4551
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Kute VB, Patel HV, Shah PR, Modi PR, Shah VR, Rizvi SJ, Pal BC, Shah PS, Wakhare PS, Shinde SG, Ghodela VA, Varyani UT, Patel MH, Trivedi VB, Trivedi HL. International kidney paired donation transplantations to increase kidney transplant of O group and highly sensitized patient: First report from India. World J Transplant 2017; 7:64-69. [PMID: 28280697 PMCID: PMC5324030 DOI: 10.5500/wjt.v7.i1.64] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 11/16/2016] [Accepted: 12/09/2016] [Indexed: 02/05/2023] Open
Abstract
AIM To report the first international living related two way kidney paired donation (KPD) transplantation from India which occurred on 17th February 2015 after legal permission from authorization committee.
METHODS Donor recipient pairs were from Portugal and India who were highly sensitized and ABO incompatible with their spouse respectively. The two donor recipient pairs had negative lymphocyte cross-matching, flow cross-match and donor specific antibody in two way kidney exchange with the intended KPD donor. Local KPD options were fully explored for Indian patient prior to embarking on international KPD.
RESULTS Both pairs underwent simultaneous uneventful kidney transplant surgeries and creatinine was 1 mg/dL on tacrolimus based immunosuppression at 11 mo follow up. The uniqueness of these transplantations was that they are first international KPD transplantations in our center.
CONCLUSION International KPD will increases quality and quantity of living donor kidney transplantation. This could be an important step to solving the kidney shortage with additional benefit of reduced costs, improved quality and increased access for difficult to match incompatible pairs like O blood group patient with non-O donor and sensitized patient. To the best of our knowledge this is first international KPD transplantation from India.
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4552
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Dou Y, Sun X, Liu D, Zhang L, Xiao J, Cheng G, Yu D, Zhao Z. Accuracy of glomerular filtration rate equations for chronic kidney disease patients at the G3a stage: a single-center cross-sectional study. BMC Res Notes 2017; 10:107. [PMID: 28235417 PMCID: PMC5399329 DOI: 10.1186/s13104-017-2400-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 01/24/2017] [Indexed: 11/13/2022] Open
Abstract
Background Kidney disease improving global outcomes provided a new classification for chronic kidney disease (CKD) by subdividing the G3 stage into G3a and G3b stages based on glomerular filtration rate (GFR) in 2012. Currently, a few methods are used to evaluate GFR, including measured GFR (mGFR) and estimated GFR (eGFR). One of the mGFR was 99mTc-DTPA scintigraphy method and eGFR using GFR equations were used clinically. Equations were modification of diet in renal disease (MDRD), chronic kidney disease epidemiology collaboration (CKD-EPI), and Chinese adapted MDRD (C-MDRD). This study assessed the accuracy of three different equations for estimated glomerular filtration rate (eGFR) with mGFR using DTPA scintigraphy method as the standard in a population of Chinese chronic kidney disease patients at the G3a stage. Results One hundred and twenty-two patients (age 52.0 ± 15.6 years, 69 were male) were determined as CKD stage 3 based on mGFR. Patients were divided into G3a (47 patients) and G3b (75 patients) subgroups. Bias between eGFR for CKD-EPI and reference mGFR was 0.92 mL/min and 95% limits of agreement was −38.82 to 40.67 mL/min. Bias between eGFR for C-MDRD and mGFR was 3.76 and 95% limits of agreement was −39.32 to 46.85 mL/min. Bias between eGFR for MDRD and mGFR was 3.53 and 95% limits of agreement was −43.35 to 50.4 mL/min. The CKD-EPI equation showed better diagnostic value with a greater area under the receiver operating characteristic curve (AUC: 0.763). AUC for MDRD and C-MDRD were 0.75 and 0.757, respectively. Conclusions There were no obvious advantages in accuracy, sensitivity, and specificity for the diagnosis of patients at the G3a stage using the CKD-EPI equation. Electronic supplementary material The online version of this article (doi:10.1186/s13104-017-2400-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yanna Dou
- The Nephrology Center of the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Zhengzhou University Institute of Nephrology, Zhengzhou, China
| | - Xiran Sun
- The Nephrology Center of the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Zhengzhou University Institute of Nephrology, Zhengzhou, China
| | - Dong Liu
- The Nephrology Center of the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Zhengzhou University Institute of Nephrology, Zhengzhou, China
| | - Li Zhang
- The Nephrology Center of the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Zhengzhou University Institute of Nephrology, Zhengzhou, China
| | - Jing Xiao
- The Nephrology Center of the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Zhengzhou University Institute of Nephrology, Zhengzhou, China
| | - Genyang Cheng
- The Nephrology Center of the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Zhengzhou University Institute of Nephrology, Zhengzhou, China
| | - Dahai Yu
- The Nephrology Center of the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Zhengzhou University Institute of Nephrology, Zhengzhou, China.,Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele, ST5 5BG, UK
| | - Zhanzheng Zhao
- The Nephrology Center of the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China. .,Zhengzhou University Institute of Nephrology, Zhengzhou, China.
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4553
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Fan H, Yang J, Liu L, Qiao Y, Wang M, Qiu L, Shi H, Xi H, Wang Y. Effect of serum albumin on the prognosis of elderly patients with stage 3-4 chronic kidney disease. Int Urol Nephrol 2017; 49:859-865. [PMID: 28224265 DOI: 10.1007/s11255-017-1542-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 02/09/2017] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To investigate the influence of serum albumin on the prognosis of elderly patients with stage 3-4 chronic kidney disease (CKD). METHODS From July 2013 to November 2015, elderly CKD patients (≥60 years), with eGFR ≥15 mL/min/1.73 m2 and <60 mL/min/1.73 m2, with CKD stage 3-4 in the geriatric nephrology clinic were enrolled. General information and underlying diseases were recorded. Laboratory indices were evaluated. Composite endpoint events (CEE) including renal endpoint events, cardiocerebral vascular endpoint events, and death were elucidated. Based on the ROC curves, the patients were divided into lower and higher serum albumin groups (<42.5 and ≥42.5 g/L). RESULTS The occurrence of CEEs was significantly higher in lower serum albumin group than those in the higher group. Also, the patients in the higher group were significantly younger with lower urinary protein, blood urea, brain natriuretic peptide, and cystatin C than those in the lower serum albumin group. Contrastingly, hemoglobin, total serum protein, serum calcium, and superoxide dismutase were remarkably higher. The composite endpoints of multifactor logistic regression analysis indicated that as the serum albumin is increased by every 1 g/L, the probability of CEEs would reduce 14.8%, and the risk occurrence rate of the lower serum albumin group was 4.739 fold than the higher group. CONCLUSION The results suggest that patients with higher serum albumin had a better prognosis than those with lower serum albumin. The low level was an independent risk factor influencing the prognosis of elderly patients in stage 3-4 CKD.
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Affiliation(s)
- Hongru Fan
- Department of Geriatric Medicine, Beijing Hospital, National Center of Gerontology, Beijing, People's Republic of China
| | - Jihong Yang
- Department of Geriatric Medicine, Beijing Hospital, National Center of Gerontology, Beijing, People's Republic of China.
