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Han Y, Jiang X, Qin Y, Zhao Y, Zhang G, Liu C. A cross-sectional study exploring the relationship between the dietary inflammatory index and hyperlipidemia based on the National Health and Nutrition Examination Survey (2005-2018). Lipids Health Dis 2023; 22:140. [PMID: 37653500 PMCID: PMC10470145 DOI: 10.1186/s12944-023-01908-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 08/21/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND Hyperlipidemia is closely associated with dietary patterns and inflammation. However, the relationship between hyperlipidemia and the inflammatory potential of diets remains unexplored. The research was conducted to examine the relationship between hyperlipidemia and dietary inflammatory index (DII). METHODS The data utilized in the research were acquired from the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2018. The information on dietary intake was gathered by conducting 24-h dietary recall interviews. Restricted cubic spline (RCS) and Survey-weighted logistic regression were utilized to determine the association between DII and hyperlipidemia. Furthermore, stratification analysis was carried out. RESULTS This study included 8982 individuals with and 3458 without hyperlipidemia. Participants with hyperlipidemia exhibited higher DII scores than those without hyperlipidemia. Following adjustment for gender, age, race, education level, marital status, poverty, drinking status, diabetes, hypertension, smoking status, body mass index (BMI), chronic kidney disease (CKD), cardiovascular disease (CVD), and hemoglobin (Hb), the association between the prevalence of hyperlipidemia and DII remained significant. The RCS data demonstrated that the hyperlipidemia prevalence did not exhibit an increase until the DII score was approximately 2.78. Stratification analysis revealed that the association between DII and hyperlipidemia persisted in all subgroups. CONCLUSIONS DII was associated with hyperlipidemia, and the threshold DII score for the risk of hyperlipidemia was 2.78.
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Affiliation(s)
- Yu Han
- Department of Pharmacy, Hebei Children's Hospital, Shijiazhuang, Hebei, People's Republic of China
| | - Xijuan Jiang
- Department of Pharmacy, Hebei Children's Hospital, Shijiazhuang, Hebei, People's Republic of China
| | - Yabin Qin
- Department of Pharmacy, Hebei Children's Hospital, Shijiazhuang, Hebei, People's Republic of China
| | - Yile Zhao
- Department of Pharmacy, Hebei Children's Hospital, Shijiazhuang, Hebei, People's Republic of China
| | - Guying Zhang
- Department of Pharmacy, Hebei Children's Hospital, Shijiazhuang, Hebei, People's Republic of China.
| | - Chao Liu
- Department of Laboratory Animal Science, Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China.
- Hebei Key Lab of Laboratory Animal Science, Shijiazhuang, Hebei, People's Republic of China.
- Department of Pharmacology, Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China.
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152
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Chen W, Feng J, Ji P, Liu Y, Wan H, Zhang J. Association of hyperhomocysteinemia and chronic kidney disease in the general population: a systematic review and meta-analysis. BMC Nephrol 2023; 24:247. [PMID: 37612681 PMCID: PMC10463317 DOI: 10.1186/s12882-023-03295-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 08/11/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND Increasing evidence shows that an elevated homocysteine(Hcy) level is associated with an increased risk of chronic kidney disease (CKD). This study systematically evaluated the correlation between homocysteine level and the incidence of CKD reported in cohort and cross-sectional studies. METHODS We searched electronic databases and reference lists for relevant articles. 4 cohort studies and 7 cross-sectional studies including 79,416 patients were analyzed in a meta-analysis. Hyperhomocysteinemia was defined as a Hcy level > 15 µmol/L, which was the criterium used in previous studies. Meta-analyses were conducted of literature searches from online databases such as PubMed, Embase, Cochrane and Scopus. Computed pooled adjusted odds ratios with corresponding 95% confidence intervals (95% CI) were used to estimate the risk of new-onset CKD according to Hcy levels in the general population. RESULTS People with high Hcy levels were more likely to suffer from CKD than people with normal Hcy levels (pooled OR, 2.09; 95% CI, 1.72-2.55). This positive relationship persisted across different study types such as cohort studies (summary OR, 2.2; 95% CI, 1.55-3.13) and cross-sectional studies (summary OR, 2.07; 95% CI, 1.63-2.63). CONCLUSIONS People with hyperhomocysteinemia have a higher incidence of CKD, Hyperhomocysteinemia may also be an independent risk factor for CKD in the general population.
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Affiliation(s)
- Wei Chen
- Guangxi Health Commission key Laboratory of Emergency and Critical Medicine, The Second Affiliated Hospital of Guangxi, Medical University, Nanning, China
| | - Jihua Feng
- Guangxi Health Commission key Laboratory of Emergency and Critical Medicine, The Second Affiliated Hospital of Guangxi, Medical University, Nanning, China
| | - Pan Ji
- Guangxi Health Commission key Laboratory of Emergency and Critical Medicine, The Second Affiliated Hospital of Guangxi, Medical University, Nanning, China
| | - Yani Liu
- Guangxi Health Commission key Laboratory of Emergency and Critical Medicine, The Second Affiliated Hospital of Guangxi, Medical University, Nanning, China
| | - Huan Wan
- Guangxi Health Commission key Laboratory of Emergency and Critical Medicine, The Second Affiliated Hospital of Guangxi, Medical University, Nanning, China
| | - Jianfeng Zhang
- Guangxi Health Commission key Laboratory of Emergency and Critical Medicine, The Second Affiliated Hospital of Guangxi, Medical University, Nanning, China.
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153
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Lapi F, Nuti L, Marconi E, Medea G, Cricelli I, Papi M, Gorini M, Fiorani M, Piccinocchi G, Cricelli C. To predict the risk of chronic kidney disease (CKD) using Generalized Additive2 Models (GA2M). J Am Med Inform Assoc 2023; 30:1494-1502. [PMID: 37330672 PMCID: PMC10436146 DOI: 10.1093/jamia/ocad097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 03/13/2023] [Accepted: 05/27/2023] [Indexed: 06/19/2023] Open
Abstract
OBJECTIVE To train and test a model predicting chronic kidney disease (CKD) using the Generalized Additive2 Model (GA2M), and compare it with other models being obtained with traditional or machine learning approaches. MATERIALS We adopted the Health Search Database (HSD) which is a representative longitudinal database containing electronic healthcare records of approximately 2 million adults. METHODS We selected all patients aged 15 years or older being active in HSD between January 1, 2018 and December 31, 2020 with no prior diagnosis of CKD. The following models were trained and tested using 20 candidate determinants for incident CKD: logistic regression, Random Forest, Gradient Boosting Machines (GBMs), GAM, and GA2M. Their prediction performances were compared by calculating Area Under Curve (AUC) and Average Precision (AP). RESULTS Comparing the predictive performances of the 7 models, the AUC and AP for GBM and GA2M showed the highest values which were equal to 88.9%, 88.8% and 21.8%, 21.1%, respectively. These 2 models outperformed the others including logistic regression. In contrast to GBMs, GA2M kept the interpretability of variable combinations, including interactions and nonlinearities assessment. DISCUSSION Although GA2M is slightly less performant than light GBM, it is not "black-box" algorithm, so being simply interpretable using shape and heatmap functions. This evidence supports the fact machine learning techniques should be adopted in case of complex algorithms such as those predicting the risk of CKD. CONCLUSION The GA2M was reliably performant in predicting CKD in primary care. A related decision support system might be therefore implemented.
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Affiliation(s)
- Francesco Lapi
- Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy
| | | | - Ettore Marconi
- Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy
| | - Gerardo Medea
- Italian College of General Practitioners and Primary Care, Florence, Italy
| | | | | | | | | | | | - Claudio Cricelli
- Italian College of General Practitioners and Primary Care, Florence, Italy
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Zhao M, Saab S, Craw C, Lee EW. The Impact of Renal Function on Hepatic Encephalopathy Following TIPS Placement for Refractory Ascites. Biomedicines 2023; 11:2171. [PMID: 37626668 PMCID: PMC10452451 DOI: 10.3390/biomedicines11082171] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 07/26/2023] [Accepted: 07/29/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND The impact of renal function on hepatic encephalopathy (HE) following transjugular intrahepatic portosystemic shunt (TIPS) placement for refractory ascites is poorly understood. We investigated the role of renal function on HE following TIPS placement. METHODS A retrospective study was performed for patients undergoing TIPS for refractory ascites from 2007-2019. Patients were stratified by GFR at time of TIPS placement and by whether they were on hemodialysis (HD). Chronic kidney disease (CKD) stage 3 or higher was defined as pre-TIPS GFR < 60 for at least 3 months. Logistic regression analyses were used to identify the role of GFR and CKD at time of TIPS placement on HE within 60 days post TIPS placement. RESULTS Among 201 TIPS patients for refractory ascites (61% male; mean age 59.1), 78 (39%) patients were in CKD, and 16 (21%) were on HD. Mean GFR at time of TIPS placement was 62.7 ± 28.2 for all non-HD patients (n = 185). Compared with the GFR ≥ 90 group, GFR < 30 or HD (OR, 3.56; 95%CI, 1.19-10.7; p = 0.023) and CKD (OR, 2.52; 95%CI, 1.40-4.53; p = 0.002) at time of TIPS placement were significant predictors of post-TIPS placement HE within 60 days. GFRs between 30-60 and 60-90 were not significant predictors. CONCLUSIONS In TIPS patients for recurrent ascites, patients with acutely impaired renal function or chronic renal dysfunction were at an increased risk for HE after TIPS.
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Affiliation(s)
- Matthew Zhao
- Division of Hepatology, Department of Medicine, UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA; (M.Z.); (S.S.); (C.C.)
| | - Sammy Saab
- Division of Hepatology, Department of Medicine, UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA; (M.Z.); (S.S.); (C.C.)
- Division of Liver and Pancreas Transplantation Surgery, Department of Surgery, UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - Chloe Craw
- Division of Hepatology, Department of Medicine, UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA; (M.Z.); (S.S.); (C.C.)
| | - Edward Wolfgang Lee
- Division of Liver and Pancreas Transplantation Surgery, Department of Surgery, UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
- Division of Interventional Radiology, Department of Radiology, UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
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155
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Liu J, Shi Y, Diao Y, Zeng X, Fu P. Strategies to Improve Long-Term Outcomes for Patients with Chronic Kidney Disease in China. KIDNEY DISEASES (BASEL, SWITZERLAND) 2023; 9:265-276. [PMID: 37899997 PMCID: PMC10601912 DOI: 10.1159/000530022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 02/17/2023] [Indexed: 10/31/2023]
Abstract
Background Chronic kidney disease (CKD) is an incurable disease requiring lifelong management. China has a high prevalence of CKD, which disproportionately affects older adults and those with chronic risk factors for CKD development. The rising prevalence of CKD in China places a substantial burden on the general population and the healthcare system. Summary In China, there are currently many unmet needs for patients with CKD and high-risk individuals, resulting from a lack of education and support to reduce risk factors, delayed diagnoses, limited knowledge of CKD among primary-care physicians, and poor access to treatments among some patient populations. An integrated, nationwide approach is required to improve the current situation of CKD management in China. There are currently several national healthcare frameworks in place that focus on new major health policies to prevent disease and encourage people to adopt healthier lifestyles, and while they do not directly target CKD, they may have a positive indirect impact. We explore the unmet needs for patients with CKD in China and discuss the potential strategies that may be required to overcome them. Such strategies include improving physician and patient education, establishing a targeted screening programme, supporting patients to improve self-management behaviours, accelerating the creation of medical consortia and medical satellite centres, and migrating from hospital- to community-based management. In addition to policy-driven strategies, development of novel therapies will be key to providing new solutions for the long-term management of CKD. Key Messages An integrated, nationwide approach is required, incorporating policy-driven changes to the clinical management of CKD, as well as the development of novel CKD treatments.
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Affiliation(s)
- Jing Liu
- Renal Division, West China Hospital of Sichuan University, Chengdu, China
- Kidney Research Institute, West China Hospital of Sichuan University, Chengdu, China
| | - Yunying Shi
- Renal Division, West China Hospital of Sichuan University, Chengdu, China
| | - Yongshu Diao
- Renal Division, West China Hospital of Sichuan University, Chengdu, China
| | - Xiaoxi Zeng
- Renal Division, West China Hospital of Sichuan University, Chengdu, China
- West China Biomedical Big Data Centre, West China Hospital, Sichuan University, Chengdu, China
| | - Ping Fu
- Renal Division, West China Hospital of Sichuan University, Chengdu, China
- Kidney Research Institute, West China Hospital of Sichuan University, Chengdu, China
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156
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Olsson KW, Mani K, Burdess A, Patterson S, Scali ST, Kölbel T, Panuccio G, Eleshra A, Bertoglio L, Ardita V, Melissano G, Acharya A, Bicknell C, Riga C, Gibbs R, Jenkins M, Bakthavatsalam A, Sweet MP, Kasprzak PM, Pfister K, Oikonomou K, Heloise T, Sobocinski J, Butt T, Dias N, Tang C, Cheng SWK, Vandenhaute S, Van Herzeele I, Sorber RA, Black JH, Tenorio ER, Oderich GS, Vincent Z, Khashram M, Eagleton MJ, Pedersen SF, Budtz-Lilly J, Lomazzi C, Bissacco D, Trimarchi S, Huerta A, Riambau V, Wanhainen A. Outcomes After Endovascular Aortic Intervention in Patients With Connective Tissue Disease. JAMA Surg 2023; 158:832-839. [PMID: 37314760 PMCID: PMC10267845 DOI: 10.1001/jamasurg.2023.2128] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 03/03/2023] [Indexed: 06/15/2023]
Abstract
Importance Endovascular treatment is not recommended for aortic pathologies in patients with connective tissue diseases (CTDs) other than in redo operations and as bridging procedures in emergencies. However, recent developments in endovascular technology may challenge this dogma. Objective To assess the midterm outcomes of endovascular aortic repair in patients with CTD. Design, Setting, and Participants For this descriptive retrospective study, data on demographics, interventions, and short-term and midterm outcomes were collected from 18 aortic centers in Europe, Asia, North America, and New Zealand. Patients with CTD who had undergone endovascular aortic repair from 2005 to 2020 were included. Data were analyzed from December 2021 to November 2022. Exposure All principal endovascular aortic repairs, including redo surgery and complex repairs of the aortic arch and visceral aorta. Main Outcomes and Measures Short-term and midterm survival, rates of secondary procedures, and conversion to open repair. Results In total, 171 patients were included: 142 with Marfan syndrome, 17 with Loeys-Dietz syndrome, and 12 with vascular Ehlers-Danlos syndrome (vEDS). Median (IQR) age was 49.9 years (37.9-59.0), and 107 patients (62.6%) were male. One hundred fifty-two (88.9%) were treated for aortic dissections and 19 (11.1%) for degenerative aneurysms. One hundred thirty-six patients (79.5%) had undergone open aortic surgery before the index endovascular repair. In 74 patients (43.3%), arch and/or visceral branches were included in the repair. Primary technical success was achieved in 168 patients (98.2%), and 30-day mortality was 2.9% (5 patients). Survival at 1 and 5 years was 96.2% and 80.6% for Marfan syndrome, 93.8% and 85.2% for Loeys-Dietz syndrome, and 75.0% and 43.8% for vEDS, respectively. After a median (IQR) follow-up of 4.7 years (1.9-9.2), 91 patients (53.2%) had undergone secondary procedures, of which 14 (8.2%) were open conversions. Conclusions and Relevance This study found that endovascular aortic interventions, including redo procedures and complex repairs of the aortic arch and visceral aorta, in patients with CTD had a high rate of early technical success, low perioperative mortality, and a midterm survival rate comparable with reports of open aortic surgery in patients with CTD. The rate of secondary procedures was high, but few patients required conversion to open repair. Improvements in devices and techniques, as well as ongoing follow-up, may result in endovascular treatment for patients with CTD being included in guideline recommendations.
