Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Zhi Tan
- Department of Medicine, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Rebecca Barry
- Department of Medicine, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Neesh Pannu
- Department of Medicine, University of Alberta, Alberta, Canada
| | - Pietro Ravani
- Department of Medicine, Cumming School of Medicine, University of Calgary, Alberta, Canada
- Libin Cardiovascular Institute of Alberta, Cumming School of Medicine, University of Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada
- O’Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | | | - Braden J. Manns
- Department of Medicine, Cumming School of Medicine, University of Calgary, Alberta, Canada
- Libin Cardiovascular Institute of Alberta, Cumming School of Medicine, University of Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada
- O’Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Brenda R. Hemmelgarn
- Department of Medicine, Cumming School of Medicine, University of Calgary, Alberta, Canada
- Libin Cardiovascular Institute of Alberta, Cumming School of Medicine, University of Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada
- O’Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Alberta, Canada
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69
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Benonisdottir S, Kristjansson RP, Oddsson A, Steinthorsdottir V, Mikaelsdottir E, Kehr B, Jensson BO, Arnadottir GA, Sulem G, Sveinbjornsson G, Kristmundsdottir S, Ivarsdottir EV, Tragante V, Gunnarsson B, Runolfsdottir HL, Arthur JG, Deaton AM, Eyjolfsson GI, Davidsson OB, Asselbergs FW, Hreidarsson AB, Rafnar T, Thorleifsson G, Edvardsson V, Sigurdsson G, Helgadottir A, Halldorsson BV, Masson G, Holm H, Onundarson PT, Indridason OS, Benediktsson R, Palsson R, Gudbjartsson DF, Olafsson I, Thorsteinsdottir U, Sulem P, Stefansson K. Sequence variants associating with urinary biomarkers. Hum Mol Genet 2019; 28:1199-1211. [PMID: 30476138 PMCID: PMC6423415 DOI: 10.1093/hmg/ddy409] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 11/15/2018] [Accepted: 11/20/2018] [Indexed: 12/21/2022] Open
Abstract
Urine dipstick tests are widely used in routine medical care to diagnose kidney and urinary tract and metabolic diseases. Several environmental factors are known to affect the test results, whereas the effects of genetic diversity are largely unknown. We tested 32.5 million sequence variants for association with urinary biomarkers in a set of 150 274 Icelanders with urine dipstick measurements. We detected 20 association signals, of which 14 are novel, associating with at least one of five clinical entities defined by the urine dipstick: glucosuria, ketonuria, proteinuria, hematuria and urine pH. These include three independent glucosuria variants at SLC5A2, the gene encoding the sodium-dependent glucose transporter (SGLT2), a protein targeted pharmacologically to increase urinary glucose excretion in the treatment of diabetes. Two variants associating with proteinuria are in LRP2 and CUBN, encoding the co-transporters megalin and cubilin, respectively, that mediate proximal tubule protein uptake. One of the hematuria-associated variants is a rare, previously unreported 2.5 kb exonic deletion in COL4A3. Of the four signals associated with urine pH, we note that the pH-increasing alleles of two variants (POU2AF1, WDR72) associate significantly with increased risk of kidney stones. Our results reveal that genetic factors affect variability in urinary biomarkers, in both a disease dependent and independent context.
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Affiliation(s)
| | | | | | | | | | - Birte Kehr
- Berlin Institute of Health (BIH), Berlin, Germany
| | | | | | | | | | - Snaedis Kristmundsdottir
- deCODE genetics/Amgen Inc., Reykjavik, Iceland
- School of Science and Engineering, Reykjavik University, Reykjavik, Iceland
| | - Erna V Ivarsdottir
- deCODE genetics/Amgen Inc., Reykjavik, Iceland
- School of Engineering and Natural Sciences, University of Iceland, Reykjavik, Iceland
| | - Vinicius Tragante
- deCODE genetics/Amgen Inc., Reykjavik, Iceland
- Department of Cardiology, Division Heart & Lungs, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | | | | | - Joseph G Arthur
- deCODE genetics/Amgen Inc., Reykjavik, Iceland
- Department of Statistics, Stanford University, Stanford, CA, USA
| | | | | | | | - Folkert W Asselbergs
- Department of Cardiology, Division Heart & Lungs, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
- Durrer Center for Cardiovascular Research, Netherlands Heart Institute, Utrecht, the Netherlands
- Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, London, UK
- Farr Institute of Health Informatics Research and Institute of Health Informatics, University College London, London, UK
| | - Astradur B Hreidarsson
- Division of Endocrinology and Metabolic Medicine, Internal Medicine Services, Landspitali, National University Hospital of Iceland, Reykjavik, Iceland
| | | | | | - Vidar Edvardsson
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
- The Rare Kidney Stone Consortium, Mayo Clinic, Rochester, MN, USA
- Children's Medical Center, Landspitali, National University Hospital of Iceland, Reykjavik, Iceland
| | - Gunnar Sigurdsson
- Division of Endocrinology and Metabolic Medicine, Internal Medicine Services, Landspitali, National University Hospital of Iceland, Reykjavik, Iceland
- Icelandic Heart Association, Kópavogur, Iceland
| | | | - Bjarni V Halldorsson
- deCODE genetics/Amgen Inc., Reykjavik, Iceland
- School of Science and Engineering, Reykjavik University, Reykjavik, Iceland
| | | | - Hilma Holm
- deCODE genetics/Amgen Inc., Reykjavik, Iceland
| | - Pall T Onundarson
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
- Department of Laboratory Hematology, Landspitali, National University Hospital of Iceland, Reykjavik, Iceland
| | - Olafur S Indridason
- Division of Nephrology, Internal Medicine Services, Landspitali, National University Hospital of Iceland, Reykjavik, Iceland
| | - Rafn Benediktsson
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
- Division of Endocrinology and Metabolic Medicine, Internal Medicine Services, Landspitali, National University Hospital of Iceland, Reykjavik, Iceland
| | - Runolfur Palsson
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
- The Rare Kidney Stone Consortium, Mayo Clinic, Rochester, MN, USA
- Division of Nephrology, Internal Medicine Services, Landspitali, National University Hospital of Iceland, Reykjavik, Iceland
| | - Daniel F Gudbjartsson
- deCODE genetics/Amgen Inc., Reykjavik, Iceland
- School of Engineering and Natural Sciences, University of Iceland, Reykjavik, Iceland
| | - Isleifur Olafsson
- Department of Clinical Biochemistry, Landspitali, National University Hospital of Iceland, Reykjavik, Iceland
| | - Unnur Thorsteinsdottir
- deCODE genetics/Amgen Inc., Reykjavik, Iceland
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | | | - Kari Stefansson
- deCODE genetics/Amgen Inc., Reykjavik, Iceland
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
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Doi R. Synergistic Effects of Pseudocolor Imaging, Differentiation, and Square and Logarithmic Conversion on Accuracy of Quantification of Chemical Characteristics Using Test Strips and Similar Products. ANAL LETT 2019. [DOI: 10.1080/00032719.2018.1556276] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Ryoichi Doi
- Faculty of Social-Human Environmentology, Daito Bunka University, Tokyo, Japan
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71
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Gao B, Wu S, Wang J, Yang C, Chen S, Hou J, Li J, Yang Y, He K, Zhao M, Chen M, Zhang L. Clinical features and long-term outcomes of diabetic kidney disease - A prospective cohort study from China. J Diabetes Complications 2019; 33:39-45. [PMID: 30482493 DOI: 10.1016/j.jdiacomp.2018.09.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 08/15/2018] [Accepted: 09/26/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND Information regarding the clinical phenotypes of diabetic kidney disease (DKD) might guide better practice for clinicians. We aim to compare the clinical features and long-term outcomes of proteinuric and non-proteinuric phenotypes of DKD, based on a prospective cohort of Chinese population. METHODS Altogether 8811 Chinese participants with diabetes were included. Kidney function decline was defined as estimated glomerular filtration rate <60 mL/min·1.73 m-2. The presence of proteinuria by urine dipstick test was further divided into micro-proteinuria (trace or 1+) and overt-proteinuria (≥2+). Participants were then stratified into 5 groups: no DKD, isolated kidney function decline, isolated micro-proteinuria, isolated overt-proteinuria, and proteinuria combined with kidney function decline. Outcomes include the first occurrence of composite cardiovascular events, end-stage renal disease (ESRD), and all-cause mortality. MAIN FINDINGS After a median follow-up of 6.9 years, there were 646 composite cardiovascular events, 31 ESRD events, and 718 deaths. Isolated kidney function decline was only associated with the higher risk of ESRD (HRs 31.33 (95% CI 3.65-269.27)). Participants of overt-proteinuria and proteinuria combined with kidney function decline phenotypes were associated with increased risk of all predefined adverse outcomes. CONCLUSIONS Proteinuric and non-proteinuric DKD phenotypes might follow different pathophysiological pathways, and result in heterogeneous clinical features and prognosis.
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Affiliation(s)
- Bixia Gao
- 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
| | - Shouling Wu
- Department of Cardiology, Kailuan General Hospital Affiliated to North China University of Science and Technology, Tangshan 063000, China
| | - Jinwei 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
| | - Chao 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
| | - Shuohua Chen
- Department of Cardiology, Kailuan General Hospital Affiliated to North China University of Science and Technology, Tangshan 063000, China
| | - Jinhong Hou
- Department of Nephrology, Kailuan General Hospital Affiliated to North China University of Science and Technology, Tangshan 063000, China
| | - Junjuan Li
- Department of Nephrology, Kailuan General Hospital Affiliated to North China University of Science and Technology, Tangshan 063000, China
| | - Yaozheng 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
| | - Kevin He
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Minghui Zhao
- 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; Peking-Tsinghua Center for Life Sciences, Beijing, China
| | - Min Chen
- 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.
| | - Luxia Zhang
- 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; Peking University, Center for Data Science in Health and Medicine, Beijing, China.
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Bellincioni C, Garigali G, Fogazzi GB. Glomerular isolated microscopic hematuria: urinary features and long term follow-up of a selected cohort of patients. J Nephrol 2018; 32:253-258. [PMID: 30535632 DOI: 10.1007/s40620-018-0560-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 11/12/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Isolated microscopic hematuria is a condition characterized by the presence in the urine of an "abnormal" number of erythrocytes in the absence of proteinuria. Several studies have been published on this condition, but with heterogeneous inclusion criteria and variable outcomes at follow-up. In this retrospective study, we describe a selected and homogenous cohort of patients who presented with isolated microscopic hematuria of glomerular origin. METHODS We included in the study patients with isolated microscopic hematuria of glomerular origin (> 1 erythrocyte/high power field at 400× and ≥ 40% dysmorphic erythrocytes and/or ≥ 5% acanthocytes and proteinuria ≤ 150 mg/24 h) with a follow-up of > 60 months from the first documentation of microscopic hematuria. RESULTS Forty-two patients (M 12, F 30, age at presentation 14-68 years, eGFR < 60 ml/min/1.73 m2: 1 patient) were included. During a medium term follow-up, microscopic hematuria was persistent in 25 patients (59.5%), transiently absent in 17 (40.5%), always glomerular in 16 patients (38.1%), and occasionally non-glomerular in 26 (61.9%); proteinuria, observed in 16 patients (38.1%), was always transient and < 500 mg/24 h. At the end of a follow-up of 181.8 ± 97.9 (median 168) months, only 2 patients (4.8%) had eGFR < 60 ml/min/1.73 m2, one of whom had reduced eGFR already at presentation. CONCLUSIONS This study on a small but selected and homogeneous cohort of patients with isolated microscopic hematuria of glomerular origin demonstrates that urinary features can transiently change over time and that the renal outcome is good.