| | - Lili Liu
- Department of Geriatric Medicine, Beijing Hospital, National Center of Gerontology, Beijing, People's Republic of China
| | - Yu Qiao
- Department of Geriatric Medicine, Beijing Hospital, National Center of Gerontology, Beijing, People's Republic of China
| | - Meng Wang
- Department of Geriatric Medicine, Beijing Hospital, National Center of Gerontology, Beijing, People's Republic of China
| | - Lei Qiu
- Department of Geriatric Medicine, Beijing Hospital, National Center of Gerontology, Beijing, People's Republic of China
| | - Hong Shi
- Department of Geriatric Medicine, Beijing Hospital, National Center of Gerontology, Beijing, People's Republic of China
| | - Huan Xi
- Department of Geriatric Medicine, Beijing Hospital, National Center of Gerontology, Beijing, People's Republic of China
| | - Yao Wang
- Department of Geriatric Medicine, Beijing Hospital, National Center of Gerontology, Beijing, People's Republic of China
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4554
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Zhang GM, Guo XX, Zhang GM. Limiting the testing of urea: Urea along with every plasma creatinine test? J Clin Lab Anal 2017; 31. [PMID: 28217923 DOI: 10.1002/jcla.22103] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 11/01/2016] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND We found that it is not necessary to simultaneously detect both creatinine (CREA) and urea until the concentration of CREA is lower than the certain level. To reduce urea testing, we suggest measuring urea only when CREA or estimated glomerular filtration rate (eGFR) exceeds a predetermined limit. MATERIALS AND METHODS CREA and urea data were analyzed consisting of almost all of people age above 65 years old check-up (n=95441) in Shuyang countryside, and inpatients (n=101631), outpatients (n=18474) and Routine Health Check-up (n=20509) in Shuyang People's Hospital. The proportions of elevated urea were derived. The data used in this study was generated from people more than 13 years old in both outpatients and inpatients. RESULTS When the limits for initiating urea testing were used at 85 μmol/L CREA and 120 mL/min/1.73 m2 eGFR, the percentage of unnecessary urea test are 94.5% and 64.7% (elderly health check-up), 67.9% and 84.5% (outpatients), 88.5% and 73.2% (inpatients), 92.2% and 81.7% (routine health check-up). The missing rate of urea are 1%, 2.5%, 4.6% and 9.2%, 0.1%, 0.4%, 0.9% and 1.8%, 0.4%, 0.8%, 1.4%, and 2.5%, 0.05%, 0.1%, 1.1%, and 0.8% of ureas exceeding 9.28 mmol/L and 8.3 mmol/L in above each group, respectively. If the CREA≤85 μmol/L or eGFR≥90 mL/min/1.73 m2 , there is 97.5% urea <10.1 mmol/L, the proportion of elevated urea missed is 2.5%. CONCLUSIONS We suggest that the initiating urea testing should be based on the upper limit of Reference Intervals serum CREA of females or a 120 mL/min/1.73 m2 eGFR limit. Conservatively, the urea testing would be reduced by 65% at least.
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Affiliation(s)
| | - Xu-Xiao Guo
- Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
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4555
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Lu Y, Zhu M, Bai B, Chi C, Yu S, Teliewubai J, Xu H, Wang K, Xiong J, Zhou Y, Ji H, Fan X, Yu X, Li J, Blacher J, Zhang Y, Xu Y. Comparison of Carotid-Femoral and Brachial-Ankle Pulse-Wave Velocity in Association With Target Organ Damage in the Community-Dwelling Elderly Chinese: The Northern Shanghai Study. J Am Heart Assoc 2017; 6:JAHA.116.004168. [PMID: 28219916 PMCID: PMC5523744 DOI: 10.1161/jaha.116.004168] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background Carotid‐femoral pulse‐wave velocity (cf‐PWV) and brachial‐ankle PWV (ba‐PWV) are the 2 most frequently applied PWV measurements. However, little is known about the comparison of hypertensive target organ damage (TOD) with cf‐PWV and ba‐PWV. Methods and Results A total of 1599 community‐dwelling elderly subjects (age >65 years) in northern Shanghai were recruited from June 2014 to August 2015. Both cf‐PWV and ba‐PWV were measured using SphygmoCor and VP1000 systems, respectively. Within the framework of comprehensive cardiovascular examinations, risk factors were assessed, and asymptomatic TOD, including left ventricular mass index, peak transmitral pulsed Doppler velocity/early diastolic tissue Doppler velocity (E/Ea), carotid intima‐media thickness, arterial plaque, creatinine clearance rate, and urinary albumin‐creatinine ratio were all evaluated. Both PWVs were significantly associated with male sex, age, waist/hip circumference, fasting plasma glucose, and systolic blood pressure, and ba‐PWV was also significantly related to body mass index. Both PWVs were significantly correlated with most TOD. When cf‐PWV and ba‐PWV were both or separately put into the stepwise linear regression model together with cardiovascular risk factors and treatment, only cf‐PWV, but not ba‐PWV, was significantly associated with carotid intima‐media thickness and creatinine clearance rate (P<0.05). When cf‐PWV and ba‐PWV were both or separately put into the same full‐mode model after adjustment for confounders, only cf‐PWV, but not ba‐PWV, showed significant association with carotid intima‐media thickness and creatinine clearance rate (P<0.05). Similar results were observed in logistic regression analysis. Conclusions Taken together, in the community‐dwelling elderly Chinese, cf‐PWV seems to be more closely associated with hypertensive TOD, especially vascular and renal TOD, as compared with ba‐PWV. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT02368938.
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Affiliation(s)
- Yuyan Lu
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Mengyun Zhu
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Bin Bai
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Chen Chi
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Shikai Yu
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jiadela Teliewubai
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Henry Xu
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Kai Wang
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jing Xiong
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yiwu Zhou
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Hongwei Ji
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Ximin Fan
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xuejing Yu
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jue Li
- Department of Prevention, Tongji University School of Medicine, Shanghai, China.,Key Laboratory of Arrhythmias, Ministry of Education, Tongji University School of Medicine, Shanghai, China
| | - Jacques Blacher
- Diagnosis and Therapeutic Center, Hôtel-Dieu, AP-HP, Paris Descartes University, Paris, France
| | - Yi Zhang
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yawei Xu
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
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4556
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Ashuntantang G, Osafo C, Olowu WA, Arogundade F, Niang A, Porter J, Naicker S, Luyckx VA. Outcomes in adults and children with end-stage kidney disease requiring dialysis in sub-Saharan Africa: a systematic review. Lancet Glob Health 2017; 5:e408-e417. [PMID: 28229924 DOI: 10.1016/s2214-109x(17)30057-8] [Citation(s) in RCA: 105] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Revised: 12/02/2016] [Accepted: 12/16/2016] [Indexed: 12/23/2022]
Abstract
BACKGROUND The burden of end-stage kidney disease (ESKD) in sub-Saharan Africa is unknown but is probably high. Access to dialysis for ESKD is limited by insufficient infrastructure and catastrophic out-of-pocket costs. Most patients remain undiagnosed, untreated, and die. We did a systematic literature review to assess outcomes of patients who reach dialysis and the quality of dialysis received. METHODS We searched PubMed, African Journals Online, WHO Global Health Library, and Web of Science for articles in English or French from sub-Saharan Africa reporting dialysis outcomes in patients with ESKD published between Jan 1, 1990, and Dec 22, 2015. No studies were excluded to best represent the current situation in sub-Saharan Africa. Outcomes of interest included access to dialysis, mortality, duration of dialysis, and markers of dialysis quality in patients with ESKD. Data were analysed descriptively and reported using narrative synthesis. FINDINGS Studies were all of medium to low quality. We identified 4339 studies, 68 of which met inclusion criteria, comprising 24 456 adults and 809 children. In the pooled analysis, 390 (96%) of 406 adults and 133 (95%) of 140 children who could not access dialysis died or were presumed to have died. Among those dialysed, 2747 (88%) of 3122 adults in incident ESKD cohorts, 496 (16%) of 3197 adults in prevalent ESKD cohorts, and 107 (36%) of 294 children with ESKD died or were presumed to have died. 2508 (84%) of 2990 adults in incident ESKD cohorts discontinued dialysis compared with 64 (5%) of 1364 adults in prevalent ESKD cohorts. 41 (1%) of 4483 adults in incident ESKD cohorts, 2280 (19%) of 12 125 adults in prevalent ESKD cohorts, and 71 (19%) of 381 children with ESKD received transplants. 16 studies reported on management of anaemia, 17 on dialysis frequency, eight on dialysis accuracy, and 22 on vascular access for dialysis INTERPRETATION: Most patients with ESKD starting dialysis in sub-Saharan Africa discontinue treatment and die. Further work is needed to develop equitable and sustainable strategies to manage individuals with ESKD in sub-Saharan Africa. FUNDING None.
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Affiliation(s)
- Gloria Ashuntantang
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
| | - Charlotte Osafo
- Department of Medicine and Therapeutics, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Wasiu A Olowu
- Paediatric Nephrology and Hypertension Unit, Department of Paediatrics, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, State of Osun, Nigeria
| | - Fatiu Arogundade
- Renal Unit, Department of Medicine, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, State of Osun, Nigeria
| | - Abdou Niang
- Internal Medicine-Nephrology, Cheikh Anta Diop University, Dakar, Senegal
| | - John Porter
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Saraladevi Naicker
- Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Valerie A Luyckx
- Institute of Biomedical Ethics, University of Zurich, Zurich, Switzerland.