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Affiliation(s)
| | - Kevin Mani
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Anne Burdess
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Suzannah Patterson
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville
| | - Salvatore T. Scali
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville
| | - Tilo Kölbel
- Department of Vascular Medicine, German Aortic Center, University Heart Center, Hamburg, Germany
| | - Giuseppe Panuccio
- Department of Vascular Medicine, German Aortic Center, University Heart Center, Hamburg, Germany
| | - Ahmed Eleshra
- Department of Vascular Medicine, German Aortic Center, University Heart Center, Hamburg, Germany
| | - Luca Bertoglio
- Division of Vascular Surgery, Vita Salute San Raffaele University, San Raffaele Hospital, Milano, Italy
| | - Vincenzo Ardita
- Division of Vascular Surgery, Vita Salute San Raffaele University, San Raffaele Hospital, Milano, Italy
| | - Germano Melissano
- Division of Vascular Surgery, Vita Salute San Raffaele University, San Raffaele Hospital, Milano, Italy
| | - Amish Acharya
- Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Colin Bicknell
- Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Celia Riga
- Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Richard Gibbs
- Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Michael Jenkins
- Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Arvind Bakthavatsalam
- Division of Vascular Surgery, Department of Surgery, University of Washington Medical Center, Seattle
| | - Matthew P. Sweet
- Division of Vascular Surgery, Department of Surgery, University of Washington Medical Center, Seattle
| | - Piotr M. Kasprzak
- Department of Vascular and Endovascular Surgery, University Medical Centre Regensburg, Regensburg, Germany
| | - Karin Pfister
- Department of Vascular and Endovascular Surgery, University Medical Centre Regensburg, Regensburg, Germany
| | - Kyriakos Oikonomou
- Department of Vascular and Endovascular Surgery, University Medical Centre Regensburg, Regensburg, Germany
- Department of Vascular and Endovascular Surgery, Cardiovascular Surgery Clinic, University Hospital Frankfurt and Johann Wolfgang Goethe University Frankfurt, Frankfurt, Germany
| | - Tessely Heloise
- Department of Vascular Surgery, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Jonathan Sobocinski
- Department of Vascular Surgery, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Talha Butt
- Vascular Center, Skåne University Hospital and Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Nuno Dias
- Vascular Center, Skåne University Hospital and Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Ching Tang
- Department of Surgery, Queen Mary Hospital, Hong Kong, China
| | - Stephen W. K. Cheng
- Division of Vascular & Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Hong Kong, China
| | - Sarah Vandenhaute
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - Isabelle Van Herzeele
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - Rebecca A. Sorber
- Department of Vascular Surgery and Endovascular Therapy, Johns Hopkins Hospital, Baltimore, Maryland
| | - James H. Black
- Department of Vascular Surgery and Endovascular Therapy, Johns Hopkins Hospital, Baltimore, Maryland
| | - Emanuel R. Tenorio
- Department of Cardiothoracic & Vascular Surgery, Advanced Aortic Research Program at the University of Texas Health Science Center at Houston, McGovern Medical School, Houston
| | - Gustavo S. Oderich
- Department of Cardiothoracic & Vascular Surgery, Advanced Aortic Research Program at the University of Texas Health Science Center at Houston, McGovern Medical School, Houston
| | - Zoë Vincent
- Department of Vascular Surgery, Waikato Hospital, University of Auckland, Hamilton, New Zealand
| | - Manar Khashram
- Department of Vascular Surgery, Waikato Hospital, University of Auckland, Hamilton, New Zealand
| | - Matthew J. Eagleton
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Steen Fjord Pedersen
- Division of Vascular Surgery, Department of Cardiovascular Sugery, Aarhus University Hospital, Aarhus, Denmark
| | - Jacob Budtz-Lilly
- Division of Vascular Surgery, Department of Cardiovascular Sugery, Aarhus University Hospital, Aarhus, Denmark
| | - Chiara Lomazzi
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Daniele Bissacco
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Santi Trimarchi
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical and Community Sciences, University of Milan, Milan, Italy
| | - Abigail Huerta
- Vascular Surgery Department, CardioVascular Institute, Hospital Clinic, Barcelona, Spain
| | - Vincent Riambau
- Vascular Surgery Department, CardioVascular Institute, Hospital Clinic, Barcelona, Spain
| | - Anders Wanhainen
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden
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Alvand S, Alatab S, Dalvand S, Shahraki-Sanavi F, Kaykhaei MA, Shahraki E, Barar E, Sepanlou SG, Ansari-Moghaddam A. Association of indoor use of pesticides with CKD of unknown origin. PLoS One 2023; 18:e0277151. [PMID: 37478079 PMCID: PMC10361486 DOI: 10.1371/journal.pone.0277151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 06/14/2023] [Indexed: 07/23/2023] Open
Abstract
INTRODUCTION Chronic kidney disease (CKD) is a growing global health problem. Recently, an epidemic of CKD of unknown origin (CKDu), a form of CKD seen mostly in agricultural communities, has been emerged. One of the proposed causes of CKDu is pesticide use in farmers. On the other hand, the research on relation between indoor use of pesticides and CKDu is little. In this study, we aimed to investigate the association between indoor use of pesticide as well as the exposure time with CKDu. This study was done as part of the population-based cohort of Prospective Epidemiological Research Studies in Iran. We used the baseline data of the Zahedan Adult Cohort Study. All subjects with diabetes mellitus and/or hypertension, estimated glomerular filtration rate (eGFR) between 60-89 ml/min/1.73 m2, and unavailable creatinine measurement were excluded. Subjects with an eGFR of less than 60 ml/min/1.73 m2 were defined as having CKDu, and their data were compared with those with an eGFR of more than 90 ml/min/1.73 m2. Data regarding indoor pesticide use and duration of exposure were obtained through a questionnaire. After applying the exclusion criteria, 1079 subjects remained in the study. Female sex, single marital status, low physical activity, triglyceride (TG) levels of more than 150 mg/dl, body mass index (BMI) of more than 25 kg/m2, non-smokers, indoor pesticide use, and high pesticide exposure time were associated with CKDu. The effects of age, female sex, TG levels more than 150 mg/dl, pesticide use (OR 1.36; 95% CI 1.01-1.84), and high exposure time (third tertile of exposure time) compared to non-users (OR 1.64; 95% CI 1.07-2.51) remained significant in multivariable analysis. CONCLUSION We found a positive association between pesticide use, as well as longer exposure time to pesticides, and impaired kidney function in cases without diabetes mellitus and hypertension. Further longitudinal studies should be carried out to confirm these findings.
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Affiliation(s)
- Saba Alvand
- Liver and Pancreatobiliary Diseases Research Center, Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Sudabeh Alatab
- Digestive Disease Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sahar Dalvand
- Liver and Pancreatobiliary Diseases Research Center, Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Mahmoud Ali Kaykhaei
- Genetics of Non-Communicable Disease Research Center, Zahedan University of Medical Science, Zahedan, Iran
| | - Elham Shahraki
- Health Promotion Research Center, Zahedan University of Medical Science, Zahedan, Iran
| | - Erfaneh Barar
- Liver and Pancreatobiliary Diseases Research Center, Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Sadaf G Sepanlou
- Digestive Disease Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
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158
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Wang Y, Ju Y, An Q, Lin L, Liu AL. mDIXON-Quant for differentiation of renal damage degree in patients with chronic kidney disease. Front Endocrinol (Lausanne) 2023; 14:1187042. [PMID: 37547308 PMCID: PMC10402729 DOI: 10.3389/fendo.2023.1187042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 07/04/2023] [Indexed: 08/08/2023] Open
Abstract
Background Chronic kidney disease (CKD) is a complex syndrome with high morbidity and slow progression. Early stages of CKD are asymptomatic and lack of awareness at this stage allows CKD to progress through to advanced stages. Early detection of CKD is critical for the early intervention and prognosis improvement. Purpose To assess the capability of mDIXON-Quant imaging to detect early CKD and evaluate the degree of renal damage in patients with CKD. Study type Retrospective. Population 35 patients with CKD: 18 cases were classifified as the mild renal damage group (group A) and 17 cases were classifified as the moderate to severe renal damage group (group B). 22 healthy volunteers (group C). Field strength/sequence A 3.0 T/T1WI, T2WI and mDIXON-Quant sequences. Assessment Transverse relaxation rate (R2*) values and fat fraction (FF) values derived from the mDIXON-Quant were calculated and compared among the three groups. Statistical tests The intra-class correlation (ICC) test; Chi-square test or Fisher's exact test; Shapiro-Wilk test; Kruskal Wallis test with adjustments for multiplicity (Bonferroni test); Area under the receiver operating characteristic (ROC) curve (AUC). The significance threshold was set at P < 0.05. Results Cortex FF values and cortex R2* values were significantly different among the three groups (P=0.028, <0.001), while medulla R2* values and medulla FF values were not (P=0.110, 0.139). Cortex FF values of group B was significantly higher than that of group A (Bonferroni adjusted P = 0.027). Cortex R2* values of group A and group B were both significantly higher than that of group C (Bonferroni adjusted P = 0.012, 0.001). The AUC of cortex FF values in distinguishing group A and group B was 0.766. The diagnostic efficiency of cortex R2* values in distinguishing group A vs. group C and group B vs. group C were 0.788 and 0.829. Conclusion The mDIXON-Quant imaging had a potential clinical value in early diagnosis of CKD and assessing the degree of renal damage in CKD patients.
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Affiliation(s)
- Yue Wang
- First Affiliated Hospital, Dalian Medical University, Dalian, China
| | - Ye Ju
- First Affiliated Hospital, Dalian Medical University, Dalian, China
| | - Qi An
- First Affiliated Hospital, Dalian Medical University, Dalian, China
| | - Liangjie Lin
- Clinical and Technical Support, Philips Healthcare, Beijing, China
| | - Ai Lian Liu
- First Affiliated Hospital, Dalian Medical University, Dalian, China
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Colalillo A, Pellicano C, Ananyeva LP, Hachulla E, Cuomo G, Györfi AH, Czirják L, de Vries-Bouwstra J, Mouthon L, Poormoghim H, Del Galdo F, Hunzelmann N, Spierings J, Kuwana M, Rosato E. Tricuspid Annular Plane Systolic Excursion/Systolic Pulmonary Artery Pressure Ratio and Cardiorenal Syndrome Type 2 in the Systemic Sclerosis EUSTAR Cohort. Arthritis Care Res (Hoboken) 2023. [PMID: 37458105 DOI: 10.1002/acr.25196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 07/07/2023] [Accepted: 07/13/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVE The aim of the study was to evaluate the association between the tricuspid annular plane systolic excursion (TAPSE)/systolic pulmonary artery pressure (sPAP) ratio and estimated glomerular filtration rate (eGFR) and their association with mortality in the European Scleroderma Trials and Research (EUSTAR) cohort. METHODS Patients with systemic sclerosis (SSc) from the EUSTAR database with TAPSE, sPAP, and parameters required to calculate eGFR were included. Logistic regression and Cox regression analysis were performed to evaluate TAPSE/sPAP as a risk factor for chronic kidney disease (CKD) and overall survival. RESULTS A total of 2,370 patients with SSc were included; 284 (12%) patients had CKD stage 3a-5. TAPSE/sPAP (odds ratio [OR] 0.479; 95% CI 0.310-0.743; P < 0.001), arterial hypertension (OR 3.118; 95% CI 2.173-4.475; P < 0.001), diastolic dysfunction (OR 1.670; 95% CI 1.148-2.428; P < 0.01), and N-terminal pro-B-type natriuretic peptide (OR 1.165; 95% CI 1.041-1.304; P < 0.01) were associated with CKD stage 3a-5. TAPSE/sPAP ≤0.32 mm/mm Hg (hazard ratio [HR] 3.589; 95% CI 2.236-5.761; P < 0.001), eGFR <60 mL/min per 1.73 m2 (HR 2.818; 95% CI 1.777-4.468; P < 0.001), and age (HR 1.782; 95% CI 1.348-2.356; P < 0.001) were the most significant predictive factors for all-cause mortality. A total of 276 patients with SSc had pulmonary hypertension (PH) confirmed by right heart catheterization, with 69 (25%) having CKD stage 3a-5. No difference was found in eGFR between patients with PH with reduced or normal cardiac index. CONCLUSION Reduced TAPSE/sPAP ratio is independently associated with CKD. TAPSE/sPAP ratio ≤0.32 mm/mm Hg and eGFR <60 mL/min per 1.73 m2 are prognostic factors for all-cause mortality. In patients with SSc with PH, eGFR is independent by reduced cardiac output.
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Affiliation(s)
| | | | | | - Eric Hachulla
- Hôpital Claude Huriez and University of Lille, Lille, France
| | | | | | | | | | - Luc Mouthon
- Hôpital Cochin, Assistance Publique Hôpitaux de Paris, and Université Paris Cité, Paris, France
| | - Hadi Poormoghim
- Firoozgar Hospital and Iran University of Medical Sciences, Tehran, Iran
| | | | | | | | - Masataka Kuwana
- Nippon Medical School Graduate School of Medicine, Tokyo, Japan
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160
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Banceu C, Harpa M, Brinzaniuc K, Tilea I, Varga A, Gliga ML, Voidazan S, Neagu N, Szabo DA, Banceu D, Cristutiu D, Balmos IA, Puscas A, Oprean M, Suciu H. The Gender Gap in Aortic Dissection: A Prospective Analysis of Risk and Outcomes. J Crit Care Med (Targu Mures) 2023; 9:178-186. [PMID: 37588179 PMCID: PMC10425927 DOI: 10.2478/jccm-2023-0024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 07/28/2023] [Indexed: 08/18/2023] Open
Abstract
Aortic dissection (AD) is a severe cardiovascular condition that could have negative consequences. Our study employed a prospective design and examined preoperative, perioperative, and postoperative data to evaluate the effects of gender on various medical conditions. We looked at how gender affected the results of aortic dissection (AD). In contrast to female patients who had more systemic hypertension (p=0.031), male patients had higher rates of hemopericardium (p=0.003), pulmonary hypertension (p=0.039), and hemopericardium (p=0.003). Dobutamine administration during surgery significantly raised the mortality risk (p=0.015). There were noticeably more women patients (p=0.01) in the 71 to 80 age group. Significant differences in age (p=0.004), eGFR at admission (p=0.009), and eGFR at discharge (p=0.006) were seen, however, there was no association between gender and mortality. In conclusion, our findings highlight that gender may no longer be such an important aspect of aortic dissection disease as we previously thought, and this information could have an important contribution for surgeons as well as for anesthesiologists involved in the management of acute aortic dissection.
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Affiliation(s)
- Cosmin Banceu
- George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
- I.O.S.U.D George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
- Emergency Institute for Cardiovascular Diseases and Transplantation Targu Mures, Romania
| | - Marius Harpa
- George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
- Emergency Institute for Cardiovascular Diseases and Transplantation Targu Mures, Romania
| | - Klara Brinzaniuc
- George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
| | - Ioan Tilea
- George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
| | - Andreea Varga
- George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
| | - Mirela Liana Gliga
- George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
| | - Septimiu Voidazan
- George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
- Emergency Institute for Cardiovascular Diseases and Transplantation Targu Mures, Romania
| | - Nicolae Neagu
- George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
| | - Dan Alexandru Szabo
- George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
| | - Diana Banceu
- Dimitrie Cantemir University of Targu Mures, Romania
| | - Daiana Cristutiu
- Emergency Institute for Cardiovascular Diseases and Transplantation Targu Mures, Romania
| | - Ionut Alexandru Balmos
- George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
| | - Alexandra Puscas
- George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
- Emergency Institute for Cardiovascular Diseases and Transplantation Targu Mures, Romania
| | - Marvin Oprean
- Dimitrie Cantemir University of Targu Mures, Romania
| | - Horatiu Suciu
- George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
- Emergency Institute for Cardiovascular Diseases and Transplantation Targu Mures, Romania
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161
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Roy S, Bhat M, Ahmed N, Sharma L, Mathur R, Tomar V. A Comparative Study of Continuous Versus Interrupted Suturing Technique in Creating a Vascular Access for Hemodialysis: An Institutional-Based Experience. Cureus 2023; 15:e42004. [PMID: 37593256 PMCID: PMC10428183 DOI: 10.7759/cureus.42004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2023] [Indexed: 08/19/2023] Open
Abstract
Background Arteriovenous fistulas (AVFs) are considered the first and best access for patients with end-stage renal disease who need permanent vascular access for hemodialysis over arteriovenous grafts and central venous catheters for reasons that have been well-established. Poor early patency rates pose the biggest challenge in creating vascular access as they cause increased morbidity and economic/psychological concerns among patients. To minimize such effects, it is critical to use a patient-centered approach and carefully choose patients for AVF access creation. This study aimed to compare the primary patency of distal vascular access provided by continuous suturing versus that provided by interrupted suturing. Methodology This prospective study was conducted in the urology department of a superspecialty, tertiary care center from November 2021 to November 2022. Patency was assessed immediately after surgery (on the table), one month later, and six months later by palpating thrill and auscultating bruit. A total of 50 patients between the ages of 18 and 70 years who met the inclusion criteria were randomly assigned to two groups of 25 each. Results The baseline characteristics of both groups were comparable. At six months (p = 0.09), the continuous suturing group was observed to be somewhat better than the interrupted suturing group, with no significant difference in immediate and one-month patency rates. When compared to the continuous suturing group, the primary patency failure rate was significantly higher in the interrupted suturing group. Conclusions Thus, under appropriate circumstances, continuous sutures can be performed with greater ease, resulting in anastomosis that is as patent as that performed with interrupted sutures.
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Affiliation(s)
- Siddhant Roy
- Urology, National Institute of Medical Sciences, Jaipur, IND
| | - Mahakshit Bhat
- Urology, National Institute of Medical Sciences, Jaipur, IND
| | - Nisar Ahmed
- Urology, National Institute of Medical Sciences, Jaipur, IND
| | - Lokesh Sharma
- Urology, National Institute of Medical Sciences, Jaipur, IND
| | - Rajeev Mathur
- Urology, National Institute of Medical Sciences, Jaipur, IND
| | - Vinay Tomar
- Urology, National Institute of Medical Sciences, Jaipur, IND
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162
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Kochi M, Kohagura K, Oshiro N, Zamami R, Nagahama K, Nakamura K, Ohya Y. Association of blood pressure and hyperuricemia with proteinuria and reduced renal function in the general population. Hypertens Res 2023; 46:1662-1672. [PMID: 36991065 DOI: 10.1038/s41440-023-01250-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 02/12/2023] [Accepted: 02/17/2023] [Indexed: 03/30/2023]
Abstract
This study aimed to investigate the effect of hyperuricemia (HU) on the association of systolic blood pressure (SBP) with the prevalence of proteinuria and low estimated glomerular filtration rate (eGFR) in the general population. This cross-sectional study enrolled 24,728 Japanese individuals (11,137 men and 13,591 women) who underwent health checkups in 2010. The prevalence of proteinuria and low eGFR (< 60 mL/min/1.73 m2) among participants classified according to serum uric acid levels and SBP was compared. HU was defined as serum uric acid levels higher than the 75th percentile in male and female participants (> 7.2 and > 5.4 mg/dL, respectively). The odds ratio (OR) for proteinuria increased with elevated SBP. This trend was significantly evident in participants with HU. Moreover, there was an interactive effect of SBP and HU on the prevalence of proteinuria in the male (Pfor interaction = 0.04) and female (Pfor interaction = 0.04) participants. Next, we evaluated the OR for low eGFR (< 60 mL/min/1.73 m2) with and without proteinuria based on the presence of HU. The multivariate analysis revealed that the OR for low eGFR with proteinuria increased with elevated SBP, but that for low eGFR without proteinuria decreased. These trends of OR tended to be prevalent among those with HU. The association between SBP and the prevalence of proteinuria was more pronounced in participants with HU. However, the association between SBP and decreased renal function with and without proteinuria might be different regardless of HU.
