51
|
Wong G, Hayen A, Chapman JR, Webster AC, Wang JJ, Mitchell P, Craig JC. Association of CKD and cancer risk in older people. J Am Soc Nephrol 2009; 20:1341-50. [PMID: 19406977 DOI: 10.1681/asn.2008090998] [Citation(s) in RCA: 202] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
People with ESRD are at increased risk for cancer, but it is uncertain when this increased risk begins in the spectrum of chronic kidney disease (CKD). The aim of our study was to determine whether moderate CKD increases the risk for cancer among older people. We linked the Blue Mountains Eye Study, a prospective population-based cohort study of 3654 residents aged 49 to 97 yr, and the New South Wales Cancer Registry. During a mean follow-up of 10.1 yr, 711 (19.5%) cancers occurred in 3654 participants. Men but not women with at least stage 3 CKD had a significantly increased risk for cancer (test of interaction for gender P = 0.004). For men, the excess risk began at an estimated GFR (eGFR) of 55 ml/min per 1.73 m2 (adjusted hazard ratio [HR] 1.39; 95% confidence interval [CI] 1.00 to 1.92) and increased linearly as GFR declined. For every 10-ml/min decrement in eGFR, the risk for cancer increased by 29% (adjusted HR 1.29; 95% CI 1.10 to 1.53), with the greatest risk at an eGFR <40 ml/min per 1.73 m2 (adjusted HR 3.01; 95% CI 1.72 to 5.27). The risk for lung and urinary tract cancers but not prostate was higher among men with CKD. In conclusion, moderate CKD (stage 3) may be an independent risk factor for the development of cancer among older men but not women, and the effect of CKD on risk may vary for different types of cancer.
Collapse
Affiliation(s)
- Germaine Wong
- National Health and Medical Research Council Centre for Clinical Research Excellence in Renal Medicine, Children's Hospital at Westmead, Westmead, New South Wales, Australia.
| | | | | | | | | | | | | |
Collapse
|
52
|
Rule AD, Bergstralh EJ, Melton LJ, Li X, Weaver AL, Lieske JC. Kidney stones and the risk for chronic kidney disease. Clin J Am Soc Nephrol 2009; 4:804-11. [PMID: 19339425 DOI: 10.2215/cjn.05811108] [Citation(s) in RCA: 245] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Kidney stones lead to chronic kidney disease (CKD) in people with rare hereditary disorders (e.g., primary hyperoxaluria, cystinuria), but it is unknown whether kidney stones are an important risk factor for CKD in the general population. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Among Olmsted County, MN, residents, all stone formers (n = 4774) whose condition was diagnosed in 1986 through 2003 were matched 1:3 to control subjects (n = 12,975). Cox proportional hazards models adjusted for age, gender, and comorbidities (hypertension, diabetes, obesity, dyslipidemia, gout, alcohol abuse, tobacco use, coronary artery disease, heart failure, cerebral infarct, and peripheral vascular disease) were used to assess the risk for incident CKD defined as a clinical diagnosis (diagnostic codes), ESRD or death with CKD, sustained (>90 d) elevated serum creatinine (>1.3 mg/dl in men, >1.1 mg/dl in women), or sustained estimated GFR <60 ml/min per 1.73 m(2). RESULTS During a mean of 8.6 yr of follow-up, stone formers were at increased risk for a clinical diagnosis of CKD, but an increased risk for ESRD or death with CKD was NS. Among patients with follow-up serum creatinine levels, stone formers were at increased risk for a sustained elevated serum creatinine and a sustained reduced GFR. CONCLUSIONS Kidney stones are a risk factor for CKD, and studies are warranted to assess screening and preventive measures for CKD in stone formers.