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4557
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Tang Q, Yang B, Fan F, Li P, Yang L, Guo Y. Effects of individualized exercise program on physical function, psychological dimensions, and health-related quality of life in patients with chronic kidney disease: A randomized controlled trial in China. Int J Nurs Pract 2017; 23. [PMID: 28217935 DOI: 10.1111/ijn.12519] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 10/23/2016] [Accepted: 12/03/2016] [Indexed: 12/27/2022]
Abstract
The aim of this study was to examine the effects of a 12-week home-based exercise program on physical function, psychological dimensions, and health-related quality of life for patients with chronic kidney disease. Ninety eligible patients were enrolled and randomly separated into the exercise group and the control group from November 2015 to May 2016. The exercise group received an individualized exercise program while the control group received only usual care and continued primary lifestyle. Physical function was measured using 6-minute walk test and 10 repetitions of the sit-to-stand test while psychological dimensions were assessed by the Hospital Anxiety and Depression scale and the Self-Efficacy for Exercise scale. Quality of life was evaluated by a disease-specific instrument, the Kidney Disease Quality of Life scale. The differences between the exercise group and the control group were statistically significant for 6-minute walk distance, the time to complete 10 repetitions of the sit-to-stand test, self-efficacy for exercise, anxiety and depression, and all domains of health-related quality of life after a 12-week exercise. This study suggests that home-based individualized exercise program is an effective and feasible way of improving physical function, psychological stress, and health-related quality of life for early stage of chronic kidney disease patients.
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Affiliation(s)
- Qing Tang
- School of Nursing, Nantong University, Nantong, China
| | - Bin Yang
- Department of Infection, Immunity & Inflammation, University of Leicester, Leicester, UK.,College of Medicine, Biological Sciences and Psychology, University of Leicester, Leicester, UK
| | - Fengyan Fan
- Department of Nephrology, Nantong University Affiliated Hospital, Nantong, China
| | - Ping Li
- School of Nursing, Nantong University, Nantong, China
| | - Lei Yang
- School of Nursing, Nantong University, Nantong, China
| | - Yujie Guo
- School of Nursing, Nantong University, Nantong, China
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4558
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Sun YP, Yang WJ, Li SH, Han YY, Liu J. Clinical Epidemiology of Mineral Bone Disorder Markers in Prevalent Hemodialysis Patients in the Xinjiang Uyghur Autonomous Region in China. Biomed Res Int 2017; 2017:2516934. [PMID: 28299319 DOI: 10.1155/2017/2516934] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 01/06/2017] [Accepted: 01/18/2017] [Indexed: 01/18/2023]
Abstract
We investigated the clinical epidemiology of mineral bone disorder markers in prevalent hemodialysis (HD) patients in Xinjiang, the largest province in China. Data were obtained from 59 hospitals. A total of 3725 patients tracked from January 1 to December 31, 2014, were enrolled. Serum calcium (Ca) levels, phosphorus (P) levels, and intact parathyroid hormone (iPTH) levels were analyzed. Serum Ca levels were lower compared to the International Dialysis Outcomes and Practice Patterns Study (DOPPS4) and the Chinese DOPPS. The hypercalcemia rate was similar to DOPPS4 and lower than in the Chinese DOPPS. Serum P levels were higher than in DOPPS4 and lower than those in the Chinese DOPPS. Hyperphosphatemia rates were higher than DOPPS4 and lower than Chinese DOPPS. Serum iPTH levels were higher than in DOPPS4 and the Chinese DOPPS. We demonstrated higher serum P and iPTH levels in Xinjiang HD patients than in the DOPPS4 and Chinese DOPPS. In contrast, serum Ca levels were lower than the other two studies. High hypocalcemia and hyperphosphatemia rates may suggest that HD services in Xinjiang are inadequate. A multidiscipline chronic kidney disease (CKD) care program needs to be established to improve chronic kidney disease-mineral and bone disorder (CKD-MBD) target achievement in Xinjiang.
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4559
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Bello AK, Qarni B, Samimi A, Okel J, Chatterley T, Okpechi IG, Vandermeer B, Braam B. Effectiveness of Multifaceted Care Approach on Adverse Clinical Outcomes in Nondiabetic CKD: A Systematic Review and Meta-analysis. Kidney Int Rep 2017; 2:617-625. [PMID: 29142980 PMCID: PMC5678655 DOI: 10.1016/j.ekir.2017.02.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 01/22/2017] [Accepted: 02/09/2017] [Indexed: 01/28/2023] Open
Abstract
Introduction The risk of major adverse events associated with chronic kidney disease (CKD) could potentially be reduced with effective medical interventions. The impact of multifaceted interventions as compared with usual care in patients with nondiabetic CKD is unclear. We performed a systematic review to analyze the impact of multifaceted interventions on reducing the risk of major adverse events in this population. Methods Systematic review and meta-analysis. We searched MEDLINE, EMBASE, CINAHL and the Cochrane Library databases for medical literature published up to November 2016. Published original studies and abstracts were reviewed that reported on adult patients in a community or specialty care setting, with 2 or more CKD risk factors, treated with a combination of more than 2 interventions. We included randomized controlled trials, observational studies, and systematic reviews. Studies focused on diabetic patients were excluded. The intervention was defined as a treatment with a combination of 2 or more interventions compared with the usual care. The outcomes were defined as a reduction in the risk of adverse clinical outcomes (renal replacement therapy, all-cause hospitalizations, all-cause and cardiovascular mortality, cardiovascular events) as primary outcomes. Secondary outcomes were optimal risk factor control (attaining guideline concordant blood pressure, reduction of proteinuria, smoking cessation). Results Five of the 5846 unique citations from our initial literature search met our study criteria. All identified studies reported on patients with CKD and their management. In comparison with usual care, multifaceted interventions tended to reduce all-cause mortality (risk ratio: 0.81, 95% confidence interval: 0.63–1.03) and were associated with a lower risk of progression to kidney failure requiring dialysis (risk ratio: 0.57, 95% confidence interval: 0.35–0.94). Multifaceted interventions were not associated with reducing risk of all-cause hospitalizations (risk ratio: 0.93, 95% confidence interval: 0.71–1.23) or improved blood pressure control (mean difference: −0.48, range: −2.5 to 1.55 mm Hg). Discussion Multifaceted interventions targeting multiple risk factors tended to reduce the risk of all-cause mortality and reduced the risk to progress to end-stage kidney failure in patients with CKD. There is a need for high-quality studies that can rigorously evaluate a set of interventions targeting multiple domains of CKD management in the population with nondiabetic CKD due to paucity of data in the current published literature.
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Affiliation(s)
- Aminu K. Bello
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Canada
- Correspondence: Aminu K. Bello, Division of Nephrology and Immunology, Department of Medicine, University of Alberta, 11-107 CSB, Edmonton, Alberta T6G2B7, Canada.Division of Nephrology and ImmunologyDepartment of MedicineUniversity of Alberta11-107 CSBEdmontonAlberta T6G2B7Canada
| | - Bilal Qarni
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Arian Samimi
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Julius Okel
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Trish Chatterley
- John W. Scott Health Sciences Library, University of Alberta, Edmonton, Canada
| | - Ikechi G. Okpechi
- Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa
| | - Ben Vandermeer
- Department of Pediatrics, University of Alberta, Edmonton, Canada
| | - Branko Braam
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Canada
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4560
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Qiao X, Zheng H, Zhang S, Liu S, Xiong Q, Mao F, Zhang Z, Wen J, Ye H, Li Y, Lu B. C-peptide is independent associated with diabetic peripheral neuropathy: a community-based study. Diabetol Metab Syndr 2017; 9:12. [PMID: 28228847 PMCID: PMC5307841 DOI: 10.1186/s13098-017-0208-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 01/21/2017] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Because the relationship between C-peptide and diabetic peripheral neuropathy (DPN) is controversial, the aim of our study was to evaluate the relationship between C-peptide and DPN in community-based Chinese patients with type 2 diabetes. METHODS In total, 220 consecutive type 2 diabetic patients treated by our regional medical consortium were enrolled. DPN was assessed by clinical symptoms, signs, and electromyography. RESULTS Fasting C-peptide, 2-h postprandial C-peptide and ΔC-peptide (i.e., 2-h postprandial C-peptide minus the fasting C-peptide) serum concentrations in the non-DPN group were significantly higher than those in the clinical DPN group (all P ≤ 0.040) and the confirmed DPN group (all P < 0.002). The three C-peptide parameters were independently associated with DPN (all P < 0.05) after adjusting for age, sex, diabetes duration, smoking status, systolic pressure, body mass index, angiotensin-converting enzyme inhibitors/angiotensin receptor blocker use, fasting plasma glucose, HbA1c, triglyceride and estimated glomerular filtration rate. Compared with the ΔC-peptide quartile 1 (reference), patients in quartile 3 (odds ratio [OR], 0.110; 95% confidence interval [CI] 0.026-0.466; P = 0.003) and quartile 4 (OR, 0.012; 95% CI 0.026-0.559; P = 0.007) had a lower risk of DPN after adjusting for the confounders. CONCLUSIONS C-peptide was negatively associated with DPN in community-based Chinese type 2 diabetic patients in China.