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Affiliation(s)
- Masako Kochi
- Yuuaikai Tomishiro Central Hospital, Tomigusuku, Japan
| | - Kentaro Kohagura
- Dialysis Unit, University of the Ryukyus Hospital, Nishihara, Japan.
| | - Nanako Oshiro
- Department of Cardiovascular Medicine, Nephrology and Neurology, Graduate School of Medicine, University of the Ryukyus, Nishihara, Japan
| | - Ryo Zamami
- Dialysis Unit, University of the Ryukyus Hospital, Nishihara, Japan
- Department of Cardiovascular Medicine, Nephrology and Neurology, Graduate School of Medicine, University of the Ryukyus, Nishihara, Japan
| | | | - Koshi Nakamura
- Department of Public Health and Hygiene, Graduate School of Medicine, University of the Ryukyus, Nishihara, Japan
| | - Yusuke Ohya
- Department of Cardiovascular Medicine, Nephrology and Neurology, Graduate School of Medicine, University of the Ryukyus, Nishihara, Japan
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163
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Lee J, Kim SH, Jeong SH, Han JH, Yuk HD, Jeong CW, Kwak C, Ku JH. Pyuria as an independent predictor of intravesical recurrence after radical nephroureterectomy in patients with upper tract urothelial carcinoma. Investig Clin Urol 2023; 64:353-362. [PMID: 37417560 DOI: 10.4111/icu.20230066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/07/2023] [Accepted: 04/12/2023] [Indexed: 07/08/2023] Open
Abstract
PURPOSE About one-third of patients who undergo radical nephroureterectomy (RNUx) for upper tract urothelial carcinoma (UTUC) experience intravesical recurrence (IVR). This study investigated whether pyuria is a feasible predictor of IVR after RNUx in patients with UTUC. MATERIALS AND METHODS Seven hundred forty-three patients with UTUC who underwent RNUx at a single institute were analyzed in this study. The participants were divided into two groups: those without pyuria (non-pyuria) and those with pyuria. Kaplan-Meier survival analysis was performed, and p-values were assessed using the log-rank test. Cox regression analyses were performed to identify the independent predictors of survival. RESULTS The pyuria group had a shorter IVR-free survival period (p=0.009). The five-year IVR-free survival rate was 60.0% in the non-pyuria group vs. 49.7% in the pyuria group according to the Kaplan-Meier survival analysis. After the multivariate Cox regression analysis, pyuria (hazard ratio [HR]=1.368; p=0.041), a concurrent bladder tumor (HR=1.757; p=0.005), preoperative ureteroscopy (HR=1.476; p=0.013), laparoscopic surgery (HR=0.682; p=0.048), tumor multiplicity (HR=1.855; p=0.007), and a larger tumor (HR=1.041; p=0.050) were predictors of risk for IVR. There was no association between pyuria and recurrence-free survival (p=0.057) or cancer-specific survival (p=0.519) in the Kaplan-Meier survival analysis. CONCLUSIONS This study concluded that pyuria was an independent predictor of IVR in patients with UTUC after RNUx.
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Affiliation(s)
- Jooho Lee
- Department of Urology, Seoul National University Hospital, Seoul, Korea
| | - Si Hyun Kim
- Department of Urology, Seoul National University Hospital, Seoul, Korea
| | - Seung-Hwan Jeong
- Department of Urology, Seoul National University Hospital, Seoul, Korea
| | - Jang Hee Han
- Department of Urology, Seoul National University Hospital, Seoul, Korea
| | - Hyeong Dong Yuk
- Department of Urology, Seoul National University Hospital, Seoul, Korea
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - Chang Wook Jeong
- Department of Urology, Seoul National University Hospital, Seoul, Korea
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - Cheol Kwak
- Department of Urology, Seoul National University Hospital, Seoul, Korea
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - Ja Hyeon Ku
- Department of Urology, Seoul National University Hospital, Seoul, Korea
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea.
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164
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Al Hammoud R, Kalaskar A, Rodriguez G, Del Bianco G, Bell C, Murphy JR, Heresi GP. Microalbuminuria in Perinatally HIV-Infected Children and Adolescents in the United States. Open Forum Infect Dis 2023; 10:ofad333. [PMID: 37426950 PMCID: PMC10326675 DOI: 10.1093/ofid/ofad333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 06/29/2023] [Indexed: 07/11/2023] Open
Abstract
Background The kidney is a common target for human immunodeficiency virus (HIV), making renal disease a common noninfectious complication of HIV. Microalbuminuria is an important marker that can detect early renal damage. Timely detection of microalbuminuria is important to initiate renal management and stop the progression of renal dysfunction in people with HIV. Limited data are available about renal abnormalities in people with perinatal HIV infection. The objective of this study was to determine the prevalence of microalbuminuria in a cohort of perinatally HIV-infected children and young adults receiving combination antiretroviral therapy and investigate correlations between microalbuminuria and clinical and laboratory findings. Methods This was a retrospective study of 71 patients with HIV followed in an urban pediatric HIV clinic in Houston, Texas, between October 2007 and August 2016. Demographic, clinical, and laboratory data were compared between subjects with persistent microalbuminuria (PM) and those without. PM is defined as a microalbumin-to-creatinine ratio ≥30 mg/g on at least 2 occasions separated by at least 1 month. Results Sixteen of 71 patients (23%) met the definition of PM. In univariate analysis, patients with PM had significantly higher CD8+ T-cell activation and lower CD4+ T-cell nadir. Multivariate analysis demonstrated increased microalbuminuria to be independently associated with older age and CD8+ T-cell activation measured as CD8+HLA-DR+ T-cell percentage. Conclusions Older age and increased activation of CD8+HLA-DR+ on T cells correlate with presence of microalbuminuria in this cohort of HIV-infected patients.
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Affiliation(s)
- Roukaya Al Hammoud
- Correspondence: Roukaya Al Hammoud, MD, Division of Infectious Diseases, Department of Pediatrics, McGovern Medical School at UTHealth Houston, and Children's Memorial Hermann Hospital, 6431 Fannin St, 3.126, Houston, TX 77030 (); Gloria P. Heresi, MD, Division of Infectious Diseases, Department of Pediatrics, McGovern Medical School at UTHealth Houston, and Children's Memorial Hermann Hospital, 6431 Fannin St, 3.126, Houston, TX 77030 ()
| | - Anupama Kalaskar
- Pediatric Infectious Diseases, Children's Minnesota, University of Minnesota, Minneapolis, Minnesota, USA
| | - Gilhen Rodriguez
- Division of Infectious Diseases, Department of Pediatrics, McGovern Medical School at UTHealth Houston, and Children's Memorial Hermann Hospital, Houston, Texas, USA
| | - Gabriela Del Bianco
- Division of Infectious Diseases, Department of Pediatrics, McGovern Medical School at UTHealth Houston, and Children's Memorial Hermann Hospital, Houston, Texas, USA
| | - Cynthia Bell
- Department of Pediatrics, McGovern Medical School at UTHealth Houston, Texas, USA
| | - James R Murphy
- Division of Infectious Diseases, Department of Pediatrics, McGovern Medical School at UTHealth Houston, and Children's Memorial Hermann Hospital, Houston, Texas, USA
| | - Gloria P Heresi
- Correspondence: Roukaya Al Hammoud, MD, Division of Infectious Diseases, Department of Pediatrics, McGovern Medical School at UTHealth Houston, and Children's Memorial Hermann Hospital, 6431 Fannin St, 3.126, Houston, TX 77030 (); Gloria P. Heresi, MD, Division of Infectious Diseases, Department of Pediatrics, McGovern Medical School at UTHealth Houston, and Children's Memorial Hermann Hospital, 6431 Fannin St, 3.126, Houston, TX 77030 ()
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165
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Pierre CC, Marzinke MA, Ahmed SB, Collister D, Colón-Franco JM, Hoenig MP, Lorey T, Palevsky PM, Palmer OP, Rosas SE, Vassalotti J, Whitley CT, Greene DN. AACC/NKF Guidance Document on Improving Equity in Chronic Kidney Disease Care. J Appl Lab Med 2023:jfad022. [PMID: 37379065 DOI: 10.1093/jalm/jfad022] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 04/05/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND Kidney disease (KD) is an important health equity issue with Black, Hispanic, and socioeconomically disadvantaged individuals experiencing a disproportionate disease burden. Prior to 2021, the commonly used estimated glomerular filtration rate (eGFR) equations incorporated coefficients for Black race that conferred higher GFR estimates for Black individuals compared to non-Black individuals of the same sex, age, and blood creatinine concentration. With a recognition that race does not delineate distinct biological categories, a joint task force of the National Kidney Foundation and the American Society of Nephrology recommended the adoption of the CKD-EPI 2021 race-agnostic equations. CONTENT This document provides guidance on implementation of the CKD-EPI 2021 equations. It describes recommendations for KD biomarker testing, and opportunities for collaboration between clinical laboratories and providers to improve KD detection in high-risk populations. Further, the document provides guidance on the use of cystatin C, and eGFR reporting and interpretation in gender-diverse populations. SUMMARY Implementation of the CKD-EPI 2021 eGFR equations represents progress toward health equity in the management of KD. Ongoing efforts by multidisciplinary teams, including clinical laboratorians, should focus on improved disease detection in clinically and socially high-risk populations. Routine use of cystatin C is recommended to improve the accuracy of eGFR, particularly in patients whose blood creatinine concentrations are confounded by processes other than glomerular filtration. When managing gender-diverse individuals, eGFR should be calculated and reported with both male and female coefficients. Gender-diverse individuals can benefit from a more holistic management approach, particularly at important clinical decision points.
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Affiliation(s)
- Christina C Pierre
- Department of Pathology and Laboratory Medicine, Penn Medicine Lancaster General Hospital, Lancaster, PA, United States
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Mark A Marzinke
- Departments of Pathology and Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Sofia B Ahmed
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - David Collister
- Division of Nephrology, University of Alberta, Edmonton, AB, Canada
- Population Health Research Institute, Hamilton, ON, Canada
| | | | - Melanie P Hoenig
- Department of Medicine, Harvard Medical School, Boston, MA, United States
- Division of Nephrology and Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Thomas Lorey
- Kaiser Permanante, The Permanante Medical Group Regional Laboratory, Berkeley, CA, United States
| | - Paul M Palevsky
- Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
- Kidney Medicine Program and Kidney Medicine Section, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, United States
- The National Kidney Foundation, Inc., New York, NY, United States
| | - Octavia Peck Palmer
- Departments of Pathology, Critical Care Medicine, and Clinical and Translational Science, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Sylvia E Rosas
- The National Kidney Foundation, Inc., New York, NY, United States
- Kidney and Hypertension Unit, Joslin Diabetes Center and Harvard Medical School, Boston, MA, United States
- Division of Nephrology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Joseph Vassalotti
- The National Kidney Foundation, Inc., New York, NY, United States
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Cameron T Whitley
- Department of Sociology, Western Washington University, Bellingham, WA, United States
| | - Dina N Greene
- Department of Laboratory Medicine and Pathology, University of Washington Medicine, Seattle, WA, United States
- LetsGetChecked Laboratories, Monrovia, CA, United States
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Golabi P, Paik JM, Kumar A, Al Shabeeb R, Eberly KE, Cusi K, GunduRao N, Younossi ZM. Nonalcoholic fatty liver disease (NAFLD) and associated mortality in individuals with type 2 diabetes, pre-diabetes, metabolically unhealthy, and metabolically healthy individuals in the United States. Metabolism 2023:155642. [PMID: 37380016 DOI: 10.1016/j.metabol.2023.155642] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 06/12/2023] [Accepted: 06/22/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND The prevalence of nonalcoholic fatty liver disease (NAFLD) is high among subjects with type 2 diabetes (T2D). However, the prevalence and outcomes of NAFLD among individuals with pre-diabetes (PreD) and metabolically healthy and metabolically unhealthy individuals without T2D are not known. Our aim was to assess prevalence and mortality of NAFLD among these four groups. METHODS The Third National Health and Nutrition Examination Survey (NHANES) III (1988-1994) with mortality data (follow up to 2019) via linkage to the National Death Index was utilized. NAFLD was defined by ultrasound and absence of other liver diseases and excess alcohol use. Pre-D was defined as fasting plasma glucose values of 100-125 mg/dL and/or HbA1c level between 5.7 %-6.4 % in the absence of established diagnosis of T2D. Metabolically healthy (MH) was defined if all of the following criteria were absent: waist circumference of ≥102 cm (men) or ≥ 88 cm (women) or BMI of ≥30; blood pressure (BP) ≥ 130/85 mmHg or using BP-lowering medication; triglyceride level ≥ 150 mg/dL or using lipid-lowering medication; lipoprotein cholesterol level of <40 mg/dL (men) or < 50 mg/dL (women); homeostasis model assessment of insulin resistance (HOMA-IR) score ≥ 2.5; C-reactive protein (CRP) level of >2 mg/L; Pre-D and T2D. Metabolically unhealthy (MU) individuals were defined as the presence of any component of metabolic syndrome but not having Pre-D and T2D. Competing risk analyses of cause-specific mortality were performed. FINDINGS 11,231 adults (20-74y) were included: mean age 43.4 years; 43.9 % male; 75.4 % white, 10.8 % Black, and 5.4 % Mexican American, 18.9 % NAFLD, 7.8 % T2D; 24.7 % PreD; 44.3 % MU; and 23.3 % in MH individuals. In multivariable adjusted logistic model, as compared to MH individuals, the highest risk of having NAFLD were in T2D individuals (Odd Ratio [OR] = 10.88 [95 % confidence interval: 7.33-16.16]), followed by Pre-D (OR = 4.19 [3.02-5.81]), and MU (OR = 3.36 [2.39-4.71]). During a median follow up of 26.7 years (21.2-28.7 years), 3982 died. NAFLD subjects had significantly higher age-adjusted mortality than non-NAFLD (32.7 % vs. 28.7 %, p < .001). Among subjects with NAFLD, the highest age-standardized cumulative mortality was observed among those with T2D (41.3 %), followed by with Pre-D (35.1 %), MU subjects (30.0 %), and MH subjects (21.9 %) (pairwise p-values<.04 vs. ND with MH). Multivariable adjusted cox models showed that NAFLD with T2D had a higher risk of all-causes and cardiac-specific deaths (Hazard Ratio [HR] = 4.71 [2.23-9.96] and HR = 20.01 [3.00-133.61]), followed by NAFLD with Pre-D (HR = 2.91 [1.41-6.02] and HR = 10.35 [1.57-68.08]) and metabolically unhealthy NAFLD (HR = 2.59 [1.26-5.33] and HR = 6.74 [0.99-46.03]) compared to metabolically healthy NAFLD. In addition to older age, independent predictors of mortality among NAFLD with T2D included high CRP, CVD, CKD, high FIB-4, and active smoking. Similarly, among NAFLD with PreD, high CRP, CKD, CVD, hypertension, and active smoking were associated with mortality. Finally, CVD and active smoking were predictors of mortality among metabolically unhealthy NAFLD, and active smoking was the only mortality risk among metabolically healthy NAFLD subjects. INTERPRETATION Metabolic abnormality impacts both prevalence and outcomes of subjects with NAFLD.
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Affiliation(s)
- Pegah Golabi
- Department of Medicine, Center for Liver Disease, Inova Fairfax Medical Campus, Falls Church, VA, United States; Beatty Liver and Obesity Research Program, Inova Health System, Falls Church, VA, United States
| | - James M Paik
- Department of Medicine, Center for Liver Disease, Inova Fairfax Medical Campus, Falls Church, VA, United States; Beatty Liver and Obesity Research Program, Inova Health System, Falls Church, VA, United States
| | - Ameeta Kumar
- Department of Medicine, Center for Liver Disease, Inova Fairfax Medical Campus, Falls Church, VA, United States
| | - Reem Al Shabeeb
- Department of Medicine, Center for Liver Disease, Inova Fairfax Medical Campus, Falls Church, VA, United States
| | - Kathrine E Eberly
- Department of Medicine, Center for Liver Disease, Inova Fairfax Medical Campus, Falls Church, VA, United States
| | - Kenneth Cusi
- Division of Endocrinology, Diabetes and Metabolism, University of Florida, Gainesville, FL, United States
| | - Nagashree GunduRao
- Department of Medicine, Center for Liver Disease, Inova Fairfax Medical Campus, Falls Church, VA, United States; Inova Medicine, Inova Health System, Falls Church, VA, United States
| | - Zobair M Younossi
- Department of Medicine, Center for Liver Disease, Inova Fairfax Medical Campus, Falls Church, VA, United States; Beatty Liver and Obesity Research Program, Inova Health System, Falls Church, VA, United States; Inova Medicine, Inova Health System, Falls Church, VA, United States.
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167
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Zhang S, Ren HF, Du RX, Sun WL, Fu ML, Zhang XC. Global, regional, and national burden of kidney dysfunction from 1990 to 2019: a systematic analysis from the global burden of disease study 2019. BMC Public Health 2023; 23:1218. [PMID: 37353821 PMCID: PMC10288715 DOI: 10.1186/s12889-023-16130-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 06/15/2023] [Indexed: 06/25/2023] Open
Abstract
OBJECTIVE We aim to explore the prevalence and temporal trends of the burden of kidney dysfunction (KD) in global, regional and national level, since a lack of related studies. DESIGN Cross-sectional study. MATERIALS The data of this research was obtained from Global Burden of Diseases Study 2019. The estimation of the prevalence, which was measured by the summary exposure value (SEV), and attributable burden of KD was performed by DisMod-MR 2.1, a Bayesian meta-regression tool. The Spearman rank order correlation method was adopted to perform correlation analysis. The temporal trends were represented by the estimated annual percentage change (EAPC). RESULTS In 2019, there were total 3.16 million deaths and 76.5 million disability-adjusted life years (DALYs) attributable to KD, increased by 101.1% and 81.7% compared with that in 1990, respectively. From 1990 to 2019, the prevalence of KD has increased in worldwide, but decreased in High-income Asia Pacific. Nearly 48.5% of countries globally, such as South Africa, Egypt and Mexico had increased mortality rates of KD from 1990 to 2019 while 44.6% for disability rate. Countries with lower socio-demographic index (SDI) are facing a higher prevalence as well as mortality and disability rate compared with those with higher SDI. Compared with females, the prevalence of KD was lower in males, however the attributable mortality and disability rate were higher in all years from 1990 to 2019. CONCLUSION With the progress of senescent, we will face more severe challenges of reducing the prevalence and attributable burden of KD, especially in regions with lower SDI. Effective measures are urgently required to alleviate the prevalence and burden of KD.
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Affiliation(s)
- Shu Zhang
- Department of Urology, Shanxi Bethune Hospital, Shanxi Academy of Medical Science, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
| | - Hui-Fang Ren
- Department of Urology, Shanxi Bethune Hospital, Shanxi Academy of Medical Science, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
| | - Rong-Xin Du
- Department of Urology, Shanxi Bethune Hospital, Shanxi Academy of Medical Science, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
| | - Wei-Li Sun
- Department of Urology, Shanxi Bethune Hospital, Shanxi Academy of Medical Science, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
| | - Mei-Li Fu
- Department of Urology, Shanxi Bethune Hospital, Shanxi Academy of Medical Science, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
| | - Xiao-Chao Zhang
- Department of Urology, Shanxi Bethune Hospital, Shanxi Academy of Medical Science, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China.