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Affiliation(s)
- Cecilia Bellincioni
- Clinical and Research Laboratory on Urinary Sediment, U.O.C. di Nefrologia, Dialisi e Trapianto di Rene, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via della Commenda, 15, Milan, Italy
| | - Giuseppe Garigali
- Clinical and Research Laboratory on Urinary Sediment, U.O.C. di Nefrologia, Dialisi e Trapianto di Rene, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via della Commenda, 15, Milan, Italy
| | - Giovanni B Fogazzi
- Clinical and Research Laboratory on Urinary Sediment, U.O.C. di Nefrologia, Dialisi e Trapianto di Rene, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via della Commenda, 15, Milan, Italy.
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Lam NN, Klarenbach S, Quinn RR, Hemmelgarn B, Tonelli M, Ye F, Ravani P, Bello AK, Brennan DC, Lentine KL. Renal Function, Albuminuria, and the Risk of Cardiovascular Events After Kidney Transplantation. Transplant Direct 2018; 4:e389. [PMID: 30498766 PMCID: PMC6233669 DOI: 10.1097/txd.0000000000000828] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Accepted: 07/18/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The risk of mortality and graft loss is higher in kidney transplant recipients with reduced estimated glomerular filtration rate (eGFR) and albuminuria. It is unclear whether these markers are also associated with cardiovascular events. METHODS We examined linked healthcare databases in Alberta, Canada to identify kidney transplant recipients between 2002 and 2013 who had at least 1 outpatient serum creatinine and albuminuria measurement at 1-year posttransplant. We determined the relationship between categories of eGFR and albuminuria and the risk of subsequent cardiovascular events. RESULTS Among 1069 eligible kidney transplant recipients, the median age was 52 years, 37% were female, and 52% had eGFR ≥60 mL/min per 1.73 m2. Over a median follow-up of 6 years, the adjusted rate of all-cause mortality and cardiovascular events was 2.7-fold higher for recipients with eGFR 15-29 mL/min per 1.73 m2 and heavy albuminuria compared to recipients with eGFR ≥60 mL/min per 1.73 m2 and normal albuminuria (rate ratio, 2.7; 95% confidence interval, 1.3-5.7). Similarly, recipients with heavy albuminuria had a threefold increased risk of all-cause mortality and heart failure compared with recipients with eGFR ≥60 mL/min per 1.73 m2 and normal albuminuria. CONCLUSIONS These findings suggest that eGFR and albuminuria should be used together to determine the risk of cardiovascular outcomes in transplant recipients.
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Affiliation(s)
- Ngan N. Lam
- Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Scott Klarenbach
- Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Robert R. Quinn
- Division of Nephrology, Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Brenda Hemmelgarn
- Division of Nephrology, Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Marcello Tonelli
- Division of Nephrology, Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Feng Ye
- Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Pietro Ravani
- Division of Nephrology, Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Aminu K. Bello
- Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Daniel C. Brennan
- Center for Transplantation, Johns Hopkins School of Medicine, Baltimore, MD
| | - Krista L. Lentine
- Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, MO
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Eamudomkarn C, Sithithaworn P, Kamamia C, Yakovleva A, Sithithaworn J, Kaewkes S, Techasen A, Loilome W, Yongvanit P, Wangboon C, Saichua P, Itoh M, M. Bethony J. Diagnostic performance of urinary IgG antibody detection: A novel approach for population screening of strongyloidiasis. PLoS One 2018; 13:e0192598. [PMID: 29985913 PMCID: PMC6037348 DOI: 10.1371/journal.pone.0192598] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 05/25/2018] [Indexed: 11/18/2022] Open
Abstract
The diagnosis of strongyloidiasis by coprological methods has a low sensitivity, underestimating the prevalence of Strongyloides stercoralis in endemic areas. Serodiagnostic tests for strongyloidiasis have shown robust diagnostic properties. However, these methods require a blood draw, an invasive and labor-intensive sample collection method, especially in the resource-limited settings where S. stercoralis is endemic. Our study examines a urine-based assay for strongyloidiasis and compares its diagnostic accuracy with coprological and serological methods. Receiver operating characteristic (ROC) curve analyses determined the diagnostic sensitivity (D-Sn) and specificity (D-Sp) of the urine ELISA, as well as estimates its positive predictive value and diagnostic risk. The likelihood ratios of obtaining a positive test result (LR+) or a negative test result (LR-) were calculated for each diagnostic positivity threshold. The urine ELISA assay correlated significantly with the serological ELISA assay for strongyloidiasis, with a D-Sn of 92.7% and a D-Sp of 40.7%, when compared to coprological methods. Moreover, the urine ELISA IgG test had a detection rate of 69%, which far exceeds the coprological method (28%). The likelihood of a positive diagnosis of strongyloidiasis by the urine ELISA IgG test increased significantly with increasing units of IgG detected in urine. The urine ELISA IgG assay for strongyloidiasis assay has a diagnostic accuracy comparable to serological assay, both of which are more sensitive than coprological methods. Since the collection of urine is easy and non-invasive, the urine ELISA IgG assay for strongyloidiasis could be used to screen populations at risk for strongyloidiasis in S. stercoralis endemic areas.
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Affiliation(s)
- Chatanun Eamudomkarn
- Department of Parasitology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
- Cholangiocarcinoma Research Institute (CARI), Khon Kaen University, Khon Kaen, Thailand
| | - Paiboon Sithithaworn
- Department of Parasitology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
- Cholangiocarcinoma Research Institute (CARI), Khon Kaen University, Khon Kaen, Thailand
- * E-mail: ,
| | - Christine Kamamia
- Department of Microbiology, Immunology & Tropical Medicine, George Washington University, Washington, D.C., United States of America
| | - Anna Yakovleva
- Department of Microbiology, Immunology & Tropical Medicine, George Washington University, Washington, D.C., United States of America
| | - Jiraporn Sithithaworn
- Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand
- Faculty of Medicine, Mahasarakham University, Mahasarakham, Thailand
| | - Sasithorn Kaewkes
- Department of Parasitology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Anchalee Techasen
- Cholangiocarcinoma Research Institute (CARI), Khon Kaen University, Khon Kaen, Thailand
- Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand
| | - Watcharin Loilome
- Cholangiocarcinoma Research Institute (CARI), Khon Kaen University, Khon Kaen, Thailand
- Department of Biochemistry, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Puangrat Yongvanit
- Cholangiocarcinoma Research Institute (CARI), Khon Kaen University, Khon Kaen, Thailand
- Department of Biochemistry, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Chompunoot Wangboon
- Biomedical Science Program, Graduate School, Khon Kaen University, Khon Kaen, Thailand
| | - Prasert Saichua
- Tropical Medicine Program, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Makoto Itoh
- Department of Infection and Immunology, Aichi Medical University School of Medicine, Nagakute, Aichi, Japan
| | - Jeffrey M. Bethony
- Department of Microbiology, Immunology & Tropical Medicine, George Washington University, Washington, D.C., United States of America
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Detección y clasificación de la enfermedad renal crónica en Atención Primaria y la importancia de la albuminuria. Semergen 2018; 44:82-89. [DOI: 10.1016/j.semerg.2016.11.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Revised: 11/19/2016] [Accepted: 11/22/2016] [Indexed: 12/16/2022]
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76
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James MT, Pannu N, Hemmelgarn BR, Austin PC, Tan Z, McArthur E, Manns BJ, Tonelli M, Wald R, Quinn RR, Ravani P, Garg AX. Derivation and External Validation of Prediction Models for Advanced Chronic Kidney Disease Following Acute Kidney Injury. JAMA 2017; 318:1787-1797. [PMID: 29136443 PMCID: PMC5820711 DOI: 10.1001/jama.2017.16326] [Citation(s) in RCA: 97] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
IMPORTANCE Some patients will develop chronic kidney disease after a hospitalization with acute kidney injury; however, no risk-prediction tools have been developed to identify high-risk patients requiring follow-up. OBJECTIVE To derive and validate predictive models for progression of acute kidney injury to advanced chronic kidney disease. DESIGN, SETTING, AND PARTICIPANTS Data from 2 population-based cohorts of patients with a prehospitalization estimated glomerular filtration rate (eGFR) of more than 45 mL/min/1.73 m2 and who had survived hospitalization with acute kidney injury (defined by a serum creatinine increase during hospitalization > 0.3 mg/dL or > 50% of their prehospitalization baseline), were used to derive and validate multivariable prediction models. The risk models were derived from 9973 patients hospitalized in Alberta, Canada (April 2004-March 2014, with follow-up to March 2015). The risk models were externally validated with data from a cohort of 2761 patients hospitalized in Ontario, Canada (June 2004-March 2012, with follow-up to March 2013). EXPOSURES Demographic, laboratory, and comorbidity variables measured prior to discharge. MAIN OUTCOMES AND MEASURES Advanced chronic kidney disease was defined by a sustained reduction in eGFR less than 30 mL/min/1.73 m2 for at least 3 months during the year after discharge. All participants were followed up for up to 1 year. RESULTS The participants (mean [SD] age, 66 [15] years in the derivation and internal validation cohorts and 69 [11] years in the external validation cohort; 40%-43% women per cohort) had a mean (SD) baseline serum creatinine level of 1.0 (0.2) mg/dL and more than 20% had stage 2 or 3 acute kidney injury. Advanced chronic kidney disease developed in 408 (2.7%) of 9973 patients in the derivation cohort and 62 (2.2%) of 2761 patients in the external validation cohort. In the derivation cohort, 6 variables were independently associated with the outcome: older age, female sex, higher baseline serum creatinine value, albuminuria, greater severity of acute kidney injury, and higher serum creatinine value at discharge. In the external validation cohort, a multivariable model including these 6 variables had a C statistic of 0.81 (95% CI, 0.75-0.86) and improved discrimination and reclassification compared with reduced models that included age, sex, and discharge serum creatinine value alone (integrated discrimination improvement, 2.6%; 95% CI, 1.1%-4.0%; categorical net reclassification index, 13.5%; 95% CI, 1.9%-25.1%) or included age, sex, and acute kidney injury stage alone (integrated discrimination improvement, 8.0%; 95% CI, 5.1%-11.0%; categorical net reclassification index, 79.9%; 95% CI, 60.9%-98.9%). CONCLUSIONS AND RELEVANCE A multivariable model using routine laboratory data was able to predict advanced chronic kidney disease following hospitalization with acute kidney injury. The utility of this model in clinical care requires further research.