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Affiliation(s)
- Xiaona Qiao
- Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, 12 Middle Urumqi Road, Shanghai, 200040 China
| | - Hangping Zheng
- Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, 12 Middle Urumqi Road, Shanghai, 200040 China
| | - Shuo Zhang
- Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, 12 Middle Urumqi Road, Shanghai, 200040 China
| | - Siying Liu
- Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, 12 Middle Urumqi Road, Shanghai, 200040 China
| | - Qian Xiong
- Departments of Endocrinology and Metabolism, Huashan Hospital Jing’an Branch, Fudan University, Shanghai, 200040 China
| | - Fei Mao
- Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, 12 Middle Urumqi Road, Shanghai, 200040 China
| | - Zhaoyun Zhang
- Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, 12 Middle Urumqi Road, Shanghai, 200040 China
| | - Jie Wen
- Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, 12 Middle Urumqi Road, Shanghai, 200040 China
- Departments of Endocrinology and Metabolism, Huashan Hospital Jing’an Branch, Fudan University, Shanghai, 200040 China
| | - Hongying Ye
- Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, 12 Middle Urumqi Road, Shanghai, 200040 China
| | - Yiming Li
- Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, 12 Middle Urumqi Road, Shanghai, 200040 China
| | - Bin Lu
- Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, 12 Middle Urumqi Road, Shanghai, 200040 China
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4561
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Goyal H, Mohanty S, Sharma M, Rani A. Study of anemia in nondialysis dependent chronic kidney disease with special reference to serum hepcidin. Indian J Nephrol 2017; 27:44-50. [PMID: 28182038 PMCID: PMC5255990 DOI: 10.4103/0971-4065.179301] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
We studied the role of serum hepcidin in anemia of chronic kidney disease (CKD) in a hospital-based cross-sectional study. Serum hepcidin, ferritin, and high-sensitivity C-reactive protein (hsCRP) levels were evaluated in patients of CKD. Hepcidin levels were increased in patients as compared to healthy adults. Hepcidin levels increased as CKD progressed through stage 3-5 (P trend = 0.015) but did not correlate with estimated glomerular filtration rate. Hepcidin correlated positively with ferritin (P < 0.0001) and transferrin saturation (TSAT) (P = 0.0217) and negatively with erythropoietin (EPO) levels (P = 0.0258) but did not correlate with either hsCRP or estimated glomerular filtration rate. Iron status influenced hepcidin levels of patients. Patients were divided according to iron status on the basis of TSAT and serum ferritin levels. We observed that while absolute iron deficiency (transferrin saturation <20%, ferritin <40 ng/ml) is associated with downregulation of hepcidin, hepcidin is elevated in other two categories of CKD patients (P = 0.0039). Iron status of patients also influenced interaction between hepcidin and hemoglobin (Hb). Hepcidin correlated negatively with Hb in patients with sufficient iron status (r = -0.7452, P < 0.0001) but nearly correlated positively with Hb in patients with absolute iron deficiency (r = 0.9428, P = 0.0572). Almost similar association persisted when cutoff value for serum ferritin was raised to 100 ng/ml as per NKF/KDOQI 2006 clinical practice guidelines except that no association was observed in absolute iron deficiency category. Cutoff value for hepcidin for differentiating absolute iron deficiency from other categories in our study population is ≤ 34 ng/ml (area under curve = 0.836, P < 0.0001). In conclusion, serum hepcidin level is increased in nondialysis CKD patients as compared to healthy adults possibly due to associated inflammation and decreased renal clearance. Furthermore, iron status modifies hepcidin level and its association with Hb. Raised hepcidin can predict the need for parenteral iron therapy and need for higher dose of recombinant human EPO to overcome iron-restricted erythropoiesis.
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Affiliation(s)
- H Goyal
- Department of Medicine, VMMC and Safdarjung Hospital, New Delhi, India
| | - S Mohanty
- Department of Medicine, VMMC and Safdarjung Hospital, New Delhi, India
| | - M Sharma
- Department of Hematology, VMMC and Safdarjung Hospital, New Delhi, India
| | - A Rani
- Department of Biochemistry, VMMC and Safdarjung Hospital, New Delhi, India
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4562
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Sha T, Huang YQ, Cai AP, Huang C, Zhang Y, Chen JY, Zhou YL, Yu XJ, Zhou D, Tang ST, Feng YQ, Tan N. Prevalence and determinants of left ventricular geometric abnormalities in hypertensive patients: A study based on the updated classification system of left ventricular geometry. Hellenic J Cardiol 2017; 58:124-32. [PMID: 28179146 DOI: 10.1016/j.hjc.2016.12.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 12/15/2016] [Accepted: 12/23/2016] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE This study was to determine whether different risk factors were associated with different type of left ventricular (LV) geometric abnormalities. METHODS This retrospective analysis included 2290 hypertensive participants without other cardiovascular disease, valve disease and with ejection fraction ≥50%. The type of LV geometric abnormality was defined on the basis of the new classification system. RESULTS LV geometric abnormalities were detected in 1479 subjects (64.6%), wherein concentric LV remodeling is the most common LV geometric abnormality (40.3%). Large waist circumference (WC) and neck circumference (NC) were positively associated with concentric LV remodeling, whereas body mass index (BMI) [odds ratio (OR) 0.89, 95% CI 0.85∼0.92, P < 0.001] and systolic blood pressure (SBP) (OR 0.99, 95% CI 0.98∼0.99, P = 0.018) were inversely associated with concentric abnormalities. SBP and age were positively associated with eccentric dilated LVH, while male was inversely associated with eccentric dilated left ventricular hypertrophy (LVH). Age was the strongest risk factor for eccentric dilated LVH (OR 1.05, 95% CI 1.03∼1.07, P < 0.001). Age, NC, SBP, hyperuricemia, and alcohol use were positively associated with concentric LVH, whereas BMI (OR 0.95, 95% CI 0.90∼0.99, P = 0.033) and male (OR 0.12, 95% CI 0.07∼0.18, P < 0.001) were negatively associated with concentric LVH. CONCLUSION The prevalence of hypertensive LV geometric abnormality in rural area of Southern China was obvious higher. Compared with eccentric LV geometric abnormalities, there were more risk factors, including large WC and NC, age, NC, SBP, hyperuricemia, alcohol use, BMI and gender, which were associated with concentric LV geometric abnormalities.