Collapse
Affiliation(s)
- Andrew D Rule
- Departments of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota 55905.
| | | | | | | | | | | |
Collapse
|
53
|
Sim JJ, Rasgon SA, Kujubu DA, Kumar VA, Liu ILA, Shi JM, Pham TT, Derose SF. Sleep Apnea in Early and Advanced Chronic Kidney Disease. Chest 2009; 135:710-716. [DOI: 10.1378/chest.08-2248] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
|
54
|
High Prevalence of Unlabeled Chronic Kidney Disease Among Inpatients at a Tertiary-Care Hospital. Am J Med Sci 2009; 337:93-7. [DOI: 10.1097/maj.0b013e318181288e] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
|
55
|
McCarthy JT, Rule AD, Achenbach SJ, Bergstralh EJ, Khosla S, Melton LJ. Use of renal function measurements for assessing fracture risk in postmenopausal women. Mayo Clin Proc 2008; 83:1231-9. [PMID: 18990322 PMCID: PMC2593794 DOI: 10.4065/83.11.1231] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To determine whether factors associated with moderate chronic kidney disease can be used to independently predict fracture risk in postmenopausal white women by analyzing the effect of adding renal function measurements to traditional risk factors (eg, age, body weight, bone mineral density) for fracture risk assessment. PARTICIPANTS AND METHODS In a prospective, population-based cohort study, postmenopausal women residing in Rochester, MN, with baseline measurements of bone mineral density and renal function were followed up for as long as 25 years for occurrence of fractures. Participants were enrolled in 1980-1984 or 1991-1993, and outcomes were analyzed in 2007. Standardized incidence ratios were used to compare the number of observed fractures with the number of predicted fractures, and potential risk factors were evaluated with Andersen-Gill time-to-fracture regression models. RESULTS During 5948 person-years of follow-up of 427 women, 254 women (59.5%) experienced a total of 563 fractures, 394 (70.0%) of which resulted from moderate trauma. Excluding incidentally diagnosed fractures, the 186 clinically diagnosed fractures were statistically undifferentiated from the 195 predicted fractures (standardized incidence ratio, 0.95; 95% confidence interval, 0.82-1.10). No significant trends were observed toward increasing fracture risk with inclusion of quintiles of declining renal function (P>.10). In univariate analyses, serum creatinine concentration, creatinine clearance rate, and estimated glomerular filtration rate were associated with greater risk of some fractures. In multivariate analyses, however, decreasing renal function was not found to be a significant risk factor, after adjusting for age, body weight, and bone mineral density. CONCLUSION The addition of serum creatinine concentration, creatinine clearance rate, or estimated glomerular filtration rate does not improve fracture risk prediction in postmenopausal white women who have moderate chronic kidney disease. This result can be partly explained by the fact that important risk factors for decreased renal function (eg, advanced age, lower body weight) are already accounted for in most fracture prediction models.
Collapse
Affiliation(s)
- James T McCarthy
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN 55905, USA
| | | | | | | | | | | |
Collapse
|
56
|
Abstract
As the US population has continued to age, the number of patients with chronic kidney disease (CKD) has dramatically increased. Faced with this increase, clinicians need a better understanding of what an elevated serum creatinine level represents and a simple codified approach to evaluating renal failure. Creatinine, a muscle waste product, has an imperfect but predictable association with the glomerular filtration rate (GFR). Although other markers of GFR exist, including cystatin C, urea, inulin, and radioisotopic methods, their role in estimating GFR remains a matter for debate, especially that of cystatin C. Diagnosis and management of CKD are challenges for the nonspecialist. We describe a systematic approach that can be used by the nonspecialist to identify most but not all causes of renal insufficiency. Although this approach should allow for earlier recognition of treatable causes of CKD, it does not eliminate the involvement of a nephrologist in the care and management of the conditions causing the renal insufficiency. The nonspecialist should also be able to recognize the 9 therapies that are helpful in preservation of renal function in all patients with CKD.
Collapse
Affiliation(s)
- John W Graves
- Division of Nephrology and Hypertension, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA.