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Affiliation(s)
- Matthew T. James
- Department of Medicine, Cumming School of Medicine, University of Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada
- O’Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Alberta, Canada
- Libin Cardiovascular Institute of Alberta, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Neesh Pannu
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - Brenda R. Hemmelgarn
- Department of Medicine, Cumming School of Medicine, University of Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada
- O’Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Alberta, Canada
- Libin Cardiovascular Institute of Alberta, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Peter C. Austin
- Institute for Clinical Evaluative Sciences, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada
| | - Zhi Tan
- Department of Medicine, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Eric McArthur
- Institute for Clinical Evaluative Sciences, Ontario, Canada
| | - Braden J. Manns
- Department of Medicine, Cumming School of Medicine, University of Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada
- O’Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Alberta, Canada
- Libin Cardiovascular Institute of Alberta, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Marcello Tonelli
- Department of Medicine, Cumming School of Medicine, University of Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada
- O’Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Alberta, Canada
- Libin Cardiovascular Institute of Alberta, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Ron Wald
- Institute for Clinical Evaluative Sciences, Ontario, Canada
- Department of Medicine, University of Toronto, Ontario, Canada
| | - Robert R. Quinn
- Department of Medicine, Cumming School of Medicine, University of Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada
- O’Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Alberta, Canada
- Libin Cardiovascular Institute of Alberta, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Pietro Ravani
- Department of Medicine, Cumming School of Medicine, University of Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada
- O’Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Alberta, Canada
- Libin Cardiovascular Institute of Alberta, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Amit X. Garg
- Institute for Clinical Evaluative Sciences, Ontario, Canada
- Department of Medicine, Western University, London, Ontario, Canada
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El-Horany HES, Abd-Ellatif RN, Watany M, Hafez YM, Okda HI. NLRP3 expression and urinary HSP72 in relation to biomarkers of inflammation and oxidative stress in diabetic nephropathy patients. IUBMB Life 2017. [PMID: 28631886 DOI: 10.1002/iub.1645] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Diabetic nephropathy (DN) is one of the major causes of end-stage renal disease. Nod-like receptors nucleotide-binding domain and leucine-rich repeat pyrin-3 domain (NLRP3) inflammasome displays a considerable role in the chronic inflammatory state observed in diabetic patients. Urinary heat shock protein 72 (uHSP72) is a sensitive and specific biomarker for the early detection of acute kidney injury. The aim of this study was to evaluate NLRP3 relative gene expression, its correlation with inflammatory and oxidative stress markers, and to assess the value of uHSP72 in the early detection of DN in type 2 diabetic patients with different degrees of DN. Forty-five type 2 diabetic patients: 15 normoalbuminuric, 15 microalbuminuric, 15 macroalbuminuric, in addition to 15 healthy controls were enrolled in this study. Clinical examination and routine laboratory investigations were performed. NLRP3 mRNA expression was assessed by real time polymerase chain reaction. Serum 8-hydroxy-2'-deoxyguanosine (8-OHdG), interleukin 1β (IL-1β), and uHSP72 levels were estimated by enzyme-linked immunosorbent assay. Serum chitotriosidase (CHIT1) activity was examined. NLRP3 mRNA relative expression, serum levels of 8-OHdG, IL-1β, and uHSP72, in addition to CHIT 1 activity were significantly increased in the macroalbuminuric patient group as compared to control and the other two diabetic groups. Also, a significant positive correlation was documented between the previously mentioned parameters and urinary albumin/creatinine ratio, serum creatinine, and HbA1c. Multiple linear regression analysis using urinary albumin/creatinine ratio as dependent variable confirmed that uHSP72 and NLRP3 mRNA relative expression were the independent predictors of DN (β were 0.432 and 0.448 respectively, P < 0.001). Receiver operating characteristic analyses revealed that both NLRP3 mRNA relative expression and uHSP72 levels were useful biomarkers discriminating DN patients from patients with type 2 diabetes mellitus (AUC were 0.957 and 0.983, respectively). uHSP72 may be considered as a novel potential diagnostic biomarker for the early detection of DN. Moreover, these data support the pivotal role of NLRP3 in the development and progression of DN. © 2017 IUBMB Life, 69(8):623-630, 2017.
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Affiliation(s)
| | - Rania Nagi Abd-Ellatif
- Medical Biochemistry Department, Faculty of Medicine, Tanta University, El-Gharbia, Egypt
| | - Mona Watany
- Clinical Pathology Department, Faculty of Medicine, Tanta University, El-Gharbia, Egypt
| | - Yasser M Hafez
- Internal Medicine Department, Faculty of Medicine, Tanta University, El-Gharbia, Egypt
| | - Hanaa Ibrahim Okda
- Internal Medicine Department, Faculty of Medicine, Tanta University, El-Gharbia, Egypt
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Folic acid therapy reduces the risk of mortality associated with heavy proteinuria among hypertensive patients. J Hypertens 2017; 35:1302-1309. [DOI: 10.1097/hjh.0000000000001292] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Li W, Wang J, Ge L, Shan J, Zhang C, Liu J. Growth arrest-specific protein 6 (Gas6) as a noninvasive biomarker for early detection of diabetic nephropathy. Clin Exp Hypertens 2017; 39:382-387. [PMID: 28513288 DOI: 10.1080/10641963.2017.1288739] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND To investigate the diagnostic level of cystatin C and growth arrest-specific gene 6 (Gas6) levels in elderly type 2 diabetic patients with different degrees of diabetic nephropathy (DN). METHODS Four hundred and eighty-two old people, including 130 healthy controls, 130 normoalbuminuric diabetic patients, 122 with microalbuminuria, and 100 with macroalbuminuria, were recruited. Plasma Gas6 and serum cystatin C levels were measured. RESULTS Plasma Gas6 concentration was significantly lower in diabetic patients with microalbuminuria or macroalbuminuria, as compared with diabetic subjects with normoalbuminuria; while cystatin C was significantly higher. Gas6 was inversely correlated with BMI, WHR, and HbA1c, while cystatin C was inversely correlated with urea nitrogen and creatinine. Multivariate logistic regression analysis showed that, after adjusted for established diabetes risk factors, higher plasma Gas6 was significantly associated with a decreased risk of DN, while higher serum cystatin C was significantly associated with an increased risk. Receiver operating characteristic curve analysis showed that Gas6 was better than cystatin C as a biomarker for early diagnosis and detection of DN, with a cutoff value of 9.435 ng/mL (86.1% sensitivity and 84.6% specificity). CONCLUSION Compared to cystatin C, Gas6 may be potentially a better noninvasive diagnostic biomarker for early detection of DN.
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Affiliation(s)
- Wenni Li
- a Department of Gerontology, South Campus, Renji Hospital School of Medicine , Shanghai Jiaotong University , Shanghai , China
| | - Junlin Wang
- a Department of Gerontology, South Campus, Renji Hospital School of Medicine , Shanghai Jiaotong University , Shanghai , China
| | - Lina Ge
- a Department of Gerontology, South Campus, Renji Hospital School of Medicine , Shanghai Jiaotong University , Shanghai , China
| | - Jiehui Shan
- a Department of Gerontology, South Campus, Renji Hospital School of Medicine , Shanghai Jiaotong University , Shanghai , China
| | - Chunbing Zhang
- a Department of Gerontology, South Campus, Renji Hospital School of Medicine , Shanghai Jiaotong University , Shanghai , China
| | - Jianping Liu
- a Department of Gerontology, South Campus, Renji Hospital School of Medicine , Shanghai Jiaotong University , Shanghai , China
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Lam NN, Tonelli M, Lentine KL, Hemmelgarn B, Ye F, Wen K, Klarenbach S. Albuminuria and posttransplant chronic kidney disease stage predict transplant outcomes. Kidney Int 2017; 92:470-478. [PMID: 28366228 DOI: 10.1016/j.kint.2017.01.028] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 12/22/2016] [Accepted: 01/19/2017] [Indexed: 02/01/2023]
Abstract
In 2012, the KDIGO guidelines updated the classification system for chronic kidney disease to include albuminuria. Whether this classification system predicts adverse clinical outcomes among kidney transplant recipients is unclear. To evaluate this, we conducted a retrospective study using linked databases in Alberta, Canada to follow kidney transplant recipients from 2002-2011. We examined the association between an estimated glomerular filtration rate (eGFR of 60 or more, 45-59, 30-44, 15-29 mL/min/1.73 m2) and albuminuria (normal, mild, heavy) at one year post-transplant and subsequent mortality and graft loss. There were 900 recipients with a functioning graft and at least one outpatient serum creatinine and urine protein measurement at one year post-transplant. The median age was 51.2 years, 38.7% were female, and 52% had an eGFR of 60 mL/min/1.73 m2 or more. The risk of all-cause mortality and death-censored graft loss was increased in recipients with reduced eGFR or heavier albuminuria. The adjusted incidence rate per 1000 person-years of all-cause mortality for recipients with an eGFR of 15-29 mL/min/1.73 m2 and heavy albuminuria vs. an eGFR 60 mL/min/1.73 m2 or more and normal protein excretion was 117 (95% confidence interval 38-371) vs. 15 (9-23) (rate ratio 8). Corresponding rates for death-censored graft loss were 273 (88-1203) vs. 6 (3-9) (rate ratio 49). Reduced eGFR and heavier albuminuria in kidney transplant recipients are associated with an increased risk of mortality and graft loss. Thus, eGFR and albuminuria may be used together to identify, evaluate, and manage transplant recipients who are at higher risk of adverse clinical outcomes.
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Affiliation(s)
- Ngan N Lam
- Department of Medicine, Division of Nephrology, University of Alberta, Edmonton, Alberta, Canada.
| | - Marcello Tonelli
- Department of Medicine, Division of Nephrology, University of Calgary, Calgary, Alberta, Canada
| | - Krista L Lentine
- Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Brenda Hemmelgarn
- Department of Medicine, Division of Nephrology, University of Calgary, Calgary, Alberta, Canada
| | - Feng Ye
- Department of Medicine, Division of Nephrology, University of Alberta, Edmonton, Alberta, Canada
| | - Kevin Wen
- Department of Medicine, Division of Nephrology, University of Alberta, Edmonton, Alberta, Canada
| | - Scott Klarenbach
- Department of Medicine, Division of Nephrology, University of Alberta, Edmonton, Alberta, Canada
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Li Z, Xu Y, Liu X, Nie Y, Zhao Z. Urinary heme oxygenase-1 as a potential biomarker for early diabetic nephropathy. Nephrology (Carlton) 2017; 22:58-64. [PMID: 26733347 DOI: 10.1111/nep.12719] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 12/24/2015] [Accepted: 12/31/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Our previous study showed that increases of urinary heme oxygenase-1 (uHO-1) could be a potential biomarker indicating evaluating intrarenal oxidative damage in obstructive nephropathy. Activation of oxidative stress is an important mediator of diabetic nephropathy (DN). The aim of this study was to investigate the clinical implications of uHO-1 levels in patients with type 2 diabetes. METHODS Eighty-four type 2 diabetic patients with normoalbuminuria (n=28), microalbuminuria (n=28), and macroalbuminuria (n=28) were included in this study. Control samples were collected from healthy volunteers (n=28) who had normal albuminuria and renal function. Urine HO-1 levels were evaluated by enzyme-linked immunosorbent assay. RESULTS Urinary HO-1/creatinine (cr.) levels were significantly elevated in diabetic patients with microalbuminuria and macroalbuminuria compared to those in diabetic patients with normoalbuminuria (P<0.001) and control subjects (all P<0.001). In diabetic patients with normoalbuminuria, uHO-1/cr. levels were also higher than those in controls (P<0.001). Multivariate regression analyses revealed that uHO-1/cr. levels were positively correlated to urinary albumin/creatinine ratio and inversely correlated to glomerular filtration rate. Receiver operating characteristic (ROC) curve analysis of uHO-1/cr. levels for early diagnosis and detection of DN revealed that the cut-off value of uHO-1/cr. was 4.59 ng/mg (sensitivity 75%, specificity 78.6%). CONCLUSIONS The findings of this study indicate that increases of urine HO-1 levels can be detected in patients with type 2 diabetes before the onset of significant albuminuria, and associated with renal derangement in patients with established diabetic nephropathy. Urinary HO-1 may be used as an early biomarker for diabetic renal injury.