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4563
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Fan Q, Yan Y, Gu L, He L, Chen N, Jiang G, Yuan L, Xue J, Zhang Y, Ma J, Jin H, Yuan W, Guo Z, Guo L, Wang N, Zhang W, Ye Z, Mao P, Pi X, Lu R, Zhu M, Zhang W, Ni Z, Qian J, Pang H. Prognostic Value of the Delivery Dialysis Dose on Twice-Weekly Hemodialysis Patients. Am J Nephrol 2017; 45:273-282. [PMID: 28171855 DOI: 10.1159/000453043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 10/13/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND Few studies have evaluated the prognostic value of dialysis dose in twice-weekly hemodialysis (HD). A single-pool Kt/V (spKt/V) over 1.70 may benefit patients receiving twice-weekly maintenance HD. METHODS This is a multicenter randomized controlled trial performed on 163 patients from 17 dialysis centers in Shanghai who were allocated to high- (n = 98) and standard-dose groups (n = 65) and followed through 96 weeks of study period. Therapeutic approaches were given to increase spKt/V to over 1.70 in the high-dose group. Data were collected every 12-24 weeks. The primary outcomes were all-cause mortality and major adverse cardio-cerebrovascular events (MACEs) occurrence, and secondary outcomes included residual kidney function (RKF) and health-related quality of life (HR-QOL). RESULTS The spKt/V in high-dose and standard-dose groups were 1.80 ± 0.23 and 1.55 ± 0.19, respectively, after an 8-week intervention (p < 0.001). At the end of the study, SF-36 physical function and total score in high-dose group were 82 (69-90) and 74 (47-84), respectively, both of which were higher than those in the standard-dose group. Decline in urine volume was observed in both groups with no significant difference (p = 0.431). No difference was found in overall survival between the 2 groups (p = 0.580). The 1-year MACE-free survival for high-dose group was 84.49%, better than 76.72% for standard-dose group (p = 0.029). CONCLUSIONS Higher spKt/V is also associated with MACE-free survival and better HR-QOL, especially in physical function aspect for twice-weekly dialysis patients. Increasing spKt/V over 1.70 in twice-weekly HD population does not cause loss of RKF.
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Affiliation(s)
- Qichen Fan
- Division of Nephrology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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4564
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Saranburut K, Vathesatogkit P, Chittamma A, Vanavanan S, Thongmung N, Tangstheanphan T, Sritara P, Kitiyakara C. Evaluation of the Framingham Heart Study risk factors and risk score for incident chronic kidney disease at 10 years in a Thai general population. Int Urol Nephrol 2017; 49:851-7. [DOI: 10.1007/s11255-017-1530-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Accepted: 01/25/2017] [Indexed: 01/08/2023]
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4565
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Cai YZ, Li ZC, Zuo PL, Pfeuffer J, Li YM, Liu F, Liu RB. Diagnostic value of renal perfusion in patients with chronic kidney disease using 3D arterial spin labeling. J Magn Reson Imaging 2017; 46:589-594. [PMID: 28181335 DOI: 10.1002/jmri.25601] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 12/05/2016] [Indexed: 02/05/2023] Open
Abstract
PURPOSE To evaluate the diagnostic value of 3D arterial spin labeling (ASL) for noninvasive quantification of renal blood flow (RBF) in patients with chronic kidney disease (CKD). MATERIALS AND METHODS CKD patients (n = 27) and healthy volunteers (n = 36) underwent renal 3T ASL magnetic resonance imaging, with inversion times from 1200 to 2000 msec for volunteers in the preliminary test, and 1800 to 2000 msec for volunteers and CKD patients in the formal experiments. The cortical RBFs were compared, and a correlation between RBF and estimated glomerular filtration rate (eGFR) was evaluated. RESULTS For healthy volunteers, RBF values increased with TIs from 1200 to 1600 msec, but were almost constant at TIs from 1600 to 2000 msec. The cortical RBF values of CKD patients were lower than that of healthy volunteers at TIs from 1800 to 2000 msec. In addition, the CKD patients had lower cortical RBF values than the healthy volunteers (P < 0.01 for both), and their RBF values positively correlated with eGFR. CONCLUSION 3D ASL is a potential noninvasive method for measuring renal perfusion that can provide valuable information for clinical CKD diagnosis. LEVEL OF EVIDENCE 1 Technical Efficacy: Stage 3 J. MAGN. RESON. IMAGING 2017;46:589-594.
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Affiliation(s)
- Yu-Zhe Cai
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, PR China
| | - Zhi-Cheng Li
- Department of Nephrology, West China Hospital of Sichuan University, Chengdu, Sichuan, PR China
| | - Pan-Li Zuo
- Siemens Healthcare, MR Collaboration NE Asia, Beijing, PR China
| | - Josef Pfeuffer
- Application Development, Siemens Healthcare, Erlangen, Germany
| | - Yu-Ming Li
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, PR China
| | - Fang Liu
- Department of Nephrology, West China Hospital of Sichuan University, Chengdu, Sichuan, PR China
| | - Rong-Bo Liu
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, PR China
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4566
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Garofalo C, Borrelli S, Minutolo R, Chiodini P, De Nicola L, Conte G. A systematic review and meta-analysis suggests obesity predicts onset of chronic kidney disease in the general population. Kidney Int 2017; 91:1224-1235. [PMID: 28187985 DOI: 10.1016/j.kint.2016.12.013] [Citation(s) in RCA: 177] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Revised: 11/25/2016] [Accepted: 12/01/2016] [Indexed: 01/01/2023]
Abstract
Obesity and chronic kidney disease (CKD) are public health priorities that share core pathophysiological mechanisms. However, whether high body mass index (BMI) increases risk of CKD de novo remains ill-defined. To evaluate the role of BMI in predicting CKD onset in the general adult population, we performed a systematic review and meta-analysis of PubMed and ISI Web of Science databases articles published between January 2000 and August 2016 without language restriction. We selected studies in adult individuals from a general population with normal renal function at baseline that reported the risk of low estimated glomerular filtration (eGFR) (under 60 mL/min/1.73m2) and/or albuminuria (1+ at dipstick or an albumin creatinine ratio of 3.4 mg/mmol or more) as hazard ratio, odds ratio or relative risk related to obesity, overweight, or BMI as continuous value. A total of 39 cohorts covering 630, 677 participants with a mean follow-up of 6.8 years were selected. Obesity increased the relative risk, 95% confidence interval and heterogeneity (I2) of developing low eGFR (1.28, 1.07-1.54, [I2: 95.0%]) and albuminuria (1.51, 1.36-1.67, [I2: 62.7%]). Increase of BMI unit was also associated with higher risk of low eGFR (1.02, 1.01-1.03, [I2: 24.3%]) and albuminuria (1.02, 1.00-1.04, [I2: 0%]). Conversely, overweight did not predict onset of either low eGFR (1.06, 0.94-1.21, [I2: 50.0%]) or albuminuria (1.24, 0.98-1.58, [I2: 49.4%]). Thus, a high BMI predicts onset of albuminuria without kidney failure (CKD stages 1-2) as well as CKD stages 3 and higher, the effect being significant only in obese individuals. Hence, our findings may have implications to improve risk stratification and recommendations on body weight control in the general population.
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Affiliation(s)
- Carlo Garofalo
- Division of Nephrology, Second University of Naples, Naples, Italy
| | - Silvio Borrelli
- Division of Nephrology, Second University of Naples, Naples, Italy
| | - Roberto Minutolo
- Division of Nephrology, Second University of Naples, Naples, Italy
| | - Paolo Chiodini
- Medical Statistics Unit, Second University of Naples, Naples, Italy
| | - Luca De Nicola
- Division of Nephrology, Second University of Naples, Naples, Italy
| | - Giuseppe Conte
- Division of Nephrology, Second University of Naples, Naples, Italy.
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4567
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Ellulu MS. Obesity, cardiovascular disease, and role of vitamin C on inflammation: a review of facts and underlying mechanisms. Inflammopharmacology 2017; 25:313-328. [PMID: 28168552 DOI: 10.1007/s10787-017-0314-7] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 01/23/2017] [Indexed: 02/07/2023]
Abstract
Obesity means the accumulation of excessive fat that may interfere with the maintenance of optimal state of health. Obesity causes cardiac and vascular disease through well-known mediators such as hypertension, type-2 diabetes mellitus, and dyslipidemia, but there are evidences for other mediators such as chronic inflammation, oxidative stress, and thrombosis. The decreased levels of antioxidants factors and nitric oxide predispose to further cardiovascular adverse events. To reduce the risks, antioxidants can help by neutralizing the free radicals and protecting from damage by donating electrons. Having the capacity, vitamin C protects from oxidative stress, prevention of non-enzymatic glycosylation of proteins, and enhances arterial dilation through its effect on nitric oxide release. It also decreases lipid peroxidation, and alleviates inflammation. The anti-inflammatory property of vitamin C could be attributed to ability to modulate the NF-kB DNA binding activity and down-regulation in the hepatic mRNA expression for the interleukins and tumor factors.
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Affiliation(s)
- Mohammed S Ellulu
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia (UPM), Serdang, Selangor, Malaysia. .,Clinical Nutrition Specialist, Gaza, Palestine.