| |
Collapse
|
57
|
Rule AD, Larson TS. Do we need another equation to estimate GFR from serum creatinine in renal allograft recipients? Nephrol Dial Transplant 2008; 23:2427-8; author reply 2428. [PMID: 18400813 DOI: 10.1093/ndt/gfn119] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
58
|
Abstract
Chronic kidney disease (CKD) is a world-wide public health problem, with adverse outcomes of kidney failure, cardiovascular disease, and premature death. The National Kidney Foundation, through its Kidney Disease Quality Outcome Initiative (K/DOQI) and other National institutions, recommend glomerular filtration rate (GFR) estimates for the definition, classification, screening, and monitoring of CKD. Prediction equations based on serum creatinine values were chosen both for adults (Cockcroft-Gault [C-G] and Modification of Diet in Renal Disease [MDRD] study equations) and for children (Schwartz and Counahan-Barratt equations). This review aims to evaluate from recent literature the clinical efficiency and relevance of these equations in terms of bias, precision, and reproducibility in different specific indications (eg, screening CKD, assessment of disease progression, or therapy efficacy) in different populations. Because these prediction equations based on serum creatinine have limitations, especially in the normal or near-normal GFR range, kidney transplant recipients, and pediatric populations, other prediction equations based on serum cystatin C value were also considered as possibly more sensitive GFR surrogate markers. Recent guidelines state that the cystatin C-based prediction equation cannot be recommended for use in clinical practice. With prediction equations based on serum creatinine, the National Kidney Disease Education Program (NKDEP) recommendations are to report a numerical estimate in round numbers only for GFR values <60 mL/min per 1.73 m(2). The MDRD equation generally outperforms the C-G equation but may still have a high level of bias, depending on creatinine assay calibration, and low precision with, at best, approximately 80% of estimated GFR in the "accuracy range" of 70-130% of the measured GFR value, even in patients with known CKD. According to Kidney Disease Improving Global Outcomes (KDIGO) recommendations, many indications remain for GFR measurements using a clearance method. In that context, it should be recalled that radiolabeled-tracer plasma or urinary clearance methods, are safe, simple, accurate and reproducible.
Collapse
Affiliation(s)
- Alain Prigent
- Department of Biophysics, Nuclear Medicine and Clinical Neurophysiology, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris-Sud, Le Kremlin Bicêtre Cedex, France.
| |
Collapse
|
59
|
Poggio ED, Rule AD. Can we do better than a single estimated GFR threshold when screening for chronic kidney disease? Kidney Int 2007; 72:534-6. [PMID: 17713563 DOI: 10.1038/sj.ki.5002452] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The Modification of Diet in Renal Disease (MDRD) equation has been used to screen for and diagnose chronic kidney disease (CKD). A fixed estimated glomerular filtration rate cutoff point has been advocated by the National Kidney Foundation to diagnose CKD. However, data derived from healthy individuals challenge this approach and suggest that age- and gender-specific reference values may be more useful in the screening setting.
Collapse
Affiliation(s)
- E D Poggio
- Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
| | | |
Collapse
|
60
|
Gerber Y, Jacobsen SJ, Killian JM, Weston SA, Roger VL. Participation bias assessment in a community-based study of myocardial infarction, 2002-2005. Mayo Clin Proc 2007; 82:933-8. [PMID: 17673061 DOI: 10.4065/82.8.933] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To compare the characteristics and survival of participants and nonparticipants in a community-based study of myocardial infarction (MI). PARTICIPANTS AND METHODS Residents of Olmsted County, MN, who presented with elevated cardiac troponin T levels from September 1, 2002, through December 31, 2005, were prospectively enrolled and classified with standardized criteria for MI. With specific Institutional Review Board approval, the medical records of patients with MI who did not provide consent but who had given general research authorization were reviewed, as was done for their consenting peers. RESULTS During the study period, 2277 individuals with elevated cardiac troponin T levels were approached, of whom 1863 (82 percent) consented to participate. Among the 414 nonparticipants, 375 (91 percent) had general research authorization. Of the 558 with general research authorization who met the criteria for incident (ie, first-ever) MI, 67 (12 percent) refused to participate. These participants tended to be older (mean plus or minus SD age, 71 plus or minus 14 vs 67 plus or minus 15 years; P equals .04), were more likely to be of races other than white (9 percent vs 2 percent; P equals .01), and had more comorbidities, including peripheral vascular disease (P equals .02), chronic pulmonary disease (P equals .06), heart failure (P equals .07), and impaired creatinine clearance (P equals .02). No significant differences were detected in cardiovascular risk factors or MI characteristics. During a median follow-up of 517 days, nonparticipants experienced increased mortality rates compared with participants (hazard ratio, 1.97; 95 percent confidence interval, 1.21 to 3.20), which was largely attributable to their older age and excess comorbidities (adjusted hazard ratio, 1.43; 95 percent confidence interval, 0.86 to 2.35). CONCLUSION In this community-based study of MI, nonparticipants experienced worse survival rates than participants largely because of differences in demographic and clinical characteristics. These differences should be kept in mind when interpreting study results, particularly if participation is low.