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Affiliation(s)
- Zhenzhen Li
- Institute of Clinical Medicine, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yuliang Xu
- Department of Nephrology, the People's Hospital of Hebi, Hebi, China
| | - Xianghua Liu
- Center for Experimental Pathology, Henan University of Traditional Chinese Medicine, Zhengzhou, China
| | - Yali Nie
- Department of Pharmacology, School of Medicine, Zhengzhou University, Zhengzhou, China
| | - Zhanzheng Zhao
- Department of Nephrology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Biljak VR, Honović L, Matica J, Krešić B, Vojak SŠ. The role of laboratory testing in detection and classification of chronic kidney disease: national recommendations. Biochem Med (Zagreb) 2017; 27:153-176. [PMID: 28392738 PMCID: PMC5382859 DOI: 10.11613/bm.2017.019] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Accepted: 12/08/2016] [Indexed: 12/18/2022] Open
Abstract
Chronic kidney disease (CKD) is a common clinical condition with significant adverse consequences for the patient and it is recognized as a significant public health problem. The role of laboratory medicine in diagnosis and management of CKD is of great importance: the diagnosis and staging are based on estimation of glomerular filtration rate (eGFR) and assessment of albuminuria (or proteinuria). Therefore, the joint working group of the Croatian society of medical biochemistry and laboratory medicine and Croatian chamber of medical biochemists for laboratory diagnostics in CKD issued this national recommendation regarding laboratory diagnostics of CKD.
Key factors for laboratories implementing the national guidelines for the diagnosis and management of CKD are:
1. Ensure good communication between laboratory professionals and clinicians, such as nephrologists or specialists in general/family medicine,
2. Ensure all patients are provided with the same availability of laboratory diagnostics,
3. Ensure creatinine assays are traceable to isotope dilution mass spectrometry (IDMS) method and have minimal bias and acceptable imprecision,
4. Select the appropriate GFR estimating formula. Recommended equation is the 2009 Chronic Kidney Disease Epidemiology Collaboration (CKD - EPI) equation,
5. In reporting the key laboratory tests (creatinine, eGFR, urine albumin-to-creatinine ratio, urine protein-to-creatinine ratio) use the appropriate reporting units,
6. Provide adequate information on limitations of creatinine measurement.
The manuscript has been organized to identify critical points in laboratory tests used in basic laboratory diagnostics of CKD and is based on the Kidney Disease: Improving Global Outcomes (KDIGO) 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease.
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Affiliation(s)
- Vanja Radišić Biljak
- Department of medical biochemistry and laboratory medicine, Merkur University Hospital, Zagreb, Croatia
| | - Lorena Honović
- Department of medical biochemistry and laboratory medicine, General Hospital Pula, Pula, Croatia
| | - Jasminka Matica
- Medical-biochemistry laboratory, Primary care center of the Primorje-Gorski Kotar County, Rijeka, Croatia
| | - Branka Krešić
- Department of medical laboratory diagnostics, University Hospital Centre Split, Split, Croatia
| | - Sanela Šimić Vojak
- Department of laboratory diagnostics, General County Hospital Požega, Požega, Croatia
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Low Rice Intake Is Associated with Proteinuria in Participants of Korea National Health and Nutrition Examination Survey. PLoS One 2017; 12:e0170198. [PMID: 28081248 PMCID: PMC5231352 DOI: 10.1371/journal.pone.0170198] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 01/02/2017] [Indexed: 11/19/2022] Open
Abstract
Little is known about the risk factors of proteinuria in the Asian population. On the basis of the association between rice intake patterns and chronic diseases, we hypothesized that rice intake patterns are associated with proteinuria in the Asian population. Data, including data regarding rice intake frequency and dipstick urinalysis results, from the Korea National Health and Nutrition Examination Survey in 1998, 2001, 2005, and 2007 were analyzed. The study involved 19,824 participants who were older than 20 years of age. Low rice intake was defined as consumption of rice ≤ 1 time/day. Proteinuria was defined as dipstick urinalysis protein ≥ 1 positive. Among the 19,824 participants, the prevalence of low rice intake and proteinuria were 17.3% and 2.9%, respectively. The low rice intake group showed a higher rate of proteinuria than the non-low rice intake group did (3.8% vs. 2.7%, P < 0.001). In multivariate logistic regression analysis, the odds ratio (OR) of low rice intake for proteinuria was 1.54 (95% confidence interval (CI): 1.25-1.89; P < 0.001). Low rice intake was also independently associated with high blood pressure (OR: 1.43, 95% CI: 1.31-1.56; P < 0.001) and diabetes (OR: 1.43, 95% CI: 1.27-1.62; P < 0.001). In conclusion, low rice intake was found to be independently associated with proteinuria in the Asian population, which might have been affected by the associations of low rice intake with high blood pressure and diabetes. Future prospective studies are needed to confirm the results of this study.
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Kim JH, Oh SY, Kim EH, Lee MJ, Jeon YK, Kim BH, Kim JM, Kim YK, Kim SS, Kim IJ. Addition of nonalbumin proteinuria to albuminuria improves prediction of type 2 diabetic nephropathy progression. Diabetol Metab Syndr 2017; 9:68. [PMID: 28912839 PMCID: PMC5588678 DOI: 10.1186/s13098-017-0267-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 08/31/2017] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Albuminuria is generally accepted as a sensitive marker of diabetic nephropathy but has limitations in predicting its progression. The aim of this study was to evaluate the use of nonalbumin proteinuria in addition to albuminuria for predicting the progression of type 2 diabetic nephropathy. METHODS In this retrospective observational study, the urine albumin-to-creatinine ratio (ACR) and the nonalbumin protein-to-creatinine ratio (NAPCR) were measured in 325 patients with type 2 diabetes and estimated glomerular filtration rates (eGFR) ≥30 mL/min/1.73 m2. The patients were divided into four groups based on the cutoff points for the urinary ACR (30 mg/g) and NAPCR (120 mg/g). The renal outcomes were chronic kidney disease (CKD) progression and accelerated eGFR decline. RESULTS During the 4.3-year follow-up period, 25 (7.7%) patients showed CKD progression and 69 (21.2%) patients showed accelerated eGFR decline. After adjusting for nine clinical parameters, the group with a NAPCR greater than 120 mg/g exhibited higher cumulative incidences of CKD progression (hazard ratio 6.84; P = 0.001) and accelerated eGFR decline (hazard ratio 1.95; P = 0.011) than the group with a NAPCR < 120 mg/g. In patients with normoalbuminuria, the group with NAPCR levels greater than 120 mg/g also exhibited a higher cumulative incidence than that with NAPCR levels <120 mg/g of CKD progression (hazard ratio 21.82; P = 0.005). The addition of NAPCR to ACR improved the model fit for CKD progression and accelerated eGFR decline. CONCLUSION Nonalbumin proteinuria showed additional value over and above that of albuminuria for predicting the progression of CKD in patients with type 2 diabetes.
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Affiliation(s)
- Jong Ho Kim
- Department of Internal Medicine, Pusan National University Hospital, Busan, South Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Seo Young Oh
- Department of Internal Medicine, Pusan National University Hospital, Busan, South Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Eun Heui Kim
- Department of Internal Medicine, Pusan National University Hospital, Busan, South Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Min Jin Lee
- Department of Internal Medicine, Pusan National University Hospital, Busan, South Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Yun Kyung Jeon
- Department of Internal Medicine, Pusan National University Hospital, Busan, South Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Bo Hyun Kim
- Department of Internal Medicine, Pusan National University Hospital, Busan, South Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Jin Mi Kim
- Department of Biostatistics, Pusan National University Hospital, Busan, South Korea
| | - Yong Ki Kim
- Kim Yong Ki Internal Medicine Clinic, Busan, South Korea
| | - Sang Soo Kim
- Department of Internal Medicine, Pusan National University Hospital, Busan, South Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Pusan National University Hospital, 179 Gudeok-Ro, Seo-Gu, Busan, 602-739 South Korea
| | - In Joo Kim
- Department of Internal Medicine, Pusan National University Hospital, Busan, South Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Pusan National University Hospital, 179 Gudeok-Ro, Seo-Gu, Busan, 602-739 South Korea
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Riemsma R, Corro Ramos I, Birnie R, Büyükkaramikli N, Armstrong N, Ryder S, Duffy S, Worthy G, Al M, Severens J, Kleijnen J. Integrated sensor-augmented pump therapy systems [the MiniMed® Paradigm™ Veo system and the Vibe™ and G4® PLATINUM CGM (continuous glucose monitoring) system] for managing blood glucose levels in type 1 diabetes: a systematic review and economic evaluation. Health Technol Assess 2016; 20:v-xxxi, 1-251. [PMID: 26933827 DOI: 10.3310/hta20170] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND In recent years, meters for continuous monitoring of interstitial fluid glucose have been introduced to help people with type 1 diabetes mellitus (T1DM) to achieve better control of their disease. OBJECTIVE The objective of this project was to summarise the evidence on the clinical effectiveness and cost-effectiveness of the MiniMed(®) Paradigm™ Veo system (Medtronic Inc., Northridge, CA, USA) and the Vibe™ (Animas(®) Corporation, West Chester, PA, USA) and G4(®) PLATINUM CGM (continuous glucose monitoring) system (Dexcom Inc., San Diego, CA, USA) in comparison with multiple daily insulin injections (MDIs) or continuous subcutaneous insulin infusion (CSII), both with either self-monitoring of blood glucose (SMBG) or CGM, for the management of T1DM in adults and children. DATA SOURCES A systematic review was conducted in accordance with the principles of the Centre for Reviews and Dissemination guidance and the National Institute for Health and Care Excellence Diagnostic Assessment Programme manual. We searched 14 databases, three trial registries and two conference proceedings from study inception up to September 2014. In addition, reference lists of relevant systematic reviews were checked. In the absence of randomised controlled trials directly comparing Veo or an integrated CSII + CGM system, such as Vibe, with comparator interventions, indirect treatment comparisons were performed if possible. METHODS A commercially available cost-effectiveness model, the IMS Centre for Outcomes Research and Effectiveness diabetes model version 8.5 (IMS Health, Danbury, CT, USA), was used for this assessment. This model is an internet-based, interactive simulation model that predicts the long-term health outcomes and costs associated with the management of T1DM and type 2 diabetes. The model consists of 15 submodels designed to simulate diabetes-related complications, non-specific mortality and costs over time. As the model simulates individual patients over time, it updates risk factors and complications to account for disease progression. RESULTS Fifty-four publications resulting from 19 studies were included in the review. Overall, the evidence suggests that the Veo system reduces hypoglycaemic events more than other treatments, without any differences in other outcomes, including glycated haemoglobin (HbA1c) levels. We also found significant results in favour of the integrated CSII + CGM system over MDIs with SMBG with regard to HbA1c levels and quality of life. However, the evidence base was poor. The quality of the included studies was generally low, often with only one study comparing treatments in a specific population at a specific follow-up time. In particular, there was only one study comparing Veo with an integrated CSII + CGM system and only one study comparing Veo with a CSII + SMBG system in a mixed population. Cost-effectiveness analyses indicated that MDI + SMBG is the option most likely to be cost-effective, given the current threshold of £30,000 per quality-adjusted life-year gained, whereas integrated CSII + CGM systems and Veo are dominated and extendedly dominated, respectively, by stand-alone, non-integrated CSII with CGM. Scenario analyses did not alter these conclusions. No cost-effectiveness modelling was conducted for children or pregnant women. CONCLUSIONS The Veo system does appear to be better than the other systems considered at reducing hypoglycaemic events. However, in adults, it is unlikely to be cost-effective. Integrated systems are also generally unlikely to be cost-effective given that stand-alone systems are cheaper and, possibly, no less effective. However, evidence in this regard is generally lacking, in particular for children. Future trials in specific child, adolescent and adult populations should include longer term follow-up and ratings on the European Quality of Life-5 Dimensions scale at various time points with a view to informing improved cost-effectiveness modelling. STUDY REGISTRATION PROSPERO Registration Number CRD42014013764. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
| | - Isaac Corro Ramos
- Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | | | - Nasuh Büyükkaramikli
- Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | | | | | | | | | - Maiwenn Al
- Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Johan Severens
- Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Jos Kleijnen
- Kleijnen Systematic Reviews Ltd, York, UK.,School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands
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Abstract
Chronic kidney disease (CKD) is an important and common noncommunicable condition globally. In national and international guidelines, CKD is defined and staged according to measures of kidney function that allow for a degree of risk stratification using commonly available markers. It is often asymptomatic in its early stages, and early detection is important to reduce future risk. The risk of cardiovascular outcomes is greater than the risk of progression to end-stage kidney disease for most people with CKD. CKD also predisposes to acute kidney injury - a major cause of morbidity and mortality worldwide. Although only a small proportion of people with CKD progress to end-stage kidney disease, renal replacement therapy (dialysis or transplantation) represents major costs for health care systems and burden for patients. Efforts in primary care to reduce the risks of cardiovascular disease, acute kidney injury, and progression are therefore required. Monitoring renal function is an important task, and primary care clinicians are well placed to oversee this aspect of care along with the management of modifiable risk factors, particularly blood pressure and proteinuria. Good primary care judgment is also essential in making decisions about referral for specialist nephrology opinion. As CKD commonly occurs alongside other conditions, consideration of comorbidities and patient wishes is important, and primary care clinicians have a key role in coordinating care while adopting a holistic, patient-centered approach and providing continuity. This review aims to summarize the vital role that primary care plays in predialysis CKD care and to outline the main considerations in its identification, monitoring, and clinical management in this context.