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168
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Patschan D, Patschan S, Matyukhin I, Ritter O, Dammermann W. Metabolomics in Acute Kidney Injury: The Clinical Perspective. J Clin Med 2023; 12:4083. [PMID: 37373777 DOI: 10.3390/jcm12124083] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 05/24/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Acute kidney injury (AKI) affects increasing numbers of hospitalized patients worldwide. The diagnosis of AKI is made too late in most individuals since it is still based on dynamic changes in serum creatinine. In recent years, new AKI biomarkers have been identified; however, none of these can reliably replace serum creatinine yet. Metabolomic profiling (metabolomics) allows the concomitant detection and quantification of large numbers of metabolites from biological specimens. The current article aims to summarize clinical studies on metabolomics in AKI diagnosis and risk prediction. METHODS The following databases were searched for references: PubMed, Web of Science, Cochrane Library, and Scopus, and the period lasted from 1940 until 2022. The following terms were utilized: 'AKI' OR 'Acute Kidney Injury' OR 'Acute Renal Failure' AND 'metabolomics' OR 'metabolic profiling' OR 'omics' AND 'risk' OR 'death' OR 'survival' OR 'dialysis' OR 'KRT' OR 'kidney replacement therapy' OR 'RRT' OR 'renal replacement therapy' OR 'recovery of kidney function' OR 'renal recovery' OR 'kidney recovery' OR 'outcome'. Studies on AKI risk prediction were only selected if metabolomic profiling allowed differentiation between subjects that fulfilled a risk category (death or KRT or recovery of kidney function) and those who did not. Experimental (animal-based) studies were not included. RESULTS In total, eight studies were identified. Six studies were related to the diagnosis of AKI; two studies were performed on metabolic analysis in AKI risk (death) prediction. Metabolomics studies in AKI already helped to identify new biomarkers for AKI diagnosis. The data on metabolomics for AKI risk prediction (death, KRT, recovery of kidney function), however, are very limited. CONCLUSIONS Both the heterogenous etiology and the high degree of pathogenetic complexity of AKI most likely require integrated approaches such as metabolomics and/or additional types of '-omics' studies to improve clinical outcomes in AKI.
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Affiliation(s)
- Daniel Patschan
- Department of Medicine 1, Cardiology, Angiology, Nephrology, Brandenburg Medical School Theodor Fontane, University Hospital Brandenburg, 14770 Brandenburg, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, 15562 Rüdersdorf bei Berlin, Germany
| | - Susann Patschan
- Department of Medicine 1, Cardiology, Angiology, Nephrology, Brandenburg Medical School Theodor Fontane, University Hospital Brandenburg, 14770 Brandenburg, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, 15562 Rüdersdorf bei Berlin, Germany
| | - Igor Matyukhin
- Department of Medicine 1, Cardiology, Angiology, Nephrology, Brandenburg Medical School Theodor Fontane, University Hospital Brandenburg, 14770 Brandenburg, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, 15562 Rüdersdorf bei Berlin, Germany
| | - Oliver Ritter
- Department of Medicine 1, Cardiology, Angiology, Nephrology, Brandenburg Medical School Theodor Fontane, University Hospital Brandenburg, 14770 Brandenburg, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, 15562 Rüdersdorf bei Berlin, Germany
| | - Werner Dammermann
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, 15562 Rüdersdorf bei Berlin, Germany
- Department of Medicine 2, Gastroenterology, Diabetes, Endocrinology, Brandenburg Medical School Theodor Fontane, University Hospital Brandenburg, 14770 Brandenburg, Germany
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169
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Zhou H, Chen W, Suo Y, Meng X, Zhao X, Wang M, Liu L, Li H, Pan Y, Wang Y. External Validation of the Nelson Equation for Kidney Function Decline in Patients with Acute Ischemic Stroke or Transient Ischemic Attack. Clin Interv Aging 2023; 18:901-909. [PMID: 37304172 PMCID: PMC10257475 DOI: 10.2147/cia.s407338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 06/01/2023] [Indexed: 06/13/2023] Open
Abstract
Background There is a close brain-kidney interaction following ischemic cerebrovascular disease. The new-onset kidney injury after stroke leads to severe neurological deficits and poor functional outcomes. We aimed to validate the Nelson equation for predicting the new-onset and long-term kidney function decline in patients with acute ischemic stroke (AIS) or transient ischemic attack (TIA). Methods A total of 3169 patients were enrolled in the Third China National Stroke Registry, whose baseline estimated glomerular filtration rate (eGFR) ≥ 60 mL/min/1.73 m2. The outcome of interest was the incident eGFR< 60 mL/min/1.73 m2 at 3 months. The prediction equation of participants with or without diabetes was validated respectively. The receiver operating characteristic curve (AUC) evaluated prediction performance. The Delong test compared the Nelson equation performance with the O'Seaghdha equation and the Chien equation. Continuous net reclassification improvement (NRI) and integrated discrimination improvement (IDI) were determined to evaluate the incremental effect. Results During the 3-mo follow-up period, among 1151 patients with diabetes, there were 31 cases (2.7%) of reduced eGFR. Meanwhile, among 2018 non-diabetic patients, there were 23 cases (1.1%) of reduced eGFR. The Nelson equation showed good discrimination and was well-calibrated in patients with diabetes (AUC 0.82, Hosmer-Lemeshow test p = 0.67) or without diabetes (AUC 0.82, Hosmer-Lemeshow test p = 0.09). The performance of the Nelson equation was superior to other equation, as increased continuous NRI (diabetic, 0.64; non-diabetic, 1.13) and IDI (diabetic, 0.10; non-diabetic, 0.13) to the Chien equation. Conclusion The Nelson equation reliably predicted the risks of the new-onset and long-term kidney function decline in patients with AIS or TIA, which could help clinicians screen high-risk patients and improve clinical care.
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Affiliation(s)
- Hongyu Zhou
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Weiqi Chen
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Yue Suo
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Xia Meng
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Xingquan Zhao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Mengxing Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Liping Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Hao Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Yuesong Pan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, People’s Republic of China
- Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
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170
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Peng J, Li A, Yin L, Yang Q, Pan J, Yi B. Estimated Glucose Disposal Rate Predicts Renal Progression in Type 2 Diabetes Mellitus: A Retrospective Cohort Study. J Endocr Soc 2023; 7:bvad069. [PMID: 37304203 PMCID: PMC10251298 DOI: 10.1210/jendso/bvad069] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Indexed: 06/13/2023] Open
Abstract
Context Insulin resistance is a feature of type 2 diabetes mellitus (T2DM). The estimated glucose disposal rate (eGDR), a validated marker for insulin resistance, is associated with complications of diabetes, but few studies have explored the relationship between eGDR and renal outcomes in T2DM. Objective This study investigated the value of eGDR in predicting renal progression in T2DM. Methods A total of 956 T2DM patients with a baseline estimated glomerular filtration rate (eGFR) ≥ 60 mL/min/1.73 m2 and 5 years of follow-up were enrolled. Primary outcomes were rapid eGFR decline, eGFR <60 mL/min/1.73 m2, and composite renal endpoint consisting of 50% eGFR decline, doubling of serum creatinine, or end-stage renal disease. A continuous scale with restricted cubic spline curves and a generalized linear model were applied to evaluate the associations between eGDR and primary outcomes. Results Rapid eGFR decline was experienced by 23.95% of patients, 21.97% with eGFR <60 mL/min/1.73 m2, and 12.13% with the composite renal endpoint. The eGDR showed a relationship with follow-up eGFR and percentage change in eGFR (P < .001). An eGDR <6.34 mg/kg/min was an independent risk factor for rapid eGFR decline, eGFR < 60 mL/min/1.73 m2, or the composite renal endpoint(P < .05). Compared with eGDR of 5.65∼6.91 mg/kg/min, eGDR levels >8.33 mg/kg/min decreased the risk of rapid eGFR decline by 75%, eGFR < 60 mL/min/1.73 m2 by 60%, and the composite renal endpoint by 61%. Subgroup analysis was performed by sex, age, and diabetes duration, which showed that eGDR was associated with primary outcomes. Conclusion Lower eGDR is a predictive factor for renal deterioration in T2DM patients.
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Affiliation(s)
- Juan Peng
- Department of Nephrology, The Third Xiangya Hospital, Central South University, Changsha, Hunan 410013, China
| | - Aimei Li
- Department of Nephrology, The Third Xiangya Hospital, Central South University, Changsha, Hunan 410013, China
| | - Liangqingqing Yin
- Department of Nephrology, The Third Xiangya Hospital, Central South University, Changsha, Hunan 410013, China
| | - Qi Yang
- Department of Nephrology, The Third Xiangya Hospital, Central South University, Changsha, Hunan 410013, China
| | - Jinting Pan
- Department of Nephrology, The Third Xiangya Hospital, Central South University, Changsha, Hunan 410013, China
| | - Bin Yi
- Correspondence: Bin Yi, MD, PhD, Department of Nephrology, The Third Xiangya Hospital, Central South University, 138 Tongzipo Road, Changsha, 410013, China.
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171
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Duong H, Tesfaye W, Van C, Sud K, Truong M, Krass I, Castelino RL. Sick day management in people with chronic kidney disease: a scoping review. J Nephrol 2023; 36:1293-1306. [PMID: 36327038 PMCID: PMC10333414 DOI: 10.1007/s40620-022-01497-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 10/10/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Use of certain medications during an acute illness may put patients at an increased risk of acute kidney injury (AKI). Patients with chronic kidney disease (CKD) are at higher risk of developing superimposed AKI. The aim of this scoping review is to collate and characterise existing evidence on sick day management considerations and practices during acute illness in people with CKD. METHODS We searched Embase, CINAHL, MEDLINE, International Pharmaceutical Abstract, Scopus, Google Scholar and grey literature sources. We followed the methodological framework for scoping reviews, while information was extracted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews. Findings are presented thematically. RESULTS Ten studies and seven guidelines met the inclusion criteria. Studies were targeted at patients, general practitioners, pharmacists, and nurses. The major themes identified included development and feasibility testing of a sick day management protocol, current practice of temporary medication discontinuation, and outcomes. Most guidelines provided recommendations for sick day management largely based on expert consensus. A digital intervention was deemed highly acceptable and easy to use, whereas patient handouts were more effective when provided along with dialogue with a health professional. While there is little evidence on the impact of sick day protocols on outcomes, a single randomised trial reported no significant association between sick day protocols and change in kidney function, AKI incidents or risk of hospitalisation. CONCLUSION The nascent literature on sick day management in patients with CKD revealed the limited available evidence to provide guidance on implementation and on outcomes. Future research needs to clarify sick day recommendations and assess their impact on clinical outcomes including prevention of superimposed AKI or hospitalisations, as well as to address barriers to implementation.
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Affiliation(s)
- Henna Duong
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Wubshet Tesfaye
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Sydney Pharmacy School, The University of Sydney, A15, Science Rd , Camperdown, NSW 2006 Australia
| | - Connie Van
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Kamal Sud
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Department of Renal Medicine, Nepean Hospital, Nepean and Blue Mountains Local Health District, Katoomba, Australia
| | - Mimi Truong
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Ines Krass
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Ronald L Castelino
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Pharmacy Department, Blacktown Hospital, WSLHD, Blacktown, Australia
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172
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Patidar KR, Naved MA, Kabir S, Grama A, Allegretti AS, Cullaro G, Asrani SK, Worden A, Desai AP, Ghabril MS, Nephew LD, Orman ES. Longer time to recovery from acute kidney injury is associated with major adverse kidney events in patients with cirrhosis. Aliment Pharmacol Ther 2023; 57:1397-1406. [PMID: 36883210 PMCID: PMC10441172 DOI: 10.1111/apt.17457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 12/27/2022] [Accepted: 02/25/2023] [Indexed: 03/09/2023]
Abstract
BACKGROUND In patients with cirrhosis and acute kidney injury (AKI), longer time to AKI-recovery may increase the risk of subsequent major-adverse-kidney-events (MAKE). AIMS To examine the association between timing of AKI-recovery and risk of MAKE in patients with cirrhosis. METHODS Hospitalised patients with cirrhosis and AKI (n = 5937) in a nationwide database were assessed for time to AKI-recovery and followed for 180-days. Timing of AKI-recovery (return of serum creatinine <0.3 mg/dL of baseline) from AKI-onset was grouped by Acute-Disease-Quality-Initiative Renal Recovery consensus: 0-2, 3-7, and >7-days. Primary outcome was MAKE at 90-180-days. MAKE is an accepted clinical endpoint in AKI and defined as the composite outcome of ≥25% decline in estimated-glomerular-filtration-rate (eGFR) compared with baseline with the development of de-novo chronic-kidney-disease (CKD) stage ≥3 or CKD progression (≥50% reduction in eGFR compared with baseline) or new haemodialysis or death. Landmark competing-risk multivariable analysis was performed to determine the independent association between timing of AKI-recovery and risk of MAKE. RESULTS 4655 (75%) achieved AKI-recovery: 0-2 (60%), 3-7 (31%), and >7-days (9%). Cumulative-incidence of MAKE was 15%, 20%, and 29% for 0-2, 3-7, >7-days recovery groups, respectively. On adjusted multivariable competing-risk analysis, compared to 0-2-days, recovery at 3-7 and >7-days was independently associated with an increased risk for MAKE: sHR 1.45 (95% CI 1.01-2.09, p = 0.042), sHR 2.33 (95% CI 1.40-3.90, p = 0.001), respectively. CONCLUSION Longer time to recovery is associated with an increased risk of MAKE in patients with cirrhosis and AKI. Further research should examine interventions to shorten AKI-recovery time and its impact on subsequent outcomes.
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Affiliation(s)
- Kavish R. Patidar
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Mobasshir A. Naved
- Department of Computer Science, Purdue University, West Lafayette, Indiana, USA
| | - Shaowli Kabir
- College of Public Health, University of Kentucky, Lexington, Kentucky, USA
| | - Ananth Grama
- Department of Computer Science, Purdue University, West Lafayette, Indiana, USA
| | - Andrew S. Allegretti
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Giuseppe Cullaro
- Division of Gastroenterology, Department of Medicine, University of California-San Francisco, San Francisco, California, USA
| | | | - Astin Worden
- Division of Internal Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Archita P. Desai
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Marwan S. Ghabril
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Lauren D. Nephew
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Eric S. Orman
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Korhonen PE, Kiiski S, Kautiainen H, Ojanen S, Tertti R. The Relationship of Kidney Function, Cardiovascular Morbidity, and All-Cause Mortality: a Prospective Primary Care Cohort Study. J Gen Intern Med 2023; 38:1834-1842. [PMID: 36544069 PMCID: PMC10271946 DOI: 10.1007/s11606-022-07885-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 10/25/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Lower-than-normal estimated glomerular filtration rate (eGFR) is associated with the risk for all-cause mortality and adverse cardiovascular events. In this regard, the role of higher-than-normal eGFR is still controversial. OBJECTIVE Investigate long-term clinical consequences across the levels of eGFR calculated by the creatinine-based Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation among apparently healthy cardiovascular risk subjects. DESIGN Prospective study. PARTICIPANTS Participants (n=1747) of a population-based screening and intervention program for cardiovascular risk factors in Finland during the years 2005-2007. MAIN MEASURES Cardiovascular morbidity and all-cause mortality. KEY RESULTS Over the 14-year follow-up, subjects with eGFR ≥105 ml/min/1.73 m2 (n=97) had an increased risk for all-cause mortality [HR 2.15 (95% CI: 1.24-3.73)], incident peripheral artery disease [HR 2.62 (95% CI: 1.00-6.94)], and atrial fibrillation/flutter [HR 2.10 (95% CI: 1.21-3.65)] when compared to eGFR category 90-104 ml/min after adjustment for cardiovascular and lifestyle-related risk factors. The eGFR category ≥105 ml/min was also associated with a two-fold increased mortality rate compared to the Finnish general population. CONCLUSIONS Renal hyperfiltration defined as eGFR ≥105 ml/min/1.73 m2 is a frequent and important finding in patients commonly treated in primary care. These patients should be followed closely for timely interventions, such as strict BP and blood glucose regulation.
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Affiliation(s)
- Päivi E Korhonen
- Department of General Practice, Turku University and Turku University Hospital, Turku, Finland.
| | - Sem Kiiski
- Department of General Practice, Turku University and Turku University Hospital, Turku, Finland
| | - Hannu Kautiainen
- Folkhälsan Research Center, Helsinki, Finland
- Unit of Primary Health Care, Kuopio University Hospital, Kuopio, Finland
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Seppo Ojanen
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Risto Tertti
- Department of Internal Medicine, Vaasa Central Hospital, Vaasa, Finland
- Department of Internal Medicine, Turku University, Turku, Finland
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174
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Vuong KT, Joseph C, Angelo JR. Review of acute kidney injury and progression to chronic kidney disease in pediatric patients undergoing hematopoietic cell transplant. Front Oncol 2023; 13:1161709. [PMID: 37287918 PMCID: PMC10242001 DOI: 10.3389/fonc.2023.1161709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 04/28/2023] [Indexed: 06/09/2023] Open
Abstract
While acute kidney injury (AKI) after hematopoietic cell transplant (HCT) has been well-described in pediatric patients, literature regarding the long term renal consequences of HCT-related AKI, the development of chronic kidney disease (CKD), and CKD care in pediatric patients post-HCT is limited. CKD affects almost 50% of patients after HCT with multifactorial etiology including infection, nephrotoxic medications, transplant-associated thrombotic microangiopathy, graft-versus-host disease, and sinusoidal obstruction syndrome. As renal function declines in CKD, eventually progressing to end stage kidney disease (ESKD), mortality increases and is more than 80% among patients requiring dialysis. Using society guidelines and current literature, this review summarizes definitions and etiologies of and management strategies among patients with AKI and CKD post-HCT with an emphasis on albuminuria, hypertension, nutrition, metabolic acidosis, anemia, and mineral bone disease. The goal of this review is to aid early identification and intervention in patients with renal dysfunction prior to development of ESKD, and to discuss ESKD and renal transplant in these patients post-HCT.