Collapse
Affiliation(s)
- Yariv Gerber
- Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | | | | | | | | |
Collapse
|
61
|
Zhang L, Zuo L, Wang F, Wang M, Wang S, Liu L, Wang H. Metabolic syndrome and chronic kidney disease in a Chinese population aged 40 years and older. Mayo Clin Proc 2007; 82:822-7. [PMID: 17605962 DOI: 10.4065/82.7.822] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To explore the relationship between metabolic syndrome and chronic kidney disease (CKD) in a study population from a developing country. PARTICIPANTS AND METHODS The prevalence of metabolic syndrome (as most recently defined by the International Diabetes Federation) and CKD (defined as an estimated glomerular filtration rate of < 60 mL/min per 1.73 m2 and/or albuminuria) was determined in 2310 study participants (age > or =40 years) from Beijing, China, between May 12 and December 7, 2004. The relationship between metabolic syndrome and CKD was then analyzed. RESULTS Participants with metabolic syndrome had a higher prevalence of CKD (15.4% vs 8.3%; P<.001) than those without the syndrome. As the number of metabolic syndrome traits increased, so did the prevalence of CKD. Strong unadjusted and adjusted associations were observed between metabolic syndrome and CKD. For participants without hypertension and diabetes, metabolic syndrome was also associated with CKD (odds ratio, 2.03; 95% confidence interval, 1.05-3.94). CONCLUSIONS In these 2310 Chinese study participants aged 40 years and older, metabolic syndrome was associated with CKD.
Collapse
Affiliation(s)
- LuXia Zhang
- Institute of Nephrology and Division of Nephrology, Peking University First Hospital, Beijing, China
| | | | | | | | | | | | | |
Collapse
|
62
|
Rule AD. Understanding estimated glomerular filtration rate: implications for identifying chronic kidney disease. Curr Opin Nephrol Hypertens 2007; 16:242-9. [PMID: 17420668 DOI: 10.1097/mnh.0b013e328057de8b] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Glomerular filtration rate (GFR) can be estimated using serum markers such as serum creatinine (SCr) or cystatin C. This review presents new insights into estimated GFR based on theory, validation studies, SCr assay standardization, cystatin C, and longitudinal comparison with measured GFR. RECENT FINDINGS The estimation of GFR by SCr differs in health and in chronic kidney disease (CKD) due to differences in GFR range and in creatinine production between these two populations. Among populations with normal baseline GFR, there is a more rapid decline in measured GFR than in SCr-based estimated GFR. While elevated SCr is specific for CKD, other disease processes may lead to elevated cystatin C. Validation is improved by refitting equation coefficients to compare populations, recognizing the asymmetry between estimated GFR and measured GFR, and using residual plots instead of Bland-Altman plots to assess bias. SUMMARY As a screening test, SCr should be interpreted as a marker of CKD probability in the context of the patient's clinical presentation. Measured GFR or creatinine clearance may be helpful in high-risk patients with normal SCr levels. GFR estimating equations should be reserved for patients with identified CKD. Standardized SCr and cystatin C assays are needed.
Collapse
Affiliation(s)
- Andrew D Rule
- Division of Nephrology, Mayo Clinic, Rochester, Minnesota, USA.
| |
Collapse
|
63
|
Cohen JT. Estimating glomerular filtration rate from serum creatinine in the general population. Mayo Clin Proc 2007; 82:385-6; author reply 386. [PMID: 17354279 DOI: 10.4065/82.3.385-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
64
|
Schwartz GL, Textor SC. Early referral for chronic kidney disease: good for those who need it, but who are they? Mayo Clin Proc 2006; 81:1420-2. [PMID: 17120394 DOI: 10.4065/81.11.1420] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|