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Affiliation(s)
- Simon DS Fraser
- Academic Unit of Primary Care and Population Sciences, Faculty of Medicine, Southampton General Hospital, University of Southampton, Southampton
| | - Tom Blakeman
- National Institute for Health Research Collaboration for Leadership in Applied Health Research Greater Manchester, Centre for Primary Care, Institute of Population Health, The University of Manchester, Manchester, UK
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Zhao YF, Zhu L, Liu LJ, Shi SF, Lv JC, Zhang H. Measures of Urinary Protein and Albumin in the Prediction of Progression of IgA Nephropathy. Clin J Am Soc Nephrol 2016; 11:947-955. [PMID: 27026518 PMCID: PMC4891752 DOI: 10.2215/cjn.10150915] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 02/17/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Proteinuria is an independent predictor for IgA nephropathy (IgAN) progression. Urine albumin-to-creatinine ratio (ACR), protein-to-creatinine ratio, and 24-hour urine protein excretion (UPE) are widely used for proteinuria evaluation in clinical practice. Here, we evaluated the association of these measurements with clinical and histologic findings of IgAN and explored which was the best predictor of IgAN prognosis. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Patients with IgAN were followed up for ≥12 months, were diagnosed between 2003 and 2012, and had urine samples available (438 patients). Spot urine ACR, protein-to-creatinine ratio, and 24-hour UPE at the time of renal biopsy were measured on a Hitachi Automatic Biochemical Analyzer 7180 (Hitachi, Yokohama, Japan). RESULTS In our patients, ACR, protein-to-creatinine ratio, and 24-hour UPE were highly correlated (correlation coefficients: 0.71-0.87). They showed good relationships with acknowledged markers reflecting IgAN severity, including eGFR, hypertension, and the biopsy parameter (Oxford severity of tubular atrophy/interstitial fibrosis parameter). However, only ACR presented with positive association with the Oxford segmental glomerulosclerosis/adhesion parameter and extracapillary proliferation lesions. The follow-up time was 37.0 (22.0-58.0) months, with the last follow-up on April 18, 2014. In total, 124 patients reached the composite end point (30% eGFR decline, ESRD, or death). In univariate survival analysis, ACR consistently had better performance than protein-to-creatinine ratio and 24-hour UPE as represented by higher area under the curve using time-dependent survival analysis. When adjusted for well known risk factors for IgAN progression, ACR was most significantly associated with the composite end point (hazard ratio, 1.56 per 1-SD change of standard normalized square root-transformed ACR; 95% confidence interval, 1.29 to 1.89; P<0.001). Compared with protein-to-creatinine ratio and 24-hour UPE, addition of ACR to traditional risk factors resulted in more improvement in the predictive ability of IgAN progression (c statistic: ACR=0.70; protein-to-creatinine ratio =0.68; 24-hour UPE =0.69; Akaike information criterion: ACR=1217.85; protein-to-creatinine ratio =1229.28; 24-hour UPE =1234.96; P<0.001). CONCLUSIONS In IgAN, ACR, protein-to-creatinine ratio, and 24-hour UPE had comparable association with severe clinical and histologic findings. Compared with protein-to-creatinine ratio and 24-hour UPE, ACR showed slightly better performance in predicting IgAN progression.
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Affiliation(s)
- Yan-feng Zhao
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China
- Institute of Nephrology, Peking University, Beijing, China
- Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China; and
- Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing, China
| | - Li Zhu
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China
- Institute of Nephrology, Peking University, Beijing, China
- Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China; and
- Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing, China
| | - Li-jun Liu
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China
- Institute of Nephrology, Peking University, Beijing, China
- Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China; and
- Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing, China
| | - Su-fang Shi
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China
- Institute of Nephrology, Peking University, Beijing, China
- Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China; and
- Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing, China
| | - Ji-cheng Lv
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China
- Institute of Nephrology, Peking University, Beijing, China
- Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China; and
- Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing, China
| | - Hong Zhang
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China
- Institute of Nephrology, Peking University, Beijing, China
- Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China; and
- Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing, China
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Brisco MA, Zile MR, Ter Maaten JM, Hanberg JS, Wilson FP, Parikh C, Testani JM. The risk of death associated with proteinuria in heart failure is restricted to patients with an elevated blood urea nitrogen to creatinine ratio. Int J Cardiol 2016; 215:521-6. [PMID: 27153048 DOI: 10.1016/j.ijcard.2016.04.100] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 04/11/2016] [Indexed: 12/16/2022]
Abstract
BACKGROUND Renal dysfunction (RD) is associated with reduced survival in HF; however, not all RD is mechanistically or prognostically equivalent. Notably, RD associated with "pre-renal" physiology, as identified by an elevated blood urea nitrogen to creatinine ratio (BUN/Cr), identifies a particularly high risk RD phenotype. Proteinuria, another domain of renal dysfunction, has also been associated with adverse events. Given that several different mechanisms can cause proteinuria, we sought to investigate whether the mechanism underlying proteinuria also affects survival in HF. METHODS AND RESULTS Subjects in the Studies of Left Ventricular Dysfunction (SOLVD) trial with proteinuria assessed at baseline were studied (n=6439). All survival models were adjusted for baseline characteristics and estimated glomerular filtration rate (eGFR). Proteinuria (trace or 1+) was present in 26% and associated with increased mortality (HR=1.2; 95% CI, 1.1-1.3, p=0.006). Proteinuria >1+ was less common (2.5%) but demonstrated a stronger relationship with mortality (HR=1.9; 95% CI, 1.5-2.5, p<0.001). In patients with BUN/Cr in the top tertile (≥17.3), any proteinuria (HR=1.3; 95% CI, 1.1-1.5, p=0.008) and >1+ proteinuria (HR=2.3; 95% CI, 1.7-3.3, p<0.001) both remained associated with mortality. However, in patients with BUN/Cr in the bottom tertile (≤13.3), any proteinuria (HR=0.95; 95% CI, 0.77-1.2, p=0.63, p interaction=0.015) and >1+ proteinuria (HR=1.3; 95% CI, 0.79-2.2, p=0.29, p interaction=0.036) were not associated with worsened survival. CONCLUSION Analogous to a reduced eGFR, the mechanism underlying proteinuria in HF may be important in determining the associated survival disadvantage.
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Affiliation(s)
- Meredith A Brisco
- Department of Medicine, Cardiology Division, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, United States
| | - Michael R Zile
- Department of Medicine, Cardiology Division, Medical University of South Carolina, Charleston, South Carolina, United States
| | - Jozine M Ter Maaten
- Department of Cardiology, University Medical Center Groningen, the Netherlands
| | - Jennifer S Hanberg
- Program of Applied Translational Research, Yale University, New Haven, Connecticut, United States
| | - F Perry Wilson
- Program of Applied Translational Research, Yale University, New Haven, Connecticut, United States
| | - Chirag Parikh
- Program of Applied Translational Research, Yale University, New Haven, Connecticut, United States
| | - Jeffrey M Testani
- Program of Applied Translational Research, Yale University, New Haven, Connecticut, United States.
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Estimated glomerular filtration rate and albuminuria in Korean population evaluated for cardiovascular risk. Int Urol Nephrol 2016; 48:759-64. [PMID: 26905406 DOI: 10.1007/s11255-016-1244-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 02/08/2016] [Indexed: 12/19/2022]
Abstract
PURPOSE This study's purpose was to examine established cardiovascular risk prediction model scores for their associations with albuminuria and estimated glomerular filtration rate (eGFR) in Korean population. METHODS We calculated the 10-year atherosclerotic cardiovascular disease (ASCVD) risk estimated score, Korean coronary heart disease risk prediction score (KRS), and the Adult Treatment Panel (ATP) III risk score for 9733 South Koreans, aged 40-79 years, who were not diagnosed with stroke, angina pectoris, or myocardial ischemia using data from the 2011-2013 Korea National Health and Nutrition Examination Survey. RESULTS The associations between cardiovascular risk model scores and the urine albumin-to-creatinine ratio (UACR) and eGFR tended to be stronger for the ASCVD risk score than for the other risk scores. The area under the receiver operating characteristic curve for increased albuminuria (UACR ≥ 30 mg/g) and decreased eGFR (<60 mL/min/1.73 m(2)) was significantly higher for the ASCVD risk score than for the ATP III risk score and the KRS (except for increased albuminuria in women). CONCLUSIONS The ASCVD risk score had a stronger relationship with and better predicted albuminuria and eGFR than did the KRS and ATP III risk score.