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4568
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Srisubat A, Sriratanaban J, Ngamkiatphaisan S, Tungsanga K. Original article. Cost-effectiveness of annual microalbuminuria screening in Thai diabetics. ASIAN BIOMED 2017. [DOI: 10.5372/1905-7415.0803.301] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
AbstractBackground: Diabetes is a leading cause of end stage renal disease (ESRD), which impacts on treatment costs and patients’ quality of life. Microalbuminuria screening in patients with diabetes as an early intervention is beneficial in slowing the progression of diabetic nephropathy.Objectives: We aimed to assess the cost-effectiveness of annual microalbuminuria screening in type 2 diabetic patients.Methods: We compared screening by urine dipsticks with a “do nothing” scenario. To replicate the natural history of diabetic nephropathy, a Markov model based on a simulated cohort of 10,000 45-year-old normotensive diabetic patients was utilized. We calculated the cost and quality of life gathered from a cross-sectional survey. The costs of dialysis were derived from The National Health Security Office (NHSO). We also calculated the incremental cost-effectiveness ratio (ICER) for lifetime with a future discount rate of 3%.Results: The ICER was 3,035 THB per quality-adjusted life year (QALY) gained. One-way and probabilistic sensitivity analyses showed that all ICERs were less than the Thai Gross Domestic Product (GDP) per capita (150,000 THB in 2011) based on World Health Organization’s suggested criteria.Conclusions: Annual microalbuminuria screening using urine dipsticks in type 2 diabetic patients is very costeffective in Thailand based on World Health Organization’s recommendations. This finding has corroborated the benefit of this screening in the public health benefit package.
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Affiliation(s)
- Attasit Srisubat
- Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | - Jiruth Sriratanaban
- Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | | | - Kriang Tungsanga
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
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4569
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Ndlovu KCZ, Sibanda W, Assounga A. Peritonitis outcomes in patients with HIV and end-stage renal failure on peritoneal dialysis: a prospective cohort study. BMC Nephrol 2017; 18:48. [PMID: 28158991 PMCID: PMC5291961 DOI: 10.1186/s12882-017-0466-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 01/31/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Few studies have investigated the management of human immunodeficiency virus (HIV)-associated end-stage renal failure particularly in low-resource settings with limited access to renal replacement therapy. We aimed to evaluate the effects of HIV infection on continuous ambulatory peritoneal dialysis (CAPD)-associated peritonitis outcomes and technique failure in highly active antiretroviral therapy (HAART)-treated HIV-positive CAPD populations. METHODS We conducted a single-center prospective cohort study of consecutive incident CAPD patients recruited from two hospitals in Durban, South Africa from September 2012-February 2015. Seventy HIV-negative and 70 HIV-positive end-stage renal failure patients were followed monthly for 18 months at a central renal clinic. Primary outcomes of peritonitis and catheter failure were assessed for the first 18 months of CAPD therapy. We assessed risk factors for peritonitis and catheter failure using Cox regression survival analysis. RESULTS The HIV-positive cohort had a significantly increased rate of peritonitis compared to the HIV-negative cohort (1.86 vs. 0.76 episodes/person-years, respectively; hazard ratio [HR], 2.41; 95% confidence interval [CI], 1.69-3.45, P < 0.001). When the baseline CD4 count was below 200 cells/μL, the peritonitis rate rose to 3.69 episodes/person-years (HR 4.54, 95% CI 2.35-8.76, P < 0.001), while a baseline CD4 count above 350 cells/μL was associated with a peritonitis rate of 1.60 episodes/person-years (HR 2.10, CI 1.39-3.15, P = 0.001). HIV was associated with increased hazards of peritonitis relapse (HR, 3.88; CI, 1.37-10.94; P = 0.010). Independent predictors associated with increased peritonitis risk were HIV (HR, 1.84; CI, 1.07-3.16; P = 0.027), diabetes (HR, 2.09; CI, 1.09-4.03; P = 0.027) and a baseline CD4 count < 200 cells/μL (HR, 3.28; CI, 1.42-7.61; P = 0.006). Catheter failure rates were 0.34 (HIV-positive cohort) and 0.24 (HIV-negative cohort) episodes/person-years (HR, 1.42; 95% CI, 0.73-2.73; P = 0.299). Peritonitis (HR, 14.47; CI, 2.79-75.00; P = 0.001), average hemoglobin concentrations (HR, 0.75; CI, 0.59-0.95; P = 0.016), and average serum C-reactive protein levels were independent predictors of catheter failure. CONCLUSIONS HIV infection in end-stage renal disease patients managed by CAPD was associated with increased peritonitis risk; however, HIV infection did not increase the risk for CAPD catheter failure rate at 18 months.
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Affiliation(s)
- Kwazi C Z Ndlovu
- Inkosi Albert Luthuli Central Hospital, Durban, South Africa. .,Department of Nephrology, University of KwaZulu-Natal, P/Bag X7, Congella, Durban, 4013, South Africa.
| | - Wilbert Sibanda
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Alain Assounga
- Inkosi Albert Luthuli Central Hospital, Durban, South Africa.,Department of Nephrology, University of KwaZulu-Natal, P/Bag X7, Congella, Durban, 4013, South Africa
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4570
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Wang Y, Fu L, Jia Q, Yu H, Zhang P, Zhang C, Huang X, He K, Tian Y. Analyzing Dynamic Changes of Laboratory Indexes in Patients with Acute Heart Failure Based on Retrospective Study. Biomed Res Int 2016; 2016:7496061. [PMID: 27144175 DOI: 10.1155/2016/7496061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 03/09/2016] [Accepted: 03/20/2016] [Indexed: 11/17/2022]
Abstract
Background. Changes of N-terminal probrain natriuretic peptide (NT-proBNP) have been studied whether in the long term or the short term in patients of acute heart failure (AHF); however, changes of NT-proBNP in the first five days and their association with other factors have not been investigated. Aims. To describe the dynamic changes of relevant laboratory indexes in the first five days between different outcomes of AHF patients and their associations. Methods and Results. 284 AHF with dynamic values recorded were analyzed. Changes of NT-proBNP, troponin T, and C-reactive protein were different between patients with different outcomes, with higher values in adverse group than in control group at the same time points (p < 0.05). Then, prognostic use and risk stratification of NT-proBNP were assessed by receiver-operating characteristic curve and logistic regression. NT-proBNP levels at day 3 showed the best prognostic power (area under the curve = 0.730, 95% confidence interval (CI): 0.657 to 0.794) and was an independent risk factor for adverse outcome (odds ratio, OR: 2.185, 95% CI: 1.584–3.015). Classified changes of NT-proBNP may be predictive for adverse outcomes in AHF patients. Conclusions. Sequential monitoring of laboratory indexes within the first 5 days may be helpful for management of AHF patients.
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4571
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Fung CSC, Wan EYF, Chan AKC, Lam CLK. Association of estimated glomerular filtration rate and urine albumin-to-creatinine ratio with incidence of cardiovascular diseases and mortality in chinese patients with type 2 diabetes mellitus - a population-based retrospective cohort study. BMC Nephrol 2017; 18:47. [PMID: 28152985 PMCID: PMC5290675 DOI: 10.1186/s12882-017-0468-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 01/31/2017] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR) are renal markers associated with risks of cardiovascular diseases (CVD) and all-cause mortality in diabetic patients. This study aims to quantify such risks in Chinese diabetic patients based on eGFR and UACR. METHODS This was a territory-wide retrospective cohort study on primary care diabetic patients with documented eGFR and UACR but without baseline CVD in 2008/2009. They were followed up till 2013 on CVD events and mortality. Associations between eGFR/UACR and incidence of CVD/mortality were evaluated by multivariable Cox proportional models adjusted with socio-demographic and clinical characteristics. RESULTS The data of 66,311 patients who had valid baseline eGFR and UACR values were analysed. The risks of CVD events and mortality increased exponentially with the decrease in eGFR, with a hazard ratio (HR) increasing from 1.63 to 4.55 for CVD, and from 1.70 to 9.49 for mortality, associated with Stage 3 to 5 CKD, compared to Stage 1 CKD. UACR showed a positive linear association with CVD events and mortality. Microalbuminuria was associated with a HR of 1.58 and 2.08 for CVD and mortality in male (1.48 and 1.79 for female), respectively, compared to no microalbuminuria. Male patients with UACR 1-1.4 mg/mmol and eGFR ≥90 ml/min/1.73 m2 (60-89 ml/min/1.73 m2) had a HR of 1.25 (1.43) for CVD. Female patients with UACR 2.5-3.4 mg/ml and eGFR ≥90 ml/min/1.73 m2 (60-89 ml/min/1.73 m2) had a HR of 1.45 (1.65) for CVD. CONCLUSIONS Risks of CVD events and mortality increased exponentially with eGFR drop, while UACR showed positive predictive linear relationships, and the risks started even in high-normal albuminuria. UACR-based HR was further modified according to eGFR level, with risk progressed with CKD stage. Combining eGFR and UACR level was more accurate in predicting risk of CVD/mortality. The findings call for more aggressive screening and intervention of microalbuminuria in diabetic patients.