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175
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Shen Z, Wang R, He P, Zhang Z, Dai Y, Li M, Liu Z, Yang H, Guan S, Sun J. Association between urinary metal concentrations and abnormal estimated glomerular filtration rate in Chinese community-dwelling elderly: Exploring the mediating effect of triglycerides. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2023; 259:114966. [PMID: 37182299 DOI: 10.1016/j.ecoenv.2023.114966] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 04/26/2023] [Accepted: 04/27/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND Environmental metal exposure is associated with elevated triglycerides (TG) and the development of chronic kidney disease (CKD). However, the relationship between metal exposure and glomerular filtration rate (GFR) remains uncertain, and the mediating effect of TG between the two is unclear. METHODS This study measured the concentrations of 14 metals in urine samples from 3752 elderly people in the community. The most relevant metals were screened by least absolute shrinkage and selection operator (LASSO) regression. The relationship between combined exposure to multiple metals and abnormal estimated glomerular filtration rate (eGFR) was explored using multivariate logistic regression analysis and Bayesian kernel machine regression (BKMR) analysis. Generalized linear regression models and the Karlson-Holm-Green (KHB) method were used to assess the mediating effects of TG. RESULTS In the single-metal model, calcium (Ca), iron (Fe), selenium (Se), strontium (Sr), and thallium (Tl) showed significant negative correlations with the prevalence of abnormal eGFR (all P < 0.05). In the multi-metals model, Ca, Se, and Tl continued to show significant negative correlations, while vanadium (V) and zinc (Zn) showed significant positive correlations with abnormal eGFR (all P < 0.05). The BKMR model showed a negative joint effect of the mixture of Ca, V, Zn, Se, and Tl on the prevalence of abnormal eGFR. The generalized linear regression model showed a significant positive correlation between the concentrations of Ca (β = 0.07), Zn (β = 0.07), Se (β = 0.09), and TG levels (all P < 0.05). In the mediation analysis, TG masked a 4.30% and 5.21% correlation between Ca and Se and the prevalence of eGFR abnormalities, respectively. CONCLUSIONS Urinary concentration of multiple metals is significantly associated with eGFR abnormalities, and Ca, and Se may be among the potential protective factors. TG masked some of the protective effects of Ca and Se.
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Affiliation(s)
- Zhuoheng Shen
- School of Public Health, Ningxia Medical University, Yinchuan Ningxia 750004, P.R. China; Key Laboratory of Environmental Factors and Chronic Disease Control, Yinchuan Ningxia 750004, P.R. China
| | - Rui Wang
- School of Public Health, Ningxia Medical University, Yinchuan Ningxia 750004, P.R. China; Key Laboratory of Environmental Factors and Chronic Disease Control, Yinchuan Ningxia 750004, P.R. China
| | - Pei He
- School of Public Health, Ningxia Medical University, Yinchuan Ningxia 750004, P.R. China; Key Laboratory of Environmental Factors and Chronic Disease Control, Yinchuan Ningxia 750004, P.R. China
| | - Zhongyuan Zhang
- School of Public Health, Ningxia Medical University, Yinchuan Ningxia 750004, P.R. China; Key Laboratory of Environmental Factors and Chronic Disease Control, Yinchuan Ningxia 750004, P.R. China
| | - Yuqing Dai
- School of Public Health, Ningxia Medical University, Yinchuan Ningxia 750004, P.R. China; Key Laboratory of Environmental Factors and Chronic Disease Control, Yinchuan Ningxia 750004, P.R. China
| | - Meiyan Li
- School of Public Health, Ningxia Medical University, Yinchuan Ningxia 750004, P.R. China; Key Laboratory of Environmental Factors and Chronic Disease Control, Yinchuan Ningxia 750004, P.R. China
| | - Zhihong Liu
- School of Public Health, Ningxia Medical University, Yinchuan Ningxia 750004, P.R. China; Key Laboratory of Environmental Factors and Chronic Disease Control, Yinchuan Ningxia 750004, P.R. China
| | - Huifang Yang
- School of Public Health, Ningxia Medical University, Yinchuan Ningxia 750004, P.R. China; Key Laboratory of Environmental Factors and Chronic Disease Control, Yinchuan Ningxia 750004, P.R. China
| | - Suzhen Guan
- School of Public Health, Ningxia Medical University, Yinchuan Ningxia 750004, P.R. China; Key Laboratory of Environmental Factors and Chronic Disease Control, Yinchuan Ningxia 750004, P.R. China.
| | - Jian Sun
- School of Public Health, Ningxia Medical University, Yinchuan Ningxia 750004, P.R. China; Key Laboratory of Environmental Factors and Chronic Disease Control, Yinchuan Ningxia 750004, P.R. China.
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176
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Gama RM, Griffiths K, Vincent RP, Peters AM, Bramham K. Performance and pitfalls of the tools for measuring glomerular filtration rate to guide chronic kidney disease diagnosis and assessment. J Clin Pathol 2023:jcp-2023-208887. [PMID: 37164629 DOI: 10.1136/jcp-2023-208887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 04/28/2023] [Indexed: 05/12/2023]
Abstract
Accurate diagnosis, classification and risk stratification for chronic kidney disease (CKD) allow for early recognition and delivering optimal care. Creatinine-based glomerular filtration rate (GFR), urinary albumin: creatinine ratio (UACR) and the kidney failure risk equation (KFRE) are important tools to achieve this, but understanding their limitations is important for optimal implementation.When accurate GFR is required (eg, chemotherapy dosing), GFR is measured using an exogenous filtration marker. In routine clinical practice, in contrast, estimated GFR (eGFR) from serum creatinine (SCr), calculated using the enzymatic method±UACR, is recommended. Limitations of SCr include non-GFR determinants such as muscle mass, diet and tubular handling. An alternative or additional endogenous filtration marker is cystatin C, which can be used alongside SCr for confirmatory testing of CKD. However, its role in the UK is more limited due to concerns regarding false positive results.The recommended creatinine-based eGFR equation in the UK is the CKD Epidemiology Collaboration 2009 equation. This was recently updated to a race-neutral 2021 version and demonstrated reduced bias in people of Black ethnicity, but has not been validated in the UK. Limitations are extremes of age, inaccuracy at greater GFRs and reduced generalisability to under-represented ethnicity groups.The KFRE (based on age, sex, SCr and UACR) has recently been developed to help determine 2-year and 5-year risk of progression to end-stage kidney disease. It has been validated in over 30 countries and provides meaningful quantitative information to patients. However, supporting evidence for their performance in ethnic minority groups and kidney diseases such as glomerulonephritis remains modest.In conclusion, early identification, risk stratification of kidney disease and timely intervention are important to impact kidney disease progression. However, clinician awareness of the limitations and variability of creatinine, cystatin C and the eGFR equations, is key to appropriate interpretation of results.
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Affiliation(s)
- Rouvick M Gama
- Department of Inflammation Biology, Faculty of Life Sciences and Medicine, King's College London, London, UK
- King's Kidney Care, King's College Hospital, London, UK
| | - Kathryn Griffiths
- King's Kidney Care, King's College Hospital, London, UK
- Department of Women and Children's Health, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Royce P Vincent
- Department of Clinical Biochemistry (Synnovis), King's College Hospital, London, UK
- Department of Nutrition and Dietetics, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Adrien Michael Peters
- Department of Nuclear Medicine, King's College Hospital NHS Foundation Trust, London, UK
| | - Kate Bramham
- King's Kidney Care, King's College Hospital, London, UK
- Department of Women and Children's Health, Faculty of Life Sciences and Medicine, King's College London, London, UK
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177
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Xiang ST, Cao Y, Dong J, Li C, Duan Y, Li X, Qiu J. Association of urine phthalate metabolites levels with kidney function in 1610 US adolescents. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023:10.1007/s11356-023-27389-0. [PMID: 37148507 DOI: 10.1007/s11356-023-27389-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 04/28/2023] [Indexed: 05/08/2023]
Abstract
Phthalates are widely used as plasticizer or fragrance ingredients in various consumer products worldwide. However, evidence for the overall effects of mixed exposure to phthalate on kidney function has not been widely investigated. The purpose of this article was to assess the association of urine phthalate metabolite levels and kidney injury parameters in adolescents. We used data from the combined 2007-2016 National Health and Nutrition Examination Survey (NHANES). We fitted weighted linear regressions and Bayesian kernel machine regressions (BKMR) models to explore the association of urinary phthalate metabolites with four parameters of kidney function after adjusting for covariates. Weighted linear regression models showed that MiBP (β = 8.057; PFDR = 0.016) was significantly positively associated with eGFR and MEP (β = -0.799; PFDR < 0.001) was significantly negatively correlated with BUN. BKMR analysis showed that the higher the concentration of phthalate metabolite mixture, the higher eGFR in adolescents. Based on the results of these two models, our findings revealed that mixed exposure to phthalates was associated with elevated eGFR in adolescents. However, as the study is cross-sectional, reverse causality is possible, and altered kidney function may impact the concentration of phthalate metabolites in urine.
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Affiliation(s)
- Shi-Ting Xiang
- Hunan Children's Research Institute (HCRI), Hunan Children's Hospital, 86 Ziyuan Road, Changsha, 410007, China
| | - Yuhan Cao
- Hunan Children's Research Institute (HCRI), Hunan Children's Hospital, 86 Ziyuan Road, Changsha, 410007, China
- Department of Occupational and Environmental Health, Xiangya School of Public Health, Central South University, 110 Xiangya Road, Changsha, 410078, China
| | - Jie Dong
- Hunan Children's Research Institute (HCRI), Hunan Children's Hospital, 86 Ziyuan Road, Changsha, 410007, China
| | - Chao Li
- Department of Epidemiology and Medical Statistics, Xiangya School of Public Health, Central South University, 110 Xiangya Road, Changsha, 410078, China
| | - Yanying Duan
- Department of Occupational and Environmental Health, Xiangya School of Public Health, Central South University, 110 Xiangya Road, Changsha, 410078, China
| | - Xun Li
- Hunan Children's Research Institute (HCRI), Hunan Children's Hospital, 86 Ziyuan Road, Changsha, 410007, China
| | - Jun Qiu
- Hunan Children's Research Institute (HCRI), Hunan Children's Hospital, 86 Ziyuan Road, Changsha, 410007, China.
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178
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Domínguez García A, Muñoz Rodríguez J, Prats López J, Almirall Daly J, Centeno Álvarez C, de Verdonces Roman L, Pla Terradellas C, Serra Aracil X. Metabolic acidosis after ileal urinary diversion and radical cystectomy. Do we know as much as we think we do? A systematic review. Actas Urol Esp 2023; 47:195-210. [PMID: 36427800 DOI: 10.1016/j.acuroe.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 10/10/2022] [Accepted: 10/11/2022] [Indexed: 05/05/2023]
Abstract
Urine contact with the mucosa of the urinary diversion (UD) after radical cystectomy (RC) produces different ion exchanges that favor the development of metabolic acidosis (MA). This phenomenon is a frequent cause of hospital readmission and short/long-term complications. We performed a systematic review of MA in RCs with ileal UD, analyzing its prevalence, diagnosis, risk factors and treatment. We systematically searched Pubmed® and Cochrane Library for original articles published before May 2022 according to PRISMA guidelines. A total of 421 articles were identified. We selected 25 studies that met the inclusion criteria involving 5811 patients. Obtaining precise data on the prevalence of MA is difficult, largely due to the heterogeneity of the diagnostic criteria used given the diversity of studies analyzed. Development of MA is multifactorial. In the early period, MA is more prevalent in patients with UD with longer ileal segments, better urinary continence, and impaired renal function. Age and diabetes are risk factors associated with MA in later periods. MA is the most common cause of second or more hospital readmissions. Prophylaxis with oral bicarbonate for three months in patients at risk could improve these results. Although MA after ileal UD is a well-known condition, this review highlights the need to implement homogeneous criteria for the diagnosis, follow-up, and treatment, in addition to protocolizing prevention/prophylaxis strategies in patients at risk.
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Affiliation(s)
- A Domínguez García
- Servicio de Urología, Hospital Universitari Parc Taulí, Universitat Autònoma de Barcelona (UAB), Sabadell, Barcelona, Spain.
| | - J Muñoz Rodríguez
- Servicio de Urología, Hospital Universitari Parc Taulí, Universitat Autònoma de Barcelona (UAB), Sabadell, Barcelona, Spain
| | - J Prats López
- Servicio de Urología, Hospital Universitari Parc Taulí, Universitat Autònoma de Barcelona (UAB), Sabadell, Barcelona, Spain
| | - J Almirall Daly
- Servicio de Nefrología, Hospital Universitari Parc Taulí, Universitat Autònoma de Barcelona (UAB), Sabadell, Barcelona, Spain
| | - C Centeno Álvarez
- Servicio de Urología, Hospital Universitari Parc Taulí, Universitat Autònoma de Barcelona (UAB), Sabadell, Barcelona, Spain
| | - L de Verdonces Roman
- Servicio de Urología, Hospital Universitari Parc Taulí, Universitat Autònoma de Barcelona (UAB), Sabadell, Barcelona, Spain
| | - C Pla Terradellas
- Servicio de Urología, Hospital Universitari Parc Taulí, Universitat Autònoma de Barcelona (UAB), Sabadell, Barcelona, Spain
| | - X Serra Aracil
- Servicio de Cirugía General y Digestiva, Hospital Universitari Parc Taulí, Universitat Autònoma de Barcelona (UAB), Sabadell, Barcelona, Spain
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179
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Li H, Li M, Dong S, Dong A, Wang J, Zhu Y, Deng Y, Chen S, Zhang M. Preliminary study of the interactive effects of coronary heart disease and lacunar infarction on renal function in patients with type 2 diabetes mellitus by gender. J Diabetes Complications 2023; 37:108477. [PMID: 37121118 DOI: 10.1016/j.jdiacomp.2023.108477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 04/10/2023] [Accepted: 04/11/2023] [Indexed: 05/02/2023]
Abstract
BACKGROUND Coronary heart disease (CHD) and lacunar infarction (LI) are the most common cardio- cerebrovascular complications of type 2 diabetes mellitus (T2DM) and a recognized risk factor for renal injury. Although a unidirectional association of CHD or LI with T2DM or the kidney has been demonstrated, however, it remains unknown whether there is an interactive effect of the coexistence of CHD and LI on renal function in T2DM patients. The aim of our study was to investigate the interaction between CHD and LI on renal function in gender-specific patients with T2DM and the association between cardio-cerebrovascular disease-related conventional serum markers and the estimated glomerular filtration rate (eGFR). METHODS We conducted a cross-sectional study in Beijing and Tianjin from April 2019 to August 2021. Participants with T2DM aged ≥18 years were asked to complete a one-to-one questionnaire and physical examination. RESULTS In this study, 389 eligible patients with T2DM were included, with a mean age of 63.04 ± 9.41 years, of whom 200 (51.41 %) were male. The proportions of patients with CHD, LI, and both CHD and LI were 28.53 %, 24.42 %, and 11.05 %, respectively. Compared to T2DM patients without either CHD or LI, those with both CHD and LI were found to have a significantly greater risk of reduced eGFR (OR: 12.82, 95 % CI 5.06-32.52, P < 0.001) than those with CHD alone (OR: 2.42, 95 % CI 1.37-3.00, P = 0.004) or LI alone (OR: 1.15, 95 % CI 0.61-2.18, P = 0.664). The combined presence of CHD and LI is associated with a significantly greater risk of decreased eGFR in female T2DM patients compared to their male counterparts. We found both multiplicative and additive effects in all T2DM patients; however, when stratified by sex, only multiplicative effects were observed. After controlling for interference from CHD, LI, and age, we found that total cholesterol (TC) was negatively correlated with eGFR in females (r = -0.156, P = 0.034), and low-density lipoprotein cholesterol (LDL-C) was negatively correlated with eGFR in males (r = -0.229, P = 0.001). CONCLUSION This study provides novel evidence that the synergistic effect of CHD and LI on renal injury in patients with T2DM is significantly greater than their individual effects. Women with T2DM who have both CHD and LI are at a 4.85-fold higher risk of decreased eGFR than men. Therefore, increased clinical attention should be given to preventing and treating vascular complications in T2DM patients, as well as aggressively reducing lipid levels, particularly TC and LDL-C, to delay or prevent renal dysfunction in T2DM patients.
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Affiliation(s)
- Hongdian Li
- Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Mingxuan Li
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
| | - Shaoning Dong
- Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital, Tianjin, China
| | - Ao Dong
- Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Jing Wang
- Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Yuanyuan Zhu
- Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Yuanyuan Deng
- Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Shu Chen
- Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Mianzhi Zhang
- Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China; Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital, Tianjin, China.
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180
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Adegbite BO, Abramson MH, Gutgarts V, Musteata MF, Chauhan K, Muwonge AN, Meliambro KA, Salvatore SP, Ghaity-Beckley SE, Kremyanskaya M, Marcellino B, Mascarenhas JO, Campbell KN, Chan L, Coca SG, Berman EM, Jaimes EA, Azeloglu EU. Dasatinib nephrotoxicity correlates with patient-specific pharmacokinetics. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.04.09.23288333. [PMID: 37131844 PMCID: PMC10153335 DOI: 10.1101/2023.04.09.23288333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Introduction Dasatinib has been associated with nephrotoxicity. We sought to examine the incidence of proteinuria on dasatinib and determine potential risk factors that may increase dasatinib-associated glomerular injury. Methods We examine glomerular injury via urine albumin-to-creatinine ratio (UACR) in 101 chronic myelogenous leukemia patients who were on tyrosine-kinase inhibitor (TKI) therapy for at least 90 days. We assay plasma dasatinib pharmacokinetics using tandem mass spectroscopy, and further describe a case study of a patient who experienced nephrotic-range proteinuria while on dasatinib. Results Patients treated with dasatinib (n= 32) had significantly higher UACR levels (median 28.0 mg/g, IQR 11.5 - 119.5) than patients treated with other TKIs (n=50; median 15.0 mg/g, IQR 8.0 - 35.0; p < 0.001). In total, 10% of dasatinib users exhibited severely increased albuminuria (UACR > 300 mg/g) versus zero in other TKIs. Average steady state concentrations of dasatinib were positively correlated with UACR (ρ = 0.54, p = 0.03) as well as duration of treatment ( p =0.003). There were no associations with elevated blood pressure or other confounding factors. In the case study, kidney biopsy revealed global glomerular damage with diffuse foot process effacement that recovered upon termination of dasatinib treatment. Conclusions Exposure to dasatinib is associated a significant chance of developing proteinuria compared to other similar TKIs. Dasatinib plasma concentration significantly correlates with increased risk of developing proteinuria while receiving dasatinib. Screening for renal dysfunction and proteinuria is strongly advised for all dasatinib patients.