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Magnitude of rate of change in kidney function and future risk of cardiovascular events. Int J Cardiol 2016; 202:657-65. [DOI: 10.1016/j.ijcard.2015.09.090] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Accepted: 09/24/2015] [Indexed: 11/20/2022]
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Grams ME, Sang Y, Ballew SH, Gansevoort RT, Kimm H, Kovesdy CP, Naimark D, Oien C, Smith DH, Coresh J, Sarnak MJ, Stengel B, Tonelli M. A Meta-analysis of the Association of Estimated GFR, Albuminuria, Age, Race, and Sex With Acute Kidney Injury. Am J Kidney Dis 2015; 66:591-601. [PMID: 25943717 PMCID: PMC4584180 DOI: 10.1053/j.ajkd.2015.02.337] [Citation(s) in RCA: 119] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 02/26/2015] [Indexed: 01/21/2023]
Abstract
BACKGROUND Acute kidney injury (AKI) is a serious global public health problem. We aimed to quantify the risk of AKI associated with estimated glomerular filtration rate (eGFR), albuminuria (albumin-creatinine ratio [ACR]), age, sex, and race (African American and white). STUDY DESIGN Collaborative meta-analysis. SETTING & POPULATION 8 general-population cohorts (1,285,049 participants) and 5 chronic kidney disease (CKD) cohorts (79,519 participants). SELECTION CRITERIA FOR STUDIES Available eGFR, ACR, and 50 or more AKI events. PREDICTORS Age, sex, race, eGFR, urine ACR, and interactions. OUTCOME Hospitalized with or for AKI, using Cox proportional hazards models to estimate HRs of AKI and random-effects meta-analysis to pool results. RESULTS 16,480 (1.3%) general-population cohort participants had AKI over a mean follow-up of 4 years; 2,087 (2.6%) CKD participants had AKI over a mean follow-up of 1 year. Lower eGFR and higher ACR were strongly associated with AKI. Compared with eGFR of 80mL/min/1.73m(2), the adjusted HR of AKI at eGFR of 45mL/min/1.73m(2) was 3.35 (95% CI, 2.75-4.07). Compared with ACR of 5mg/g, the risk of AKI at ACR of 300mg/g was 2.73 (95% CI, 2.18-3.43). Older age was associated with higher risk of AKI, but this effect was attenuated with lower eGFR or higher ACR. Male sex was associated with higher risk of AKI, with a slight attenuation in lower eGFR but not in higher ACR. African Americans had higher AKI risk at higher levels of eGFR and most levels of ACR. LIMITATIONS Only 2 general-population cohorts could contribute to analyses by race; AKI identified by diagnostic code. CONCLUSIONS Reduced eGFR and increased ACR are consistent strong risk factors for AKI, whereas associations of AKI with age, sex, and race may be weaker in more advanced stages of CKD.
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Affiliation(s)
- Morgan E. Grams
- Department of Medicine, Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD (M.E.G.); the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (M.E.G.,Y.S., S.H.B., J.C.); the Department of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands (R.T.G.); the Department of Epidemiology and Health Promotion, Graduate School of Public Health, Yonsei University, Seoul, Korea (H.K.); the Memphis Veterans Affairs Medical Center, Memphis, TN (C.K.); the Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada (D.N.); Norwegian University of Science and Technology and St Olavs University Hospital, Norway (C.O.); the Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (D.H.S.); the Division of Nephrology, Tufts Medical Center, Boston, MA (M.J.S.); the Inserm U1018, CESP Centre for Research in Epidemiology and Population Health, and UMRS 1018, Paris-Sud University, Villejuif, France (B.S.); the Departments of Medicine, University of Calgary, Calgary, Alberta, Canada (M.T.)
| | - Yingying Sang
- Department of Medicine, Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD (M.E.G.); the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (M.E.G.,Y.S., S.H.B., J.C.); the Department of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands (R.T.G.); the Department of Epidemiology and Health Promotion, Graduate School of Public Health, Yonsei University, Seoul, Korea (H.K.); the Memphis Veterans Affairs Medical Center, Memphis, TN (C.K.); the Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada (D.N.); Norwegian University of Science and Technology and St Olavs University Hospital, Norway (C.O.); the Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (D.H.S.); the Division of Nephrology, Tufts Medical Center, Boston, MA (M.J.S.); the Inserm U1018, CESP Centre for Research in Epidemiology and Population Health, and UMRS 1018, Paris-Sud University, Villejuif, France (B.S.); the Departments of Medicine, University of Calgary, Calgary, Alberta, Canada (M.T.)
| | - Shoshana H. Ballew
- Department of Medicine, Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD (M.E.G.); the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (M.E.G.,Y.S., S.H.B., J.C.); the Department of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands (R.T.G.); the Department of Epidemiology and Health Promotion, Graduate School of Public Health, Yonsei University, Seoul, Korea (H.K.); the Memphis Veterans Affairs Medical Center, Memphis, TN (C.K.); the Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada (D.N.); Norwegian University of Science and Technology and St Olavs University Hospital, Norway (C.O.); the Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (D.H.S.); the Division of Nephrology, Tufts Medical Center, Boston, MA (M.J.S.); the Inserm U1018, CESP Centre for Research in Epidemiology and Population Health, and UMRS 1018, Paris-Sud University, Villejuif, France (B.S.); the Departments of Medicine, University of Calgary, Calgary, Alberta, Canada (M.T.)
| | - Ron T. Gansevoort
- Department of Medicine, Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD (M.E.G.); the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (M.E.G.,Y.S., S.H.B., J.C.); the Department of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands (R.T.G.); the Department of Epidemiology and Health Promotion, Graduate School of Public Health, Yonsei University, Seoul, Korea (H.K.); the Memphis Veterans Affairs Medical Center, Memphis, TN (C.K.); the Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada (D.N.); Norwegian University of Science and Technology and St Olavs University Hospital, Norway (C.O.); the Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (D.H.S.); the Division of Nephrology, Tufts Medical Center, Boston, MA (M.J.S.); the Inserm U1018, CESP Centre for Research in Epidemiology and Population Health, and UMRS 1018, Paris-Sud University, Villejuif, France (B.S.); the Departments of Medicine, University of Calgary, Calgary, Alberta, Canada (M.T.)
| | - Heejin Kimm
- Department of Medicine, Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD (M.E.G.); the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (M.E.G.,Y.S., S.H.B., J.C.); the Department of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands (R.T.G.); the Department of Epidemiology and Health Promotion, Graduate School of Public Health, Yonsei University, Seoul, Korea (H.K.); the Memphis Veterans Affairs Medical Center, Memphis, TN (C.K.); the Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada (D.N.); Norwegian University of Science and Technology and St Olavs University Hospital, Norway (C.O.); the Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (D.H.S.); the Division of Nephrology, Tufts Medical Center, Boston, MA (M.J.S.); the Inserm U1018, CESP Centre for Research in Epidemiology and Population Health, and UMRS 1018, Paris-Sud University, Villejuif, France (B.S.); the Departments of Medicine, University of Calgary, Calgary, Alberta, Canada (M.T.)
| | - Csaba P. Kovesdy
- Department of Medicine, Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD (M.E.G.); the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (M.E.G.,Y.S., S.H.B., J.C.); the Department of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands (R.T.G.); the Department of Epidemiology and Health Promotion, Graduate School of Public Health, Yonsei University, Seoul, Korea (H.K.); the Memphis Veterans Affairs Medical Center, Memphis, TN (C.K.); the Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada (D.N.); Norwegian University of Science and Technology and St Olavs University Hospital, Norway (C.O.); the Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (D.H.S.); the Division of Nephrology, Tufts Medical Center, Boston, MA (M.J.S.); the Inserm U1018, CESP Centre for Research in Epidemiology and Population Health, and UMRS 1018, Paris-Sud University, Villejuif, France (B.S.); the Departments of Medicine, University of Calgary, Calgary, Alberta, Canada (M.T.)
| | - David Naimark
- Department of Medicine, Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD (M.E.G.); the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (M.E.G.,Y.S., S.H.B., J.C.); the Department of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands (R.T.G.); the Department of Epidemiology and Health Promotion, Graduate School of Public Health, Yonsei University, Seoul, Korea (H.K.); the Memphis Veterans Affairs Medical Center, Memphis, TN (C.K.); the Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada (D.N.); Norwegian University of Science and Technology and St Olavs University Hospital, Norway (C.O.); the Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (D.H.S.); the Division of Nephrology, Tufts Medical Center, Boston, MA (M.J.S.); the Inserm U1018, CESP Centre for Research in Epidemiology and Population Health, and UMRS 1018, Paris-Sud University, Villejuif, France (B.S.); the Departments of Medicine, University of Calgary, Calgary, Alberta, Canada (M.T.)
| | - Cecilia Oien
- Department of Medicine, Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD (M.E.G.); the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (M.E.G.,Y.S., S.H.B., J.C.); the Department of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands (R.T.G.); the Department of Epidemiology and Health Promotion, Graduate School of Public Health, Yonsei University, Seoul, Korea (H.K.); the Memphis Veterans Affairs Medical Center, Memphis, TN (C.K.); the Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada (D.N.); Norwegian University of Science and Technology and St Olavs University Hospital, Norway (C.O.); the Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (D.H.S.); the Division of Nephrology, Tufts Medical Center, Boston, MA (M.J.S.); the Inserm U1018, CESP Centre for Research in Epidemiology and Population Health, and UMRS 1018, Paris-Sud University, Villejuif, France (B.S.); the Departments of Medicine, University of Calgary, Calgary, Alberta, Canada (M.T.)
| | - David H. Smith
- Department of Medicine, Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD (M.E.G.); the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (M.E.G.,Y.S., S.H.B., J.C.); the Department of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands (R.T.G.); the Department of Epidemiology and Health Promotion, Graduate School of Public Health, Yonsei University, Seoul, Korea (H.K.); the Memphis Veterans Affairs Medical Center, Memphis, TN (C.K.); the Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada (D.N.); Norwegian University of Science and Technology and St Olavs University Hospital, Norway (C.O.); the Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (D.H.S.); the Division of Nephrology, Tufts Medical Center, Boston, MA (M.J.S.); the Inserm U1018, CESP Centre for Research in Epidemiology and Population Health, and UMRS 1018, Paris-Sud University, Villejuif, France (B.S.); the Departments of Medicine, University of Calgary, Calgary, Alberta, Canada (M.T.)
| | - Josef Coresh
- Department of Medicine, Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD (M.E.G.); the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (M.E.G.,Y.S., S.H.B., J.C.); the Department of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands (R.T.G.); the Department of Epidemiology and Health Promotion, Graduate School of Public Health, Yonsei University, Seoul, Korea (H.K.); the Memphis Veterans Affairs Medical Center, Memphis, TN (C.K.); the Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada (D.N.); Norwegian University of Science and Technology and St Olavs University Hospital, Norway (C.O.); the Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (D.H.S.); the Division of Nephrology, Tufts Medical Center, Boston, MA (M.J.S.); the Inserm U1018, CESP Centre for Research in Epidemiology and Population Health, and UMRS 1018, Paris-Sud University, Villejuif, France (B.S.); the Departments of Medicine, University of Calgary, Calgary, Alberta, Canada (M.T.)
| | - Mark J. Sarnak
- Department of Medicine, Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD (M.E.G.); the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (M.E.G.,Y.S., S.H.B., J.C.); the Department of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands (R.T.G.); the Department of Epidemiology and Health Promotion, Graduate School of Public Health, Yonsei University, Seoul, Korea (H.K.); the Memphis Veterans Affairs Medical Center, Memphis, TN (C.K.); the Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada (D.N.); Norwegian University of Science and Technology and St Olavs University Hospital, Norway (C.O.); the Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (D.H.S.); the Division of Nephrology, Tufts Medical Center, Boston, MA (M.J.S.); the Inserm U1018, CESP Centre for Research in Epidemiology and Population Health, and UMRS 1018, Paris-Sud University, Villejuif, France (B.S.); the Departments of Medicine, University of Calgary, Calgary, Alberta, Canada (M.T.)
| | - Benedicte Stengel
- Department of Medicine, Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD (M.E.G.); the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (M.E.G.,Y.S., S.H.B., J.C.); the Department of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands (R.T.G.); the Department of Epidemiology and Health Promotion, Graduate School of Public Health, Yonsei University, Seoul, Korea (H.K.); the Memphis Veterans Affairs Medical Center, Memphis, TN (C.K.); the Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada (D.N.); Norwegian University of Science and Technology and St Olavs University Hospital, Norway (C.O.); the Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (D.H.S.); the Division of Nephrology, Tufts Medical Center, Boston, MA (M.J.S.); the Inserm U1018, CESP Centre for Research in Epidemiology and Population Health, and UMRS 1018, Paris-Sud University, Villejuif, France (B.S.); the Departments of Medicine, University of Calgary, Calgary, Alberta, Canada (M.T.)
| | - Marcello Tonelli
- Department of Medicine, Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD (M.E.G.); the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (M.E.G.,Y.S., S.H.B., J.C.); the Department of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands (R.T.G.); the Department of Epidemiology and Health Promotion, Graduate School of Public Health, Yonsei University, Seoul, Korea (H.K.); the Memphis Veterans Affairs Medical Center, Memphis, TN (C.K.); the Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada (D.N.); Norwegian University of Science and Technology and St Olavs University Hospital, Norway (C.O.); the Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (D.H.S.); the Division of Nephrology, Tufts Medical Center, Boston, MA (M.J.S.); the Inserm U1018, CESP Centre for Research in Epidemiology and Population Health, and UMRS 1018, Paris-Sud University, Villejuif, France (B.S.); the Departments of Medicine, University of Calgary, Calgary, Alberta, Canada (M.T.)