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Affiliation(s)
- Colman Siu Cheung Fung
- Department of Family Medicine and Primary Care, the University of Hong Kong, 3/F Ap Lei Chau Clinic, 161 Main Street, Ap Lei Chau, Hong Kong.
| | - Eric Yuk Fai Wan
- Department of Family Medicine and Primary Care, the University of Hong Kong, 3/F Ap Lei Chau Clinic, 161 Main Street, Ap Lei Chau, Hong Kong
| | - Anca Ka Chun Chan
- Department of Family Medicine and Primary Care, the University of Hong Kong, 3/F Ap Lei Chau Clinic, 161 Main Street, Ap Lei Chau, Hong Kong
| | - Cindy Lo Kuen Lam
- Department of Family Medicine and Primary Care, the University of Hong Kong, 3/F Ap Lei Chau Clinic, 161 Main Street, Ap Lei Chau, Hong Kong
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4572
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Mohammed-Ali Z, Lu C, Marway MK, Carlisle RE, Ask K, Lukic D, Krepinsky JC, Dickhout JG. Endoplasmic reticulum stress inhibition attenuates hypertensive chronic kidney disease through reduction in proteinuria. Sci Rep 2017; 7:41572. [PMID: 28148966 DOI: 10.1038/srep41572] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 12/21/2016] [Indexed: 12/22/2022] Open
Abstract
Endoplasmic reticulum (ER) stress is implicated in chronic kidney disease (CKD) development in patients and in animal models. Here we show that ER stress inhibition through 4-phenylbutyric acid (4-PBA) administration decreases blood pressure, albuminuria, and tubular casts in an angiotensin II/deoxycorticosterone acetate/salt murine model of CKD. Lower albuminuria in 4-PBA-treated mice was associated with higher levels of cubilin protein in renal tissue membrane fractions. 4-PBA decreased renal interstitial fibrosis, renal CD3+ T-cell and macrophage infiltration, mRNA expression of TGFβ1, Wnt signaling molecules, and ER stress-induced pro-inflammatory genes. CHOP deficient mice that underwent this model of CKD developed hypertension comparable to wild type mice, but had less albuminuria and tubular casts. CHOP deficiency resulted in higher nephrin levels and decreased glomerulosclerosis compared to wild type mice; this effect was accompanied by lower macrophage infiltration and fibrosis. Our findings portray ER stress inhibition as a means to alleviate hypertensive CKD by preserving glomerular barrier integrity and tubular function. These results demonstrate ER stress modulation as a novel target for preserving renal function in hypertensive CKD.
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4573
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Zeng Q, Dong SY, Wang ML, Wang WM, Li JM, Dai ZX, Li J, Yang SW, Zhu L. Serum glycated albumin, glycated hemoglobin, and arterial stiffness in a general Chinese population. Clin Chim Acta 2017; 468:33-38. [PMID: 28163034 DOI: 10.1016/j.cca.2017.02.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 02/01/2017] [Accepted: 02/01/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Both glycated albumin (GA) and glycated hemoglobin (HbA1c) reflect the mean glucose levels. This study was conducted to investigate the relationships among GA, HbA1c, and arterial stiffness in the general population. METHODS A total of 11,014 participants were included. Serum GA; HbA1c; and arterial stiffness indices, including brachial-ankle pulse wave velocity (baPWV) and central systolic blood pressure (cSBP), were measured. Single-factor and multivariate regression analyses were performed. Receiver operating characteristic (ROC) analysis was performed to compare the predictive value of GA, HbA1c, and their combination for arterial stiffness. All analyses were stratified by sex. RESULTS Men had a lower GA level than women. GA, HbA1c, and plasma glucose levels were correlated. The levels of baPWV and cSBP increased across sex-specific quartiles of GA and HbA1c (P for trend<0.001 for all). Both GA and HbA1c were positively related to elevated baPWV and cSBP after adjusting for conventional factors (P<0.05 for all). These relationships remained significant when participants were divided into groups with normal glucose tolerance, prediabetes, or diabetes. Regarding screening for elevated baPWV and cSBP, the values of the area under the ROC curve (AUC) for GA were similar to those for HbA1c in men but were lower than those for HbA1c in women. The combination of GA and HbA1c did not improve the AUC compared with HbA1c alone. CONCLUSIONS Both GA and HbA1c were associated with arterial stiffness. The predictive value of GA for arterial stiffness was similar in men but lower in women compared with that of HbA1c.
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Affiliation(s)
- Qiang Zeng
- Health Management Institute, Chinese PLA General Hospital, Beijing 100853, China.
| | - Sheng-Yong Dong
- Healthcare Department, Agency for Offices Administration of PLA, Beijing 100034, China
| | - Man-Liu Wang
- Center of Biomedical Analysis, Tsinghua University, Beijing 100084, China
| | - Wei-Min Wang
- Health Management Institute, Chinese PLA General Hospital, Beijing 100853, China
| | - Jin-Ming Li
- Healthcare Department, Agency for Offices Administration of PLA, Beijing 100034, China
| | - Zheng-Xue Dai
- Healthcare Department, Agency for Offices Administration of PLA, Beijing 100034, China
| | - Jie Li
- Healthcare Department, Agency for Offices Administration of PLA, Beijing 100034, China
| | - Shu-Wen Yang
- Physical Examination Center, Beijing Hospital, Beijing 100730, China
| | - Ling Zhu
- Physical Examination Center, Beijing Hospital, Beijing 100730, China.
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4574
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Affiliation(s)
- Alfonso Eirin
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
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4575
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Moriya T, Tanaka S, Sone H, Ishibashi S, Matsunaga S, Ohashi Y, Akanuma Y, Haneda M, Katayama S. Patients with type 2 diabetes having higher glomerular filtration rate showed rapid renal function decline followed by impaired glomerular filtration rate: Japan Diabetes Complications Study. J Diabetes Complications 2017; 31:473-478. [PMID: 27396240 DOI: 10.1016/j.jdiacomp.2016.06.020] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Revised: 05/29/2016] [Accepted: 06/22/2016] [Indexed: 01/08/2023]
Abstract
AIMS The Japan Diabetes Complications Study (JDCS), a nation-wide, multicenter, prospective study of patients with type 2 diabetes, reported that hemoglobin A1c (HbA1c), systolic blood pressure, and smoking were risk factors for the onset of macroalbuminuria. This study explored the risk factors for glomerular filtration rate (GFR) decline in the JDCS patients. METHODS We examined the 1407 JDCS patients (667 women, mean age 59years, 974 normoalbuminuria, 433 microalbuminuria) whose urinary albumin-to-creatinine ratio (UACR) and estimated GFR (eGFR) were determined at baseline with an 8-year follow-up. We divided all the patients into four groups according to baseline eGFR: G1 (120≤eGFR), G2 (90≤eGFR<120), G3 (60≤eGFR<90), G4 (eGFR<60). RESULTS The eGFRs in groups G1 and G2 decreased at follow-up compared to those at the baseline. The risk of annual eGFR decline rate≥3ml/min/1.73m2 (rapid decliners) increased as the baseline eGFR increased. Advanced age, high HbA1c, and UACR, or diabetic retinopathy at baseline were risk factors for the rapid decliners. Especially the G1 group had a significant risk for the rapid decliners. The frequency of the patients with GFR<60ml/min/1.73m2 at the follow-up amounted to 31.1% in the rapid decliners, which was higher than 12% in the non-rapid decliners. CONCLUSIONS In normo- and microalbuminuric patients with type 2 diabetes, extra careful attention should be paid to patients with eGFR ≥120ml/min/1.73m2 to detect cases with rapidly decreased GFR under the normal range.