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181
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Thakur M, Junho CVC, Bernhard SM, Schindewolf M, Noels H, Döring Y. NETs-Induced Thrombosis Impacts on Cardiovascular and Chronic Kidney Disease. Circ Res 2023; 132:933-949. [PMID: 37053273 PMCID: PMC10377271 DOI: 10.1161/circresaha.123.321750] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
Arterial and venous thrombosis constitute a major source of morbidity and mortality worldwide. Association between thrombotic complications and cardiovascular and other chronic inflammatory diseases are well described. Inflammation and subsequent initiation of thrombotic events, termed immunothrombosis, also receive growing attention but are still incompletely understood. Nevertheless, the clinical relevance of aberrant immunothrombosis, referred to as thromboinflammation, is evident by an increased risk of thrombosis and cardiovascular events in patients with inflammatory or infectious diseases. Proinflammatory mediators released from platelets, complement activation, and the formation of NETs (neutrophil extracellular traps) initiate and foster immunothrombosis. In this review, we highlight and discuss prominent and emerging interrelationships and functions between NETs and other mediators in immunothrombosis in cardiovascular disease. Also, with patients with chronic kidney disease suffering from increased cardiovascular and thrombotic risk, we summarize current knowledge on neutrophil phenotype, function, and NET formation in chronic kidney disease. In addition, we elaborate on therapeutic targeting of NETs-induced immunothrombosis. A better understanding of the functional relevance of antithrombotic mediators which do not increase bleeding risk may provide opportunities for successful therapeutic interventions to reduce thrombotic risk beyond current treatment options.
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Affiliation(s)
- Manovriti Thakur
- Division of Angiology, Swiss Cardiovascular Center, Inselspital (M.T., S.M.B., M.S., Y.D.), Bern University Hospital, University of Bern, Switzerland
- Department for BioMedical Research (DBMR) (M.T., S.M.B., M.S., Y.D.), Bern University Hospital, University of Bern, Switzerland
| | - Carolina Victoria Cruz Junho
- Institute for Molecular Cardiovascular Research (IMCAR), University Hospital RWTH Aachen, Germany (C.V.C.J., H.N.)
| | - Sarah Maike Bernhard
- Division of Angiology, Swiss Cardiovascular Center, Inselspital (M.T., S.M.B., M.S., Y.D.), Bern University Hospital, University of Bern, Switzerland
- Department for BioMedical Research (DBMR) (M.T., S.M.B., M.S., Y.D.), Bern University Hospital, University of Bern, Switzerland
| | - Marc Schindewolf
- Division of Angiology, Swiss Cardiovascular Center, Inselspital (M.T., S.M.B., M.S., Y.D.), Bern University Hospital, University of Bern, Switzerland
- Department for BioMedical Research (DBMR) (M.T., S.M.B., M.S., Y.D.), Bern University Hospital, University of Bern, Switzerland
| | - Heidi Noels
- Institute for Molecular Cardiovascular Research (IMCAR), University Hospital RWTH Aachen, Germany (C.V.C.J., H.N.)
- Department of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, the Netherlands (H.N.)
| | - Yvonne Döring
- Division of Angiology, Swiss Cardiovascular Center, Inselspital (M.T., S.M.B., M.S., Y.D.), Bern University Hospital, University of Bern, Switzerland
- Department for BioMedical Research (DBMR) (M.T., S.M.B., M.S., Y.D.), Bern University Hospital, University of Bern, Switzerland
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany (Y.D.)
- Institute for Cardiovascular Prevention (IPEK), Ludwig-Maximilians-University Munich (LMU), Munich, Germany (Y.D.)
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182
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Baaten CCFMJ, Vondenhoff S, Noels H. Endothelial Cell Dysfunction and Increased Cardiovascular Risk in Patients With Chronic Kidney Disease. Circ Res 2023; 132:970-992. [PMID: 37053275 PMCID: PMC10097498 DOI: 10.1161/circresaha.123.321752] [Citation(s) in RCA: 26] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
The endothelium is considered to be the gatekeeper of the vessel wall, maintaining and regulating vascular integrity. In patients with chronic kidney disease, protective endothelial cell functions are impaired due to the proinflammatory, prothrombotic and uremic environment caused by the decline in kidney function, adding to the increase in cardiovascular complications in this vulnerable patient population. In this review, we discuss endothelial cell functioning in healthy conditions and the contribution of endothelial cell dysfunction to cardiovascular disease. Further, we summarize the phenotypic changes of the endothelium in chronic kidney disease patients and the relation of endothelial cell dysfunction to cardiovascular risk in chronic kidney disease. We also review the mechanisms that underlie endothelial changes in chronic kidney disease and consider potential pharmacological interventions that can ameliorate endothelial health.
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Affiliation(s)
- Constance C F M J Baaten
- Institute for Molecular Cardiovascular Research (IMCAR), University Hospital RWTH Aachen, Aachen, Germany (C.C.F.M.J.B., S.V., H.N.)
- Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands (C.C.F.M.J.B., H.N.)
| | - Sonja Vondenhoff
- Institute for Molecular Cardiovascular Research (IMCAR), University Hospital RWTH Aachen, Aachen, Germany (C.C.F.M.J.B., S.V., H.N.)
| | - Heidi Noels
- Institute for Molecular Cardiovascular Research (IMCAR), University Hospital RWTH Aachen, Aachen, Germany (C.C.F.M.J.B., S.V., H.N.)
- Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands (C.C.F.M.J.B., H.N.)
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183
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Shiraishi YA, Ishikawa Y, Ishikawa J, Matsumura M, Ishikawa S. Age and sex differences in the risk of cardiovascular diseases by chronic kidney disease in a general Japanese population. Heart Vessels 2023:10.1007/s00380-023-02264-7. [PMID: 37039880 DOI: 10.1007/s00380-023-02264-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 03/23/2023] [Indexed: 04/12/2023]
Abstract
The risk of cardiovascular diseases (CVD) by chronic kidney disease (CKD) stratified by age and sex has not been examined in detail in rural Japanese populations. Therefore, we herein investigated the long-term risk of CVD by CKD and performed an age- and sex-stratified risk analysis. We examined 5163 subjects who underwent health screening between 1992 and 1995 with calculated eGFR and follow-up information on CVD events. The mean follow-up period was 10 years. We analyzed the incidences of CVD events, including stroke and myocardial infarction (MI). We compared the risk of CVD between subjects with and without CKD using a Cox proportional hazards model adjusted for well-known CVD confounding factors. The total number of CVD events was 175. The hazard ratios (HRs) for all events, stroke, MI, and sudden death by CKD relative to non-CKD were 1.18 (95% C.I.:0.83-1.68), 0.96 (0.63-1.46), 3.02 (1.2-7.62), and 1.29 (0.43-3.87), respectively. HRs for MI were 7.24 in subjects < 65 years and 1.65 in those ≥ 65 years. HRs for MI by sex were 3.55 in men and 2.09 in women. A younger age and men sex were identified as independent risk factors for the risk of MI in the presence of CKD. These results suggest that among CKD patients, the management of a younger age group and men will effectively prevent MI.
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Affiliation(s)
- Yuko Ago Shiraishi
- Division of General Medicine, Center for Community Medicine, Jichi Medical University School of Medicine, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.
| | - Yukiko Ishikawa
- Division of General Medicine, Center for Community Medicine, Jichi Medical University School of Medicine, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Joji Ishikawa
- Department of Cardiology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, 35-2 Sakae, Itabashi, Tokyo, 173-0015, Japan
| | - Masami Matsumura
- Division of General Medicine, Center for Community Medicine, Jichi Medical University School of Medicine, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Shizukiyo Ishikawa
- Division of Public Health, Center for Community Medicine, Jichi Medical University School of Medicine, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
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Zhang M, Ye C, Wang R, Zhang Z, Huang X, Halimulati M, Sun M, Ma Y, Zhang Z. Association between Dietary Acid Load and Hyperuricemia in Chinese Adults: Analysis of the China Health and Nutrition Survey (2009). Nutrients 2023; 15:nu15081806. [PMID: 37111025 PMCID: PMC10144330 DOI: 10.3390/nu15081806] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 04/04/2023] [Accepted: 04/05/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND This study evaluates the association between dietary acid load (DAL) and hyperuricemia in Chinese adults. METHODS The China Health and Nutrition Survey (CHNS) in 2009 was used in this cross-sectional study. Potential renal acid load (PRAL) and net endogenous acid production (NEAP) were applied to estimate DAL. A multiple logistic regression model was used to test the relationship between DAL and hyperuricemia risk. RESULTS A total of 7947 participants were included in this study, of whom 1172 had hyperuricemia. The PRAL score was positively related to the prevalence of hyperuricemia, even when potential covariates were taken into account. In comparison with Q1, the ORs were 1.12 (95% CI, 0.92-1.38), 1.20 (95% CI, 0.97-1.47) and 1.42 (95% CI, 1.16-1.75) in Q2, Q3 and Q4. However, there was no significant relationship between NEAP scores and hyperuricemia. Every 10 g increase in energy-adjusted fat, protein and animal protein intakes caused a 10%, 17% and 18% increase in hyperuricemia risk, respectively (OR: 1.10, 95% CI: 1.04-1.16; OR: 1.17, 95% CI: 1.11-1.25; OR: 1.18, 95% CI: 1.12-1.24, respectively). An obvious linear correlation was also suggested by the restricted cubic spline. CONCLUSIONS Hyperuricemia risk was associated with higher PRAL among Chinese adults. This means that a diet low in PRAL scores could be a very valuable uric acid-lowering dietary pattern.
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Affiliation(s)
- Min Zhang
- Department of Nutrition & Food Hygiene, School of Public Health, Peking University Health Science Center, Haidian District, Beijing 100191, China
| | - Chen Ye
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Ruoyu Wang
- Department of Nutrition & Food Hygiene, School of Public Health, Peking University Health Science Center, Haidian District, Beijing 100191, China
| | - Zongfeng Zhang
- Department of Nutrition & Food Hygiene, School of Public Health, Peking University Health Science Center, Haidian District, Beijing 100191, China
| | - Xiaojie Huang
- Department of Nutrition & Food Hygiene, School of Public Health, Peking University Health Science Center, Haidian District, Beijing 100191, China
| | - Mairepaiti Halimulati
- Department of Nutrition & Food Hygiene, School of Public Health, Peking University Health Science Center, Haidian District, Beijing 100191, China
| | - Meng Sun
- Department of Nutrition & Food Hygiene, School of Public Health, Peking University Health Science Center, Haidian District, Beijing 100191, China
| | - Yuxin Ma
- Department of Nutrition & Food Hygiene, School of Public Health, Peking University Health Science Center, Haidian District, Beijing 100191, China
| | - Zhaofeng Zhang
- Department of Nutrition & Food Hygiene, School of Public Health, Peking University Health Science Center, Haidian District, Beijing 100191, China
- Beijing's Key Laboratory of Food Safety Toxicology Research and Evaluation, Haidian District, Beijing 100191, China
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185
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Lu L, Lu J, Chen J, Wang B, Peng H, Peng J, Liu X, Lin F, Xiong G. Biomarker identification and pathway analysis of Astragalus membranaceus and Curcuma zedoaria couplet medicines on adenine-induced chronic kidney disease in rats based on metabolomics. Front Pharmacol 2023; 14:1103527. [PMID: 37089928 PMCID: PMC10116179 DOI: 10.3389/fphar.2023.1103527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 03/22/2023] [Indexed: 04/08/2023] Open
Abstract
Background: Chronic kidney disease (CKD) is usually insidious, and most affected individuals are asymptomatic until the disease becomes advanced. The effective treatment of CKD would rely on the incorporation of multidisciplinary approaches. Astragalus membranaceus (AM) and Curcuma zedoaria (CZ) have been widely used in the treatment of CKD. However, the mechanism of AM and CZ in the treatment of CKD is still unclear.Methods: This study was designed to evaluate the effects of AM and CZ on adenine-induced rats and to investigate the underlying mechanism by using metabolomic analysis. Addition of 0.75% adenine to the diet of rats for 3 weeks induced the animal model of CKD. The rats in the treatment group were treated with AM and CZ (2.1 g/kg/day) for 4 weeks. Blood and kidney samples were collected for biochemical and histological examination. Ultra-high-performance liquid chromatography/Q Exactive HFX mass spectrometer (UHPLC-QE-MS) was applied to analyze metabolic profiling variations in the kidney.Results: The results showed that AM and CZ could significantly reduce serum creatinine (Scr) and blood urea nitrogen (BUN) levels in CKD rats and alleviate renal pathological injury. By comparing the endogenous components of the normal group and the model group in positive ion mode and negative ion mode, a total of 365 and 155 different metabolites were screened, respectively. A total of 117 and 73 metabolites with significantly different expressions were identified between model group and AM and CZ group in positive ion mode and negative ion mode, respectively. The pivotal pathways affected by AM and CZ included nicotinate and nicotinamide metabolism, and glycine, serine and threonine metabolism. Furthermore, significant changes in metabolites in CKD rats after AM and CZ therapies were observed, including L-Threonine, D-pantothenic acid, and nicotinamide. Moreover, we found that AM and CZ significantly reduced renal fibrosis and inflammation in CKD rats, which may be related to the regulation of SIRT1/JNK signaling pathway.Conclusion: In conclusion, AM and CZ significantly reduced renal fibrosis and inflammation in CKD rats, which may be related to the regulation of SIRT1/JNK signaling pathway. Furthermore, L-Threonine, D-pantothenic acid, and nicotinamide may be potential biomarkers for the progression and treatment of CKD.
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Affiliation(s)
- Lingfei Lu
- Department of Nephrology, Shenzhen Traditional Chinese Medicine Hospital, Guangzhou University of Chinese Medicine, Shenzhen, Guangdong, China
- The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, Guangdong, China
| | - Jiandong Lu
- Department of Nephrology, Shenzhen Traditional Chinese Medicine Hospital Nanjing University of Chinese Medicine, Shenzhen, China
| | - Jiwei Chen
- Department of Nephrology, Shenzhen Traditional Chinese Medicine Hospital, Guangzhou University of Chinese Medicine, Shenzhen, Guangdong, China
- The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, Guangdong, China
| | - Bing Wang
- Department of Nephrology, Shenzhen Traditional Chinese Medicine Hospital Nanjing University of Chinese Medicine, Shenzhen, China
| | - Hongcheng Peng
- Department of Nephrology, Shenzhen Traditional Chinese Medicine Hospital, Guangzhou University of Chinese Medicine, Shenzhen, Guangdong, China
- The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, Guangdong, China
| | - Jinting Peng
- Department of Gynecology, Shenzhen Traditional Chinese Medicine Hospital, Guangzhou University of Chinese Medicine, Shenzhen, Guangdong, China
| | - Xinhui Liu
- Department of Nephrology, Shenzhen Traditional Chinese Medicine Hospital, Guangzhou University of Chinese Medicine, Shenzhen, Guangdong, China
| | - Feng Lin
- Department of Urology, Shenzhen Traditional Chinese Medicine Hospital Guangzhou University of Chinese Medicine, Shenzhen, Guangdong, China
- *Correspondence: Feng Lin, ; Guoliang Xiong,
| | - Guoliang Xiong
- Department of Nephrology, Shenzhen Traditional Chinese Medicine Hospital, Guangzhou University of Chinese Medicine, Shenzhen, Guangdong, China
- *Correspondence: Feng Lin, ; Guoliang Xiong,
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186
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Sezer B, Kodaman Dokumacıgil N, Kaya R, Güven S, Türkkan ÖN, Çiçek N, Alpay H, Kargül B. Association between serum biomarkers and oral health status in children with chronic kidney disease: A cross-sectional study. Clin Oral Investig 2023:10.1007/s00784-023-04989-1. [PMID: 37014503 DOI: 10.1007/s00784-023-04989-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 03/28/2023] [Indexed: 04/05/2023]
Abstract
OBJECTIVES The aim of this study was to investigate the association between serum biomarkers and oral health parameters in children with chronic kidney disease (CKD). MATERIALS AND METHODS Serum hemoglobin, blood urea nitrogen, serum creatinine, calcium, parathormone, magnesium, and phosphorus levels were measured in 62 children with CKD aged between 4 and 17 years. Intraoral examinations of the patients were performed by two different pediatric dentists. Dental caries was assessed using the decayed-missing-filled-teeth (DMFT/dmft) indexes, and oral hygiene was assessed using the debris (DI), calculus (CI), and simplified oral hygiene (OHI-S) indexes. Spearman's rho coefficient and generalized linear modeling were used to examine the association between serum biomarkers and oral health parameters. RESULTS The results of the study showed that there were negative and statistically significant correlations between serum hemoglobin and creatinine levels and dmft scores in pediatric patients with CKD (p = 0.021 and p = 0.019, respectively). Furthermore, blood urea nitrogen levels and DI and OHI-S scores (p = 0.047 and p = 0.050, respectively); serum creatinine levels and DI, CI, and OHI-S scores (p = 0.005, p = 0.047, p = 0.043, respectively); and parathormone levels and CI and OHI-S scores (p = 0.001 and p = 0.017, respectively) were found to be positively and statistically significantly related. CONCLUSIONS There are associations between various serum biomarker levels and dental caries and oral hygiene parameters in pediatric patients with CKD. CLINICAL RELEVANCE The impact of changes in serum biomarkers on oral and dental health is important for dentists' and medical professionals' approaches to patients' oral and systemic health.
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Affiliation(s)
- Berkant Sezer
- Department of Pediatric Dentistry, School of Dentistry, Çanakkale Onsekiz Mart University, Çanakkale, Türkiye.
| | - Nur Kodaman Dokumacıgil
- Department of Pediatric Dentistry, School of Dentistry, Marmara University, Istanbul, Türkiye
| | - Remziye Kaya
- Department of Pediatric Dentistry, School of Dentistry, Marmara University, Istanbul, Türkiye
| | - Serçin Güven
- Division of Pediatric Nephrology, Department of Pediatrics, School of Medicine, Marmara University, Istanbul, Türkiye
| | - Özde Nisa Türkkan
- Division of Pediatric Nephrology, Department of Pediatrics, School of Medicine, Marmara University, Istanbul, Türkiye
| | - Neslihan Çiçek
- Division of Pediatric Nephrology, Department of Pediatrics, School of Medicine, Marmara University, Istanbul, Türkiye
| | - Harika Alpay
- Division of Pediatric Nephrology, Department of Pediatrics, School of Medicine, Marmara University, Istanbul, Türkiye
| | - Betül Kargül
- Department of Pediatric Dentistry, School of Dentistry, Marmara University, Istanbul, Türkiye
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187
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Lapi F, Marconi E, Piccinocchi G, Cricelli I, Medea G, Cricelli C. Early identification of chronic kidney disease: it is time to enhance patient and population-based informatics tools for general practitioners. Curr Med Res Opin 2023; 39:771-774. [PMID: 37005364 DOI: 10.1080/03007995.2023.2197498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Abstract
Chronic kidney disease (CKD) is a global public health issue that can lead to several complications such as, kidney failure, cerebro/cardiovascular disease, and death.There is a well-documented "awareness gap" among general practitioners (GPs) to recognize CKD. As shown by estimates stemming from the Health Search Database (HSD) of the Italian College of General Practitioners and Primary Care (SIMG), no substantial changes were observed in terms of the incident rate of CKD over the last 10 years. Namely, 10.3 to 9.5 per 1,000 new cases of CKD were estimated in 2012 and 2021, respectively. Thus, strategies to reduce under-recognized cases are needed. Early identification of CKD might improve patient's quality of life and clinical outcomes. In this context, patient- and population-based informatic tools may support both opportunistic and systematic screening of patients at greater risk of CKD. As such, the new effective pharmacotherapies for CKD would be proficiently administered. To this aim, these two complimentary tools have been developed and will be further implemented by GPs.The effectiveness of these instruments in identifying the condition at an early stage and reducing the burden of CKD on the national health system needs to be verified according to the new regulations on medical device (MDR: (EU) 2017/745).