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Should the spot albumin-to-creatinine ratio replace the spot protein-to-creatinine ratio as the primary screening tool for proteinuria in pregnancy? Pregnancy Hypertens 2015; 5:298-302. [PMID: 26597744 DOI: 10.1016/j.preghy.2015.07.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 07/28/2015] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To determine the correlation between the spot albumin-to-creatinine (ACR) ratio and protein-to-creatinine ratio (PCR) in pregnancy and if either test is predictive of adverse pregnancy outcome. STUDY DESIGN Prospective consecutive cohort study in a single tertiary centre examining 181 patients undergoing proteinuria screening after 20weeks of pregnancy. A spot PCR and ACR was performed on the first void of the day. Comparison was with linear and logistic regression and ROC curve. Optimal values for the ACR were obtained and compared to a PCR value of 30mg/mmol with respect to adverse pregnancy outcomes. MAIN OUTCOME MEASURES Birth weight <10th centile, preterm birth <32 and <37weeks, placental abruption, caesarean section, induction of labour, fetal death in utero or neonatal death, Apgar score <5 at 1min and/or 5min, pulmonary oedema, sustained blood pressure >170/110mmHg, magnesium infusion or labetalol infusion during labour. RESULTS 254 tests were performed. The ACR and PCR were highly correlated (r=0.95, p<0.001) and the area under ROC curve was 0.98. An ACR of 13.4mg/mmol corresponded to a PCR of 30mg/mmol. Neither was more predictive of adverse pregnancy outcome nor was the level of proteinuria. CONCLUSIONS The ACR is not inferior to nor does it perform better than the PCR in screening for proteinuria in pregnancy. Clinicians should use the test with which they are more familiar and may wish to assess local laboratory costs and methods in their selection.
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Urinary monocyte chemoattractant protein-1 and vitamin D-binding protein as biomarkers for early detection of diabetic nephropathy in type 2 diabetes mellitus. Mol Cell Biochem 2015; 408:25-35. [PMID: 26104579 DOI: 10.1007/s11010-015-2479-y] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 06/13/2015] [Indexed: 01/15/2023]
Abstract
Diabetic nephropathy is a serious complication of both type 1 and type 2 diabetes and, unless arrested, leads to end-stage renal disease. Therefore, early prediction and detection of DN would greatly benefit the disease management and delay its progression. The aim of this study is to evaluate the levels of urinary monocyte chemoattractant protein-1 (uMCP-1) and urinary vitamin D-binding protein (uVDBP) in type 2 diabetic patients with different degrees of diabetic nephropathy (DN) and to assess the value of uMCP-1 and uVDBP in the early detection of DN. Seventy-five type 2 diabetic patients with normoalbuminuria (n = 25), microalbuminuria (n = 25), macroalbuminuria (n = 25), and 25 healthy controls were included in this study. Urinary MCP-1 and VDBP levels were evaluated by enzyme-linked immunosorbent assay. A significant elevation in the uMCP-1 and uVDBP levels was found in macroalbuminuric (p < 0.001) and microalbuminuric (p < 0.01) diabetic patients compared to that in normoalbuminuric diabetic patients and control subjects (p < 0.001). Correlation study revealed that both uMCP-1 and uVDBP were significantly positively correlated to urinary albumin/creatinine ratio (r = 0.968, p < 0.001 and r = 0.973, p < 0.001, respectively), serum urea (r = 0.461, p = 0.001 and r = 0.456, p = 0.002, respectively), and serum creatinine (r = 0.475, p = 0.001 and r = 0.448, p = 0.004, respectively) and significantly inversely correlated to glomerular filtration rate (r = -0.983, p < 0.001 and r = -0.988, p < 0.001, respectively). Receiver operating characteristic (ROC) curve analysis of uMCP-1 and uVDBP levels for early diagnosis and detection of DN revealed that the cut-off value of uMCP-1 was 110 pg/mg with 92% sensitivity and 100% specificity; whereas, the cut-off value of uVDBP was 550 ng/mg with 96% sensitivity and 84% specificity. The findings of the present study suggest that uMCP-1 and uVDBP may be considered as novel potential diagnostic biomarkers for the early detection of diabetic nephropathy.
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Mun PS, Ting HN, Ong TA, Wong CM, Ng KH, Chong YB. A Study of Dielectric Properties of Proteinuria between 0.2 GHz and 50 GHz. PLoS One 2015; 10:e0130011. [PMID: 26066351 PMCID: PMC4466538 DOI: 10.1371/journal.pone.0130011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2014] [Accepted: 05/16/2015] [Indexed: 12/02/2022] Open
Abstract
This paper investigates the dielectric properties of urine in normal subjects and subjects with chronic kidney disease (CKD) at microwave frequency of between 0.2 GHz and 50 GHz. The measurements were conducted using an open-ended coaxial probe at room temperature (25°C), at 30°C and at human body temperature (37°C). There were statistically significant differences in the dielectric properties of the CKD subjects compared to those of the normal subjects. Statistically significant differences in dielectric properties were observed across the temperatures for normal subjects and CKD subjects. Pearson correlation test showed the significant correlation between proteinuria and dielectric properties. The experimental data closely matched the single-pole Debye model. The relaxation dispersion and relaxation time increased with the proteinuria level, while decreasing with the temperature. As for static conductivity, it increased with proteinuria level and temperature.
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Affiliation(s)
- Peck Shen Mun
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia
| | - Hua Nong Ting
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia
| | - Teng Aik Ong
- Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chew Ming Wong
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Kwan Hong Ng
- Department of Biomedical Imaging, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Yip Boon Chong
- Damansara Specialist Hospital, Petaling Jaya, Selangor, Malaysia
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Michener KH, Mitchell GF, Noubary F, Huang N, Harris T, Andresdottir MB, Palsson R, Gudnason V, Levey AS. Aortic stiffness and kidney disease in an elderly population. Am J Nephrol 2015; 41:320-8. [PMID: 26067356 DOI: 10.1159/000431332] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Accepted: 05/07/2015] [Indexed: 01/28/2023]
Abstract
BACKGROUND/AIMS The causes of chronic kidney disease (CKD) in older people are not well understood. Aortic stiffness increases with age and results in the transmission of increased pulsatility into the kidney microvasculature, potentially contributing to CKD in older populations. METHODS We utilized data from the Age, Gene/Environment, Susceptibility-Reykjavik Study, a community-based prospective cohort study of cardiovascular disease (CVD) in Iceland. The relationship of carotid pulse pressure (CPP) and carotid-femoral pulse wave velocity (CFPWV) with estimated glomerular filtration rate (eGFR) based on creatinine and cystatin C and urine albumin-creatinine ratio (ACR) was assessed using linear regression, adjusting for demographics and CVD risk factors. RESULTS 940 participants (mean (SD) age 75.8 (4.7) years, mean (SD) CFPWV 12.9 (4.2) m/s, mean (SD) CPP 69 (21) mm Hg, mean (SD) eGFR 68 (16) ml/min/1.73 m(2), and median (IQR) ACR 3 (2-6) mg/g) were included in this study. At CPP greater than 85 mm Hg, a higher CPP was associated with a lower eGFR in unadjusted analyses but not after adjustment. CPP was significantly associated with a higher ACR in fully adjusted models (β (95% CI) = 0.14 (0.03, 0.24) ln mg/g per SD). Higher CFPWV was associated with lower eGFR and higher ACR in unadjusted analyses but not after adjustment. CONCLUSION Greater aortic stiffness may be associated with modestly higher levels of albuminuria in the elderly. The association between aortic stiffness and lower eGFR may be confounded by age and CVD risk factors.
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97
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Liu Q, Lv J, Li H, Jiao L, Yang H, Song Y, Xu G. Validation of chronic kidney disease risk categorization system in Chinese patients with kidney disease: A cohort study. Nephrology (Carlton) 2015; 20:936-44. [PMID: 26032648 DOI: 10.1111/nep.12528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2015] [Indexed: 11/28/2022]
Abstract
AIM To validate the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines risk stratification system based on the combination of estimated glomerular filtration rate (eGFR) and proteinuria. METHODS This was a cohort study. A total of 1219 study population were recruited. Estimated GFR and proteinuria measured by using 24 h urine protein excretion rate (PER) were predictors. Adverse outcomes included all-cause mortality (ACM) and end-stage renal disease (ESRD). Follow-up was done by regular visit, telephone interview and electronic medical records. RESULTS Over a median follow-up of 4.6 years, 153 (12.6%) and 43 (3.5%) patients experienced ESRD and ACM, respectively. On multivariable analysis, the adjusted hazard ratio for ESRD and ACM (compared with patients with eGFR > 60 mL/min per 1.7 m²) was of 29.8 and 3.6 for those with eGFR of 15-29 mL/min per 1.73 m², respectively. The adjusted hazard ratio for ESRD and ACM (compared with patients with PER < 150 mg/24h) was of 15.9 and 3.9 for those with PER > 500 mg/24h. Higher KDIGO guidelines risk categories (indicating lower eGFR or higher proteinuria) were associated with a graded increase in the risk for the ESRD (P < 0.001) and ACM (P < 0.001). Reclassification of KDIGO guidelines risk categories yielded net reclassification improvements for those with ESRD or ACM event (NRIevents ) of 33.3% or 30.2%. CONCLUSION Lower eGFR and higher proteinuria are risk factors for ESRD and ACM in Chinese patients. The KDIGO guidelines risk categorization system assigned patients who went on to have the event to more appropriate CKD risk categories.
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Affiliation(s)
- Qingyan Liu
- Department of Clinical Laboratory, Peking University First Hospital, Beijing, China
| | - Jicheng Lv
- Division of Nephrology and Institute of Nephrology, Peking University First Hospital, Beijing, China.,Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China.,Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing, China
| | - Haixia Li
- Department of Clinical Laboratory, Peking University First Hospital, Beijing, China
| | - Lili Jiao
- Department of Clinical Laboratory, Peking University First Hospital, Beijing, China
| | - Hongyun Yang
- Department of Clinical Laboratory, Peking University First Hospital, Beijing, China
| | - Yinan Song
- Department of Clinical Laboratory, Peking University First Hospital, Beijing, China
| | - Guobin Xu
- Department of Clinical Laboratory, Peking University First Hospital, Beijing, China
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98
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James MT, Grams ME, Woodward M, Elley CR, Green JA, Wheeler DC, de Jong P, Gansevoort RT, Levey AS, Warnock DG, Sarnak MJ. A Meta-analysis of the Association of Estimated GFR, Albuminuria, Diabetes Mellitus, and Hypertension With Acute Kidney Injury. Am J Kidney Dis 2015; 66:602-12. [PMID: 25975964 DOI: 10.1053/j.ajkd.2015.02.338] [Citation(s) in RCA: 190] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 02/26/2015] [Indexed: 02/08/2023]
Abstract
BACKGROUND Diabetes mellitus and hypertension are risk factors for acute kidney injury (AKI). Whether estimated glomerular filtration rate (eGFR) and urine albumin-creatinine ratio (ACR) remain risk factors for AKI in the presence and absence of these conditions is uncertain. STUDY DESIGN Meta-analysis of cohort studies. SETTING & POPULATION 8 general-population (1,285,045 participants) and 5 chronic kidney disease (CKD; 79,519 participants) cohorts. SELECTION CRITERIA FOR STUDIES Cohorts participating in the CKD Prognosis Consortium. PREDICTORS Diabetes and hypertension status, eGFR by the 2009 CKD Epidemiology Collaboration creatinine equation, urine ACR, and interactions. OUTCOME Hospitalization with AKI, using Cox proportional hazards models to estimate HRs of AKI and random-effects meta-analysis to pool results. RESULTS During a mean follow-up of 4 years, there were 16,480 episodes of AKI in the general-population and 2,087 episodes in the CKD cohorts. Low eGFRs and high ACRs were associated with higher risks of AKI in individuals with or without diabetes and with or without hypertension. When compared to a common reference of eGFR of 80mL/min/1.73m(2) in nondiabetic patients, HRs for AKI were generally higher in diabetic patients at any level of eGFR. The same was true for diabetic patients at all levels of ACR compared with nondiabetic patients. The risk gradient for AKI with lower eGFRs was greater in those without diabetes than with diabetes, but similar with higher ACRs in those without versus with diabetes. Those with hypertension had a higher risk of AKI at eGFRs>60mL/min/1.73m(2) than those without hypertension. However, risk gradients for AKI with both lower eGFRs and higher ACRs were greater for those without than with hypertension. LIMITATIONS AKI identified by diagnostic code. CONCLUSIONS Lower eGFRs and higher ACRs are associated with higher risks of AKI among individuals with or without either diabetes or hypertension.
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Affiliation(s)
- Matthew T James
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Morgan E Grams
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Mark Woodward
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; The George Institute for Global Health, University of Sydney, Sydney, NSW, Australia; The George Institute for Global Health, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - C Raina Elley
- Department of General Practice and Primary Health Care, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Jamie A Green
- Nephrology Department, Geisinger Medical Center, Danville, PA
| | | | - Paul de Jong
- University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Ron T Gansevoort
- University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Andrew S Levey
- Division of Nephrology at Tufts Medical Center, Boston, MA
| | | | - Mark J Sarnak
- Division of Nephrology at Tufts Medical Center, Boston, MA
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99
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Masson P, Webster AC, Hong M, Turner R, Lindley RI, Craig JC. Chronic kidney disease and the risk of stroke: a systematic review and meta-analysis. Nephrol Dial Transplant 2015; 30:1162-9. [PMID: 25681099 DOI: 10.1093/ndt/gfv009] [Citation(s) in RCA: 179] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2014] [Accepted: 01/07/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND People with chronic kidney disease (CKD) have an increased risk of stroke but the magnitude of increased risk and the independent effects of glomerular filtration rate (GFR) and albuminuria are unclear. We aimed to quantify the association between the independent and combined effects of GFR and albuminuria on stroke risk. METHODS We searched MEDLINE and EMBASE (February 2014) for cohort studies or randomized controlled trials (RCTs) which reported stroke incidence in adults with a baseline measurement of GFR and/or albuminuria. We extracted study and participant characteristics, risk of bias and relative risks (RR, with confidence interval; CI) of stroke associated with GFR and/or quantity of albuminuria, synthesized data using random effects meta-analysis and explored heterogeneity using meta-regression. RESULTS We identified 83 studies; 63 cohort studies (2 085 225 participants) and 20 RCTs (168 516 participants) reporting 30 392 strokes. There was an inverse linear relationship between GFR and risk of stroke, with risk of stroke increasing 7% (RR: 1.07, CI: 1.04-1.09) for every 10 mL/min/1.73 m(2) decrease in GFR. A 25 mg/mmol increase in albumin-creatinine ratio was associated with a 10% increased risk of stroke (RR: 1.10, 95% CI: 1.01-1.20). The effect of albuminuria was independent of GFR. Results were not different across subtypes of stroke, sex and varying prevalence of cardiovascular risk factors. CONCLUSIONS Stroke risk increases linearly and additively with declining GFR and increasing albuminuria. CKD staging may also be a useful clinical tool for identifying people who may benefit most from interventions to reduce cardiovascular risk.
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Affiliation(s)
- Philip Masson
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Angela C Webster
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia Centre for Renal and Transplant Research, Westmead Hospital, Sydney, NSW, Australia
| | - Martin Hong
- University of Sydney, Westmead Clinical School, Sydney, NSW, Australia
| | - Robin Turner
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Richard I Lindley
- University of Sydney, Westmead Clinical School, Sydney, NSW, Australia George Institute for Global Health, Sydney, NSW, Australia
| | - Jonathan C Craig
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
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Turin TC, Ahmed SB, Tonelli M, Manns B, Ravani P, James M, Quinn RR, Jun M, Gansevoort R, Hemmelgarn B. Kidney function, albuminuria and life expectancy. Can J Kidney Health Dis 2014; 1:33. [PMID: 25780622 PMCID: PMC4349777 DOI: 10.1186/s40697-014-0033-6] [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: 09/25/2014] [Accepted: 12/05/2014] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Lower estimated glomerular filtration rate is associated with reduced life expectancy. Whether this association is modified by the presence or absence of albuminuria, another cardinal finding of chronic kidney disease, is unknown. OBJECTIVE Our objective was to estimate the life expectancy of middle-aged men and women with varying levels of eGFR and concomitant albuminuria. DESIGN A retrospective cohort study. SETTING A large population-based cohort identified from the provincial laboratory registry in Alberta, Canada. PARTICIPANTS Adults aged ≥30 years who had outpatient measures of serum creatinine and albuminuria between May 1, 2002 and March 31, 2008. MEASUREMENTS PREDICTOR Baseline levels of kidney function identified from serum creatinine and albuminuria measurements. OUTCOMES all cause mortality during the follow-up. METHODS Patients were categorized based on their estimated glomerular filtration rate (eGFR) (≥60, 45-59, 30-44, and 15-29 mL/min/1 · 73 m(2)) as well as albuminuria (normal, mild, and heavy) measured by albumin-to-creatinine ratio or urine dipstick. The abridged life table method was applied to calculate the life expectancies of men and women from age 40 to 80 years across combined eGFR and albuminuria categories. We also categorized participants by severity of kidney disease (low risk, moderately increased risk, high risk, and very high risk) using the combination of eGFR and albuminuria levels. RESULTS Among men aged 50 years and with eGFR ≥60 mL/min/1.73 m(2), estimated life expectancy was 24.8 (95% CI: 24.6-25.0), 17.5 (95% CI: 17.1-17.9), and 13.5 (95% CI: 12.6-14.3) years for participants with normal, mild and heavy albuminuria respectively. Life expectancy for men with mild and heavy albuminuria was 7.3 (95% CI: 6.9-7.8) and 11.3 (95% CI: 10.5-12.2) years shorter than men with normal proteinuria, respectively. A reduction in life expectancy was associated with an increasing severity of kidney disease; 24.8 years for low risk (95% CI: 24.6-25.0), 19.1 years for moderately increased risk (95% CI: 18.7-19.5), 14.2 years for high risk (95% CI: 13.5-15.0), and 9.6 years for very high risk (95% CI: 8.4-10.8). Among women of similar age and kidney function, estimated life expectancy was 28.9 (95% CI: 28.7-29.1), 19.8 (95% CI: 19.2-20.3), and 14.8 (95% CI: 13.5-16.0) years for participants with normal, mild and heavy albuminuria respectively. Life expectancy for women with mild and heavy albuminuria was 9.1 (95% CI: 8.5-9.7) and 14.2 (95% CI: 12.9-15.4) years shorter than the women with normal proteinuria, respectively. For women also a graded reduction in life expectancy was observed across the increasing severity of kidney disease; 28.9 years for low risk (95% CI: 28.7-29.1), 22.5 years for moderately increased risk (95% CI: 22.0-22.9), 16.5 years for high risk (95% CI: 15.4-17.5), and 9.2 years for very high risk (95% CI: 7.8-10.7). LIMITATIONS Possible misclassification of long-term kidney function categories cannot be eliminated. Possibility of confounding due to concomitant comorbidities cannot be ruled out. CONCLUSION The presence and degree of albuminuria was associated with lower estimated life expectancy for both gender and was especially notable in those with eGFR ≥30 mL/min/1.73 m(2). Life expectancy associated with a given level of eGFR differs substantially based on the presence and severity of albuminuria.
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Affiliation(s)
- Tanvir Chowdhury Turin
- />Department of Family Medicine, University of Calgary, Room G012F, 3330 Hospital Drive Northwest, Calgary, Alberta T2N 4N1 Canada
- />Department of Community Health Sciences, University of Calgary, Calgary, Alberta Canada
- />Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta Canada
- />Institute of Public Health, University of Calgary, Calgary, Alberta Canada
| | - Sofia B Ahmed
- />Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta Canada
- />Department of Medicine, University of Calgary, Calgary, Alberta Canada
| | - Marcello Tonelli
- />Department of Medicine, University of Alberta, Edmonton, Alberta Canada
| | - Braden Manns
- />Department of Community Health Sciences, University of Calgary, Calgary, Alberta Canada
- />Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta Canada
- />Institute of Public Health, University of Calgary, Calgary, Alberta Canada
- />Department of Medicine, University of Calgary, Calgary, Alberta Canada
| | - Pietro Ravani
- />Department of Community Health Sciences, University of Calgary, Calgary, Alberta Canada
- />Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta Canada
- />Institute of Public Health, University of Calgary, Calgary, Alberta Canada
- />Department of Medicine, University of Calgary, Calgary, Alberta Canada
| | - Matthew James
- />Department of Community Health Sciences, University of Calgary, Calgary, Alberta Canada
- />Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta Canada
- />Institute of Public Health, University of Calgary, Calgary, Alberta Canada
- />Department of Medicine, University of Calgary, Calgary, Alberta Canada
| | - Robert R Quinn
- />Department of Community Health Sciences, University of Calgary, Calgary, Alberta Canada
- />Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta Canada
- />Institute of Public Health, University of Calgary, Calgary, Alberta Canada
- />Department of Medicine, University of Calgary, Calgary, Alberta Canada
| | - Min Jun
- />Department of Medicine, University of Calgary, Calgary, Alberta Canada
| | - Ron Gansevoort
- />Department of Nephrology, University Medical Center Groningen, Groningen, The Netherlands
| | - Brenda Hemmelgarn
- />Department of Community Health Sciences, University of Calgary, Calgary, Alberta Canada
- />Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta Canada
- />Institute of Public Health, University of Calgary, Calgary, Alberta Canada
- />Department of Medicine, University of Calgary, Calgary, Alberta Canada
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