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Affiliation(s)
- Francesco Lapi
- Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy
| | - Ettore Marconi
- Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy
| | | | | | - Gerardo Medea
- Italian College of General Practitioners and Primary Care, Florence, Italy
| | - Claudio Cricelli
- Italian College of General Practitioners and Primary Care, Florence, Italy
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188
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Cho KH, Jang SM, Ashjian EJ. Evaluation of Curricula Content on Kidney Disease in US Doctor of Pharmacy Programs. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2023; 87:ajpe9112. [PMID: 36375847 PMCID: PMC10159022 DOI: 10.5688/ajpe9112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 07/29/2022] [Indexed: 05/03/2023]
Abstract
Objective. Although pharmacists improve outcomes in the care of patients with kidney diseases and current guidelines advocate multidisciplinary care, pharmacist nephrology training is not well described. This study seeks to characterize required and elective coursework within US Doctor of Pharmacy curricula. This information will be valuable in identification and evaluation of educational gaps for pharmacists as best practices in the education and care of kidney diseases for pharmacists are established.Methods. This prospective, cross-sectional, descriptive study assessed current practices and trends in education on kidney diseases within Doctor of Pharmacy curricula at accredited programs in the United States through an electronic survey.Results. Forty-three percent (N=61) of all ACPE-accredited pharmacy institutions were represented in the survey. Content on kidney diseases was found to be taught in both required and elective coursework, and one-third of responding institutions offered advanced pharmacy practice experiences focused on kidney diseases. Variation was found in the amount of time allotted for the teaching of kidney diseases topics in pharmacy curricula and the types of experiential training offered. Six respondents reported offering postgraduate education that focused on kidney diseases. Most respondents were clinical faculty who had completed residency training and board certification.Conclusion. Given the complex interplay between kidney diseases and other health conditions, the increasing incidence and prevalence of kidney diseases, and the potential expansion of pharmacists' roles in the care of patients with kidney diseases, a review of current Doctor of Pharmacy curricula is necessary to guide any future optimization efforts to ensure practice-ready pharmacists.
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Affiliation(s)
- Katherine H Cho
- Temple University School of Pharmacy, Philadelphia, Pennsylvania
| | - Soo Min Jang
- Loma Linda University School of Pharmacy, Loma Linda, California
| | - Emily J Ashjian
- University of Michigan College of Pharmacy, Ann Arbor, Michigan
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189
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Cai L, Shu L, Yujun Z, Ke C, Qiang W. Lack of furosemide responsiveness predict severe acute kidney injury after liver transplantation. Sci Rep 2023; 13:4978. [PMID: 36973328 PMCID: PMC10042839 DOI: 10.1038/s41598-023-31757-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 03/16/2023] [Indexed: 03/29/2023] Open
Abstract
Acute kidney injury (AKI) remains to be a common but severe complication after liver transplantation (LT). However, there are still few clinically validated biomarkers. A total of 214 patients who underwent routine furosemide (1-2 mg/kg) after LT were retrospectively included. The urine output during the first 6 h was recorded to evaluate the predictive value of AKI stage 3 and renal replacement therapy (RRT). 105 (49.07%) patients developed AKI, including 21 (9.81%) progression to AKI stage 3 and 10 (4.67%) requiring RRT. The urine output decreased with the increasing severity of AKI. The urine output of AKI stage 3 did not significantly increase after the use of furosemide. The area under the receiver operator characteristic (ROC) curves for the total urine output in the first hour to predict progression to AKI stage 3 was 0.94 (p < 0.001). The ideal cutoff for predicting AKI progression during the first hour was a urine volume of less than 200 ml with a sensitivity of 90.48% and specificity of 86.53%. The area under the ROC curves for the total urine output in the six hours to predict progression to RRT was 0.944 (p < 0.001). The ideal cutoff was a urine volume of less than 500 ml with a sensitivity of 90% and specificity of 90.91%. Severe AKI after liver transplantation seriously affects the outcome of patients. Lack of furosemide responsiveness quickly and accurately predict AKI stage 3, and patients requiring RRT after the operation.
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Affiliation(s)
- Li Cai
- Department of Transplantation, The Third Xiangya Hospital, Central South University, Changsha, China
- Engineering and Technology Research Center for Transplantation Medicine of National Health Comission, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Liu Shu
- Department of Transplantation, The Third Xiangya Hospital, Central South University, Changsha, China
- Engineering and Technology Research Center for Transplantation Medicine of National Health Comission, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Zhao Yujun
- Department of Transplantation, The Third Xiangya Hospital, Central South University, Changsha, China
- Engineering and Technology Research Center for Transplantation Medicine of National Health Comission, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Cheng Ke
- Department of Transplantation, The Third Xiangya Hospital, Central South University, Changsha, China.
- Engineering and Technology Research Center for Transplantation Medicine of National Health Comission, The Third Xiangya Hospital, Central South University, Changsha, China.
| | - Wang Qiang
- Department of Transplantation, The Third Xiangya Hospital, Central South University, Changsha, China.
- Engineering and Technology Research Center for Transplantation Medicine of National Health Comission, The Third Xiangya Hospital, Central South University, Changsha, China.
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190
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Peng Y, Li Y, Zhang W, ShangGuan Y, Xie T, Wang K, Qiu J, Pu W, Hu B, Zhang X, Yin L, Tang D, Dai Y. The characteristics of extrachromosomal circular DNA in patients with end-stage renal disease. Eur J Med Res 2023; 28:134. [PMID: 36967395 PMCID: PMC10041755 DOI: 10.1186/s40001-023-01064-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 02/15/2023] [Indexed: 03/28/2023] Open
Abstract
BACKGROUND End-stage renal disease (ESRD) is the final stage of chronic kidney disease (CKD). In addition to the structurally intact chromosome genomic DNA, there is a double-stranded circular DNA called extrachromosomal circular DNA (eccDNA), which is thought to be involved in the epigenetic regulation of human disease. However, the features of eccDNA in ESRD patients are barely known. In this study, we identified eccDNA from ESRD patients and healthy people, as well as revealed the characteristics of eccDNA in patients with ESRD. METHODS Using the high-throughput Circle-Sequencing technique, we examined the eccDNA in peripheral blood mononuclear cells (PBMCs) from healthy people (NC) (n = 12) and ESRD patients (n = 16). We analyzed the length distribution, genome elements, and motifs feature of eccDNA in ESRD patients. Then, after identifying the specific eccDNA in ESRD patients, we explored the potential functions of the target genes of the specific eccDNA. Finally, we investigated the probable hub eccDNA using algorithms. RESULTS In total, 14,431 and 11,324 eccDNAs were found in the ESRD and NC groups, respectively, with sizes ranging from 0.01 kb to 60 kb at most. Additionally, the ESRD group had a greater distribution of eccDNA on chromosomes 4, 11, 13, and 20. In two groups, we also discovered several motifs of specific eccDNAs. Furthermore, we identified 13,715 specific eccDNAs in the ESRD group and 10,585 specific eccDNAs in the NC group, both of which were largely annotated as mRNA catalog. Pathway studies using Gene Ontology (GO) and the Kyoto Encyclopedia of Genes and Genomes (KEGG) showed that the specific eccDNA in ESRD was markedly enriched in cell junction and communication pathways. Furthermore, we identified potentially 20 hub eccDNA-targeting genes from all ESRD-specific eccDNA-targeting genes. Also, we found that 39 eccDNA-targeting genes were associated with ESRD, and some of these eccDNAs may be related to the pathogenesis of ESRD. CONCLUSIONS Our findings revealed the characteristics of eccDNA in ESRD patients and discovered potentially hub and ESRD-relevant eccDNA-targeting genes, suggesting a novel probable mechanism of ESRD.
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Affiliation(s)
- Yue Peng
- Clinical Medical Research Center, Guangdong Provincial Engineering Research Center of Autoimmune Disease Precision Medicine, Shenzhen Engineering Research Center of Autoimmune Disease, The Second Clinical Medical College of Jinan University, Shenzhen People's Hospital, Jinan University, Shenzhen, China
- Institute of Nephrology and Blood Purification, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, China
| | - Yixi Li
- Clinical Medical Research Center, Guangdong Provincial Engineering Research Center of Autoimmune Disease Precision Medicine, Shenzhen Engineering Research Center of Autoimmune Disease, The Second Clinical Medical College of Jinan University, Shenzhen People's Hospital, Jinan University, Shenzhen, China
- Institute of Nephrology and Blood Purification, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, China
| | - Wei Zhang
- Clinical Medical Research Center, Guangdong Provincial Engineering Research Center of Autoimmune Disease Precision Medicine, Shenzhen Engineering Research Center of Autoimmune Disease, The Second Clinical Medical College of Jinan University, Shenzhen People's Hospital, Jinan University, Shenzhen, China
| | - Yu ShangGuan
- Clinical Medical Research Center, Guangdong Provincial Engineering Research Center of Autoimmune Disease Precision Medicine, Shenzhen Engineering Research Center of Autoimmune Disease, The Second Clinical Medical College of Jinan University, Shenzhen People's Hospital, Jinan University, Shenzhen, China
| | - Ting Xie
- Clinical Medical Research Center, Guangdong Provincial Engineering Research Center of Autoimmune Disease Precision Medicine, Shenzhen Engineering Research Center of Autoimmune Disease, The Second Clinical Medical College of Jinan University, Shenzhen People's Hospital, Jinan University, Shenzhen, China
- Institute of Nephrology and Blood Purification, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, China
| | - Kang Wang
- Key Renal Laboratory of Shenzhen, Department of Nephrology, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University, Shenzhen, 518020, Guangdong, China
| | - Jing Qiu
- Key Renal Laboratory of Shenzhen, Department of Nephrology, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University, Shenzhen, 518020, Guangdong, China
| | - Wenjun Pu
- Clinical Medical Research Center, Guangdong Provincial Engineering Research Center of Autoimmune Disease Precision Medicine, Shenzhen Engineering Research Center of Autoimmune Disease, The Second Clinical Medical College of Jinan University, Shenzhen People's Hospital, Jinan University, Shenzhen, China
| | - Biying Hu
- Institute of Nephrology and Blood Purification, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, China
| | - Xinzhou Zhang
- Key Renal Laboratory of Shenzhen, Department of Nephrology, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University, Shenzhen, 518020, Guangdong, China
| | - Lianghong Yin
- Clinical Medical Research Center, Guangdong Provincial Engineering Research Center of Autoimmune Disease Precision Medicine, Shenzhen Engineering Research Center of Autoimmune Disease, The Second Clinical Medical College of Jinan University, Shenzhen People's Hospital, Jinan University, Shenzhen, China.
- Guangzhou Enttxs Medical Products Co., Ltd. P.R. Guangzhou, Guangzhou, China.
| | - Donge Tang
- Clinical Medical Research Center, Guangdong Provincial Engineering Research Center of Autoimmune Disease Precision Medicine, Shenzhen Engineering Research Center of Autoimmune Disease, The Second Clinical Medical College of Jinan University, Shenzhen People's Hospital, Jinan University, Shenzhen, China.
| | - Yong Dai
- Clinical Medical Research Center, Guangdong Provincial Engineering Research Center of Autoimmune Disease Precision Medicine, Shenzhen Engineering Research Center of Autoimmune Disease, The Second Clinical Medical College of Jinan University, Shenzhen People's Hospital, Jinan University, Shenzhen, China.
- Department of Pathology, The 924th Hospital of the Chinese People's Liberation Army Joint Logistic Support Force, Guangxi Key Laboratory of Metabolic Diseases Research, Guilin, 541002, Guangxi, China.
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191
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Shen Y, Wu H, Liu X, Zhu J, Shao W, Wang B, Pan B, Guo W. Comparison of the 2021 and 2009 Chronic Kidney Disease Epidemiology Collaboration Creatinine equation for estimated glomerular filtration rate in a Chinese population. Clin Biochem 2023; 116:59-64. [PMID: 36940843 DOI: 10.1016/j.clinbiochem.2023.03.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 03/15/2023] [Accepted: 03/16/2023] [Indexed: 03/22/2023]
Abstract
OBJECTIVES To retrospectively compare the clinical effects of the newly released 2021 and 2009 Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations for estimated glomerular filtration rate based on creatinine (eGFRcr) in a Chinese population with a broad spectrum of clinical characteristics using historical data. DESIGN AND METHODS Patients and healthy individuals who visited the Zhongshan Hospital, Fudan University, between July 1, 2020, and July 1, 2022, were enrolled. The exclusion criteria were age < 18 years, amputees, pregnant women, patients with muscle-related diseases, and patients who had undergone ultrafiltration or dialysis. The final study population included 1,051,827 patients with a median age of 57 years; 57.24% of the enrolled individuals were men. eGFRcr was calculated using the 2009 and 2021 CKD-EPI equations and initial creatinine level. Results were evaluated statistically by sex, age, creatinine level, and CKD stage. RESULTS The 2021 equation increased the eGFRcr in all participants compared to the 2009 equation by 4.46%. The median eGFRcr deviation of the 2021 CKD-EPI equation compared to the 2009 CKD-EPI equation was 4 ml/min/1.73 m2. 903443 subjects (85.89%) had higher eGFRcr owing to the utilization of the 2021 CKD-EPI equation, which did not cause CKD stage change. A total of 11.57% of subjects (121,666) had improved CKD stage with the 2021 CKD-EPI equation. 1.79% (18,817) had the same CKD stage with both equations, and 0.75% (7,901) had lower eGFRcr but no change in the CKD stage with the 2021 equation. CONCLUSIONS The 2021 CKD-EPI equation typically produces higher eGFRcr results than the 2009 version. Applying the new equation could lead to changes in the CKD stage for some patients, which doctors should consider. .
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Affiliation(s)
- Yifeng Shen
- Department of Laboratory Medicine, Zhongshan Hospital, Fudan University, Shanghai China
| | - Hao Wu
- Department of Laboratory Medicine, Zhongshan Hospital, Fudan University, Shanghai China
| | - Xiaowen Liu
- Department of Laboratory Medicine, Zhongshan Hospital, Fudan University, Shanghai China
| | - Jing Zhu
- Department of Laboratory Medicine, Zhongshan Hospital, Fudan University, Shanghai China
| | - Wenqi Shao
- Department of Laboratory Medicine, Zhongshan Hospital, Fudan University, Shanghai China
| | - Beili Wang
- Department of Laboratory Medicine, Zhongshan Hospital, Fudan University, Shanghai China; Department of Laboratory Medicine, Xiamen Branch, Zhongshan Hospital, Fudan University, Xiamen China
| | - Baishen Pan
- Department of Laboratory Medicine, Zhongshan Hospital, Fudan University, Shanghai China; Department of Laboratory Medicine, Xiamen Branch, Zhongshan Hospital, Fudan University, Xiamen China.
| | - Wei Guo
- Department of Laboratory Medicine, Zhongshan Hospital, Fudan University, Shanghai China; Department of Laboratory Medicine, Xiamen Branch, Zhongshan Hospital, Fudan University, Xiamen China; Department of Laboratory Medicine, Wusong Branch, Zhongshan Hospital, Fudan University, Shanghai China.
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192
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Fonseca RID, Menezes LRA, Santana-Filho AP, Schiefer EM, Pecoits-Filho R, Stinghen AEM, Sassaki GL. Untargeted plasma 1H NMR-based metabolomic profiling in different stages of chronic kidney disease. J Pharm Biomed Anal 2023; 229:115339. [PMID: 36963247 DOI: 10.1016/j.jpba.2023.115339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 03/09/2023] [Accepted: 03/10/2023] [Indexed: 03/13/2023]
Abstract
Chronic kidney disease (CKD) is a serious public health issue affecting thousands of people worldwide. CKD diagnosis is usually made by Estimated Glomerular Filtration Rate (eGFR) and albuminuria, which limit the knowledge of the mechanisms behind CKD progression. The aim of the present study was to identify changes in the metabolomic profile that occur as CKD advances. In this sense, 77 plasma samples from patients with CDK were evaluated by 1D and 2D Nuclear Magnetic Resonance Spectroscopy (NMR). The NMR data showed significant changes in the metabolomic profile of CKD patients and the control group. Principal component analysis (PCA) clustered CKD and control patients into three distinct groups, control, stage 1 (G1)-stage 4 (G4) and stage 5 (G5). Lactate, glucose, acetate and creatinine were responsible for discriminating the control group from all the others CKD stages. Valine, alanine, glucose, creatinine, glutamate and lactate were responsible for the clustering of G1-G4 stages. G5 was discriminated by calcium ethylenediamine tetraacetic acid, magnesium ethylenediamine tetraacetic acid, creatinine, betaine/choline/trimethylamine N-oxide (TMAO), lactate and acetate. CKD G5 plasma pool which was submitted in MetaboAnalyst 4.0 platform (MetPA) analysis and showed 13 metabolic pathways involved in CKD physiopathology. Metabolic changes associated with glycolysis and gluconeogenesis allowed discriminating between CKD and control patients. The determination of involved molecules in TMAO generation in G5 suggests an important role in this uremic toxin linked to CKD and cardiovascular diseases. The aforementioned results propose the feasibility of metabolic assessment of CKD by NMR during treatment and disease progression.
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Affiliation(s)
| | | | | | - Elberth Manfron Schiefer
- Universidade Tecnológica Federal do Paraná, Av. Sete de Setembro, 3165, Curitiba 80230-901, Brazil
| | - Roberto Pecoits-Filho
- Center for Health and Biological Sciences, Pontifícia Universidade Católica do Paraná, Curitiba CEP 80215-901, Brazil
| | | | - Guilherme Lanzi Sassaki
- Department of Biochemistry and Molecular Biology, Universidade Federal do Paraná, Curitiba 80050-540, Brazil.
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Villasis-Keever MA, Zurita-Cruz JN, Zepeda-Martinez C, Alegria-Torres G, Serret-Montoya J, Estrada-Loza MDJ, Hernández-Hernández BC, Alonso-Flores S, Zavala-Serret M. Adipokines as predictive factor of cardiac function in pediatric patients with chronic kidney disease. Front Endocrinol (Lausanne) 2023; 14:1120445. [PMID: 36967775 PMCID: PMC10034059 DOI: 10.3389/fendo.2023.1120445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 02/24/2023] [Indexed: 03/11/2023] Open
Abstract
Background Adipokines are associated with cardiovascular disease; in chronic kidney disease (CKD) patients adipokines could be useful prognostic factors. Objectives To explore whether leptin and adiponectin in kidney replacement therapy (KRT) children could have a role on their cardiac function, in the long-term. Design Prospective cohort study was performed with pediatric KRT patients, aged 8 to 17 years who were undergoing hemodialysis or peritoneal dialysis. At enrollment, lipid profile, adipokines (leptin, leptin receptor, free leptin, and adiponectin), anthropometric measurements and cardiological evaluation were determined. At two-year follow-up, a new cardiological evaluation was performed. Statistical analysis: Quantitative data are presented as median and interquartile range (IQR). Mann-Whitney U test and Chi-squared were used for the between-group comparison. Multivariate analyzes were performed to determine the association of adipokines levels with ventricular ejection fraction (LEVF). Results We included 56 patients, with a median age of 12.5 years. In the first cardiological evaluation, median LVEF was 70.0% (IQR 61%, 76%), 20 patients (35.7%) had some cardiovascular condition, and 10 (17.8%) altered LVEF. At 24-month follow-up, the median LVEF was 70.5% (IQR 65.1%, 77%), while the delta-LVEF values was 3% (IQR -6.5%, 7%). Delta-LVEF were correlated with baseline adipokines serum levels, and the only positive correlation found was with free leptin (r=0.303, p=0.025). In multivariate analysis, levels of free leptin (Coef. 0.12, p<0.036) and leptin (coef. 1.72, p=0.049), as well as baseline LVEF (Coef. -0.65, p<0.001) were associated with delta-LVEF. Conclusions Free leptin, leptin and LVEF at the beginning of follow-up were associated with the LVEF decrease at the 24-month follow-up in KRT children.
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Affiliation(s)
- Miguel Angel Villasis-Keever
- Research Unit in Analysis and Synthesis of the Evidence, National Medical Center XXI Century, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Jessie Nallely Zurita-Cruz
- Hospital Infantil de Mexico Federico Gómez, Facultad de Medicina Universidad Nacional Autónoma de Mexico, Mexico City, Mexico
| | - Claudia Zepeda-Martinez
- Department of Pediatric Nephology, Children’s Hospital, National Medical Center XXI Century, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Gabriela Alegria-Torres
- Department of Pediatric Nephology, Children’s Hospital, National Medical Center XXI Century, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Juana Serret-Montoya
- Adolescent Medicine Service, Hospital Infantil de Mexico Federico Gómez, Ministry of Health, Secretaria de Salud (SSA), Mexico City, Mexico
| | - Maria de Jesus Estrada-Loza
- Department of Pediatric Cardiology, Children’s Hospital, National Medical Center XXI Century, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Beatriz Carolina Hernández-Hernández
- Department of Pediatric Nephology, Children’s Hospital, National Medical Center XXI Century, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Sara Alonso-Flores
- Department of Pediatric Nephology, Children’s Hospital, National Medical Center XXI Century, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Monica Zavala-Serret
- Adolescent Medicine Service, Hospital Infantil de Mexico Federico Gómez, Ministry of Health, Secretaria de Salud (SSA), Mexico City, Mexico
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194
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Worden A, Pike F, Allegretti AS, Kaur H, Peng JL, Kettler CD, Orman ES, Desai AP, Nephew LD, Ghabril MS, Patidar KR. The prognostic impact of acute kidney injury recovery patterns in critically ill patients with cirrhosis. Liver Transpl 2023; 29:246-258. [PMID: 36811876 PMCID: PMC10068809 DOI: 10.1097/lvt.0000000000000008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 10/11/2022] [Indexed: 02/24/2023]
Abstract
BACKGROUND The prognostic impact of acute kidney injury (AKI) recovery patterns in critically ill patients with cirrhosis is unknown. We aimed to compare mortality stratified by AKI recovery patterns and identify predictors of mortality in patients with cirrhosis and AKI admitted to the intensive care unit. MATERIALS AND METHODS Patients with cirrhosis and AKI from 2016 to 2018 at 2 tertiary care intensive care units were analyzed (N=322). AKI recovery was defined by Acute Disease Quality Initiative consensus: return of serum creatinine <0.3 mg/dL of baseline within 7 days of AKI onset. Recovery patterns were categorized by Acute Disease Quality Initiative consensus: 0-2 days, 3-7 days, and no-recovery (persistence of AKI >7 d). Landmark competing risk univariable and multivariable models (liver transplant as competing risk) was used to compare 90-day mortality between AKI recovery groups and to determine independent predictors of mortality. RESULTS Sixteen percent (N=50) and 27% (N=88) achieved AKI recovery within 0-2 and 3-7 days, respectively; 57% (N=184) had no-recovery. Acute on chronic liver failure was prevalent (83%) and patients with no-recovery were more likely to have grade 3 acute on chronic liver failure (N=95, 52%) compared to patients with AKI recovery [0-2: 16% (N=8); 3-7: 26% (N=23); p<0.001]. Patients with no-recovery had significantly higher probability of mortality [unadjusted-sub-HR (sHR): 3.55; 95% CI: 1.94-6.49; p<0.001] compared to patients with recovery within 0-2 days, while the probability was similar between 3-7 and 0-2 days (unadjusted-sub-HR: 1.71; 95% CI: 0.91-3.20; p=0.09). On multivariable analysis, AKI no-recovery (sub-HR: 2.07; 95% CI: 1.33-3.24; p=0.001), severe alcohol-associated hepatitis (sub-HR: 2.41; 95% CI: 1.20-4.83; p=0.01), and ascites (sub-HR: 1.60; 95% CI: 1.05-2.44; p=0.03) were independently associated with mortality. CONCLUSION AKI no-recovery occurs in over half of critically ill patients with cirrhosis and AKI and is associated with worse survival. Interventions that facilitate AKI recovery may improve outcomes in this patient population.
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Affiliation(s)
- Astin Worden
- Division of Internal Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Francis Pike
- Department of Biostatistics, Indiana University, Indianapolis, Indiana, USA
| | - Andrew S. Allegretti
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Harleen Kaur
- Division of Internal Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Jennifer L. Peng
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Carla D. Kettler
- Department of Biostatistics, Indiana University, Indianapolis, Indiana, USA
| | - Eric S. Orman
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Archita P. Desai
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Lauren D. Nephew
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Marwan S. Ghabril
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Kavish R. Patidar
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
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195
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Prescription Rates and Prognostic Implications of Optimally Targeted Guideline-Directed Medical Treatment in Heart Failure and Atrial Fibrillation: Insights From The MISOAC-AF Trial. J Cardiovasc Pharmacol 2023; 81:203-211. [PMID: 36626410 DOI: 10.1097/fjc.0000000000001390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 10/22/2022] [Indexed: 01/07/2023]
Abstract
ABSTRACT Heart failure (HF) and atrial fibrillation (AF) commonly coexist in real-life clinical practice. Among patients with HF with reduced ejection fraction (HFrEF) or HF with mildly reduced ejection fraction (HFmrEF), guidelines call for evidence-based target doses of renin-angiotensin-aldosterone system inhibitors and beta-blockers. However, target doses of guideline-directed medical treatment (GDMT) are often underused in real-world conditions, including HF-AF comorbidity. This retrospective cohort study of a randomized trial (Motivational Interviewing to Support Oral AntiCoagulation adherence in patients with nonvalvular AF) included hospitalized patients with AF and HFrEF or HFmrEF. Optimally targeted GDMT was defined as intake of evidence-based target doses of renin-angiotensin-aldosterone system and beta-blockers at 3 months after discharge. Rates of optimally targeted GDMT achievement across the baseline estimated glomerular filtration rate (eGFR) were assessed. Independent predictors of nontargeted GDMT and its association with all-cause mortality and the composite of cardiovascular death or HF hospitalization were assessed by regression analyses. In total, 374 patients with AF and HFrEF or HFmrEF were studied. At 3 months after discharge, 30.7% received target doses of GDMT medications. The rate of optimally targeted GDMT was reduced by 11% for every 10 mg/min/1.73 m 2 decrease in baseline eGFR [adjusted β = 0.99; 95% confidence interval (CI), 0.98-0.99] levels. After a median 31-month follow-up period, 37.8% patients in the optimally targeted GDMT group died, as compared with 67.8% (adjusted hazard ratio: 1.49; 95% CI, 1.05-2.13) in the nontargeted GDMT group. The risk of cardiovascular death or HF hospitalization was also higher in these patients (adjusted hazard ratio: 1.60; 95% CI, 1.17-2.20). Target doses of all HF drugs were reached in roughly one-third of patients with AF and HFrEF or HFmrEF 3 months after hospital discharge. Nontargeted GDMT was more frequent across lower eGFR levels and was associated with worse outcomes.
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196
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Gottlieb ER, Estiverne C, Tolan NV, Melanson SEF, Mendu ML. Estimated GFR With Cystatin C and Creatinine in Clinical Practice: A Retrospective Cohort Study. Kidney Med 2023; 5:100600. [PMID: 36879723 PMCID: PMC9984886 DOI: 10.1016/j.xkme.2023.100600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Rationale & Objective Estimation of glomerular filtration rate (eGFR) and staging of chronic kidney disease (CKD) are essential to guide management. Although creatinine is routinely used, a recent national task force recommended the use of cystatin C for confirmation. The objective of this study was to examine the following parameters: (1) how cystatin C correlates with creatinine eGFR; (2) how it indicates differences in CKD staging; and (3) how it may affect kidney care delivery. Study Design Retrospective observational cohort study. Setting & Participants 1,783 inpatients and outpatients who had cystatin C and creatinine levels drawn within 24 hours at Brigham Health-affiliated clinical laboratories. Predictors Serum creatinine levels, basic clinical/sociodemographic variables, and reasons for ordering cystatin C from a structured partial chart review. Analytical Approach Univariate and multivariable linear and logistic regression. Results Cystatin C-based eGFR was very strongly correlated with creatinine-based eGFR (Spearman correlation ρ = 0.83). Cystatin C eGFR resulted in a change to a later CKD stage in 27%, an earlier stage in 7%, and no change in 66% of patients. Black race was associated with a lower likelihood of change to a later stage (OR, 0.53; 95% CI [0.36, 0.75]; P < 0.001), whereas age (OR per year OR, 1.03; 95% CI [1.02, 1.04]; P < 0.001) and Elixhauser score (OR per point OR, 1.22; 95% CI [1.10, 1.36]; P < 0.001) were associated with a higher likelihood of change to a later stage. Limitations Single center, no direct measurement of clearance for comparison, and inconsistent self-identification of race/ethnicity. Conclusions Cystatin C eGFR correlates strongly with creatinine eGFR but can have a substantial effect on CKD staging. As cystatin C is adopted, clinicians must be informed on this impact.
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Affiliation(s)
- Eric Raphael Gottlieb
- Department of Medicine, Mount Auburn Hospital, Cambridge, Massachusetts.,Harvard Medical School, Boston, Massachusetts.,Laboratory for Computational Physiology, Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - Christopher Estiverne
- Harvard Medical School, Boston, Massachusetts.,Division of Renal Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Nicole V Tolan
- Harvard Medical School, Boston, Massachusetts.,Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Stacy E F Melanson
- Harvard Medical School, Boston, Massachusetts.,Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Mallika L Mendu
- Harvard Medical School, Boston, Massachusetts.,Division of Renal Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
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197
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Harty T, O'Shaughnessy M, Harney S. Therapeutics in rheumatology and the kidney. Rheumatology (Oxford) 2023; 62:1009-1020. [PMID: 35951751 DOI: 10.1093/rheumatology/keac460] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 07/08/2022] [Accepted: 08/05/2022] [Indexed: 11/13/2022] Open
Abstract
The field of rheumatology has advanced significantly in recent years to provide rheumatologists with an extensive array of medications to combat rheumatic joint conditions. In contrast to an older era, when NSAIDs and other nephrotoxic agents were the mainstay of treatment, modern DMARDs vary considerably in their nephrotoxic potential and their use is not always precluded in populations with pre-existing chronic kidney disease (CKD). This review will explore in detail the safety and efficacy profiles of medications used to treat rheumatologic disease, specifically in the setting of CKD. Specifically, we discuss both traditional agents used, i.e. NSAIDs, CSs and conventional synthetic DMARDs, as well as novel biologic DMARDs and targeted synthetic DMARDs. Anti-gout prescribing in CKD is also reviewed. We aim to provide practical guidance to rheumatologists, nephrologists and general physicians when prescribing these medications in the setting of CKD.
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Affiliation(s)
| | | | - Sinead Harney
- School of Medicine, University College Cork.,Department of Rheumatology, Cork University Hospital, Cork, Ireland
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198
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Pham NYT, Owen JG, Singh N, Shaffi SK. The Use of Thiazide Diuretics for the Treatment of Hypertension in Patients With Advanced Chronic Kidney Disease. Cardiol Rev 2023; 31:99-107. [PMID: 34224450 DOI: 10.1097/crd.0000000000000404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The use of thiazide diuretics for the treatment of hypertension in patients with advance chronic kidney disease. Thiazides have been recommended as the first-line for the treatment of hypertension, yet their use has been discouraged in advanced chronic kidney disease (CKD), as they are suggested to be ineffective in advanced CKD. Recent data suggest that thiazide diuretics may be beneficial blood pressure control in addition to natriuresis in existing CKD. This review discusses the commercially available thiazides with a focus on thiazide pharmacology, most common adverse effects, clinical uses of thiazide diuretic, and the evidence for efficacy of thiazide use in advanced CKD.
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Affiliation(s)
- Ngoc-Yen T Pham
- From the University of New Mexico Hospitals, Albuquerque, NM
| | - Jonathan G Owen
- University of New Mexico Health Sciences Center, Albuquerque, NM
| | - Namita Singh
- University of New Mexico Health Sciences Center, Albuquerque, NM
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199
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Lee O, Kim MJ, Lee JE, Hwang NY, Kim K, Lee KW, Park JB. The Protective Role of Protocol Biopsy for Allograft Kidney Maintenance in Kidney Transplantation. Transplant Proc 2023:S0041-1345(23)00095-7. [PMID: 36990887 DOI: 10.1016/j.transproceed.2023.01.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 01/04/2023] [Indexed: 03/29/2023]
Abstract
Many studies have reported that protocol biopsy (PB) may help preserve kidney function in kidney transplant recipients. Early detection and treatment of subclinical rejection may reduce the incidence of chronic antibody-mediated rejection and graft failure. However, no consensus has been reached regarding PB effectiveness, timing, and policy. This study aimed to evaluate the protective role of routine PB performed 2 weeks and 1 year after kidney transplantation. We reviewed 854 kidney transplant recipients at the Samsung Medical Center between July 2007 and August 2017, with PBs planned at 2 weeks and 1 year after transplantation. We compared the trends in graft function, chronic kidney disease (CKD) progression, new-onset CKD, infection, and patient and graft survival between the 504 patients who underwent PB and 350 who did not undergo PB. The PB group was again divided into 2 groups: the single PB group (n = 207) and the double PB group (n = 297). The PB group was significantly different from the no-PB group in terms of the trends in graft function (estimated glomerular filtration rate). The Kaplan-Meier curve showed that PB did not significantly improve graft or overall patient survival. However, in the multivariate Cox analysis, the double PB group had advantages in graft survival, CKD progression, and new-onset CKD. PB can play a protective role in the maintenance of kidney grafts in kidney transplant recipients.
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200
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Nguyen HD. Effects of mixed heavy metals on kidney function in premenopausal and postmenopausal women. Menopause 2023; 30:296-305. [PMID: 36728565 DOI: 10.1097/gme.0000000000002131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To evaluate the relationships between heavy metals (cadmium, lead, and mercury) and their mixtures and estimated glomerular filtration rate (eGFR) in premenopausal and postmenopausal women. METHODS Using data from the Korean National Health and Nutrition Examination Survey (2009-2017), multivariate linear regression models, marginal effects, and weighted quantile sum regression, we assessed the associations between single heavy metals and their mixtures and eGFR among 5,372 women. RESULTS Risks of reduced eGFR, comorbidities, and heavy metal exposure were found to be higher in postmenopausal women than in premenopausal women. A negative association of cadmium ( β = -2.97; 95% CI, -5.10 to -0.85) and a positive association of mercury ( β = 2.97; 95% CI, 1.49 to 4.44), with eGFR in postmenopausal women. Inverse associations of lead with eGFR in both premenopausal women ( β = -4.75; 95% CI, -6.04 to -3.46) and postmenopausal women ( β = -4.54; 95% CI, -6.96 to -2.13). Interactions were identified between lead and mercury, as well as cadmium and lead for eGFR among premenopausal women ( β = -2.04; 95% CI, -2.98 to -1.10) and postmenopausal women ( β = -3.52; 95% CI, -6.04 to -1.01), respectively. There was a negative association between mixed heavy metals and eGFR in both premenopausal women ( β = -2.23; 95% CI, -3.51 to -0.96) and postmenopausal women ( β = -3.86; 95% CI, -6.89 to -0.83). Lead was found as a key chemical related to reduced eGFR. Cutoff values for each heavy metal concentration related to eGFR were provided. CONCLUSION Postmenopausal women were more influenced by mixed heavy metals' effects on kidney function than premenopausal women. Early interventions (eg, water filtering, heavy metal yearly screening) in women, especially postmenopausal women, are needed to reduce the incidence of chronic kidney disease.
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Affiliation(s)
- Hai Duc Nguyen
- From the Department of Pharmacy, College of Pharmacy and Research Institute of Life and Pharmaceutical Sciences, Sunchon National University, Sunchon, Jeonnam, Republic of Korea
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