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Affiliation(s)
- Tatsumi Moriya
- Health Care Center, Kitasato University, Kanagawa, Japan.
| | - Shiro Tanaka
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - Hirohito Sone
- Department of Hematology, Endocrinology and Metabolism, Niigata University Faculty of Medicine, Niigata, Japan
| | - Shun Ishibashi
- Division of Endocrinology and Metabolism, Jichii Medical University School of Medicine, Tochigi, Japan
| | - Satoshi Matsunaga
- Department of Hematology, Endocrinology and Metabolism, Niigata University Faculty of Medicine, Niigata, Japan
| | - Yasuo Ohashi
- Department of Integrated Science and Engineering for Sustainable Society, Chuo University, Tokyo, Japan
| | - Yasuo Akanuma
- The Institute for Adult Disease, Asahi Life Foundation, Tokyo, Japan
| | - Masakazu Haneda
- Department of Medicine, Asahikawa Medical University, Hokkaido, Japan
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4576
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Fernandes MIDCD, Soares CDS, Tinôco JDDS, Delgado MF, Paiva MDGMND, Lopes MVDO, Lira ALBDC. Excess fluid volume: sociodemographic and clinical analysis in haemodialysis patients. Rev Bras Enferm 2017; 70:15-21. [DOI: 10.1590/0034-7167-2015-0138] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 07/17/2016] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: To analyse the defining characteristics and related factors in the nursing diagnosis Excess fluid volume and its relationship to sociodemographic and clinical variables in haemodialysis patients. Method: Cross-sectional study, conducted using a form and physical examination, with a sample of 100 patients, between December 2012 and April 2013 at a university hospital and a dialysis clinic. Results: It was found 10 significant statistical associations between the defining characteristics/ related factors of Excess fluid volume and the sociodemographic and clinical variables. Conclusion: The defining characteristics and related factors of Excess fluid volume could be influenced by sociodemographic and clinical variables in haemodialysis clientele.
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4577
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Das SK, Mcintyre HD, Mamun AA. An early life course association of pulse pressure with adulthood estimated glomerular filtration rate: evidence from a large community-based birth cohort study. J Hypertens 2017; 35:392-400. [DOI: 10.1097/hjh.0000000000001172] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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4578
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Hyun YY, Lee KB, Han SH, Kim YH, Kim YS, Lee SW, Oh YK, Chae DW, Ahn C. Nutritional Status in Adults with Predialysis Chronic Kidney Disease: KNOW-CKD Study. J Korean Med Sci 2017; 32:257-263. [PMID: 28049236 PMCID: PMC5219991 DOI: 10.3346/jkms.2017.32.2.257] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 11/14/2016] [Indexed: 11/20/2022] Open
Abstract
Adverse changes in nutrition are prevalent and are strong indicators of adverse outcomes in patients with chronic kidney disease (CKD). The International Society of Renal Nutrition and Metabolism (ISRNM) proposed a common nomenclature and diagnostic criteria to identify protein-energy wasting (PEW) in CKD patients. We examined the nutritional status in 1,834 adults with predialysis CKD enrolled in the KoreaN cohort study for Outcome in patients With Chronic Kidney Disease (KNOW-CKD) study. As there was a need for further understanding of nutritional status and associated factors in CKD, we evaluated the prevalence and associated factors of PEW in adults with predialysis CKD. The prevalence of PEW was about 9.0% according to ISRNM criteria and tended to increase with advanced stage in predialysis CKD. Those who concurrently had PEW, inflammation, and CVD were a small proportion (0.4%). In multivariate logistic regression model, PEW was independently associated with estimated glomerular filtration rate (eGFR) (odds ratio [OR], 0.98; 95% confidence interval [CI], 0.96-0.99), total CO₂ (OR, 0.93; 95% CI, 0.87-0.99), physical activity (OR, 0.43; 95% CI, 0.26-0.69), comorbid diabetes (OR, 1.68; 95% CI, 1.09-2.59), and high sensitivity C-reactive protein (hs-CRP) (OR, 1.03; 95% CI, 1.01-1.06). Our study suggests that PEW increases with advanced CKD stage. PEW is independently associated with renal function, low total CO₂, low physical activity, comorbid diabetes, and increased hs-CRP in adults with predialysis CKD.
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Affiliation(s)
- Young Youl Hyun
- Division of Nephrology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyu Beck Lee
- Division of Nephrology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Seung Hyeok Han
- Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yeong Hoon Kim
- Department of Internal Medicine, Inje University Pusan Paik Hospital, Busan, Korea
| | - Yong Soo Kim
- Department of Internal Medicine, The Catholic University of Korea, Seoul St Mary's Hospital, Seoul, Korea
| | - Sung Woo Lee
- Department of Internal Medicine, Eulji General Hospital, Eulji University, Seoul, Korea
| | - Yun Kyu Oh
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Dong Wan Chae
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Curie Ahn
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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4579
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Yang JK, Wang YY, Liu C, Shi TT, Lu J, Cao X, Yang FY, Feng JP, Chen C, Ji LN, Xu A. Urine Proteome Specific for Eye Damage Can Predict Kidney Damage in Patients With Type 2 Diabetes: A Case-Control and a 5.3-Year Prospective Cohort Study. Diabetes Care 2017; 40:253-260. [PMID: 27903615 DOI: 10.2337/dc16-1529] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 11/16/2016] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The predictive value of microalbuminuria (MAU) for kidney damage is limited in type 2 diabetes (T2D). We studied whether a urine proteome specific for sight-threatening proliferative diabetic retinopathy (PDR) is an indicator to predict chronic renal insufficiency (CRI) in patients with T2D. RESEARCH DESIGN AND METHODS A shotgun urine proteomic analysis was performed in patients with MAU and PDR (case subjects) and in patients with MAU and a duration of T2D for >10 years but without any degree of retinopathy (control subjects). In the cohort study, 210 patients with T2D with an estimated glomerular filtration rate (eGFR) ≥80 mL/min/1.73 m2 were followed for a median of 5.3 years. Urine proteins specific for PDR were used for predicting CRI (eGFR <60 mL/min/1.73 m2). RESULTS The top two urine proteins with the highest difference in ratio of case subjects to control subjects were haptoglobin (8.7 times; P < 0.0001) and α-2-macroglobulin (5.7 times; P < 0.0001). In the cohort study, patients with baseline urinary haptoglobin ≥20 ng/min (haptoglobinuria) had a higher incidence of CRI than those without (hazard ratio [95% CI] 3.27 [1.41-7.58]; P = 0.006). The overall CRI rate was 3.2% for patients without haptoglobinuria or MAU, 9.5% for those with MAU, and 13.3% for those with haptoglobinuria. The highest rate for CRI (22.4%) was in patients with both MAU and haptoglobinuria (P < 0.001). CONCLUSIONS Urine haptoglobin, which is specific for PDR, is a novel biomarker and complement to urine albumin for predicting kidney damage in patients with T2D.
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Affiliation(s)
- Jin-Kui Yang
- Beijing Key Laboratory of Diabetes Research and Care, Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Ying-Ying Wang
- Beijing Key Laboratory of Diabetes Research and Care, Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Chang Liu
- Beijing Key Laboratory of Diabetes Research and Care, Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Ting-Ting Shi
- Beijing Key Laboratory of Diabetes Research and Care, Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Jing Lu
- Beijing Key Laboratory of Diabetes Research and Care, Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Xi Cao
- Beijing Key Laboratory of Diabetes Research and Care, Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Fang-Yuan Yang
- Beijing Key Laboratory of Diabetes Research and Care, Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Jian-Ping Feng
- Beijing Key Laboratory of Diabetes Research and Care, Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Chen Chen
- School of Biomedical Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Li-Nong Ji
- Endocrinology and Metabolism Department, Peking University People's Hospital, Beijing, China
| | - Aimin Xu
- State Key Laboratory of Pharmaceutical Biotechnology, Department of Medicine, University of Hong Kong, Hong Kong
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4580
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Dong K, Huang X, Zhang Q, Yu Z, Ding J, Song H. A lower baseline glomerular filtration rate predicts high mortality and newly cerebrovascular accidents in acute ischemic stroke patients. Medicine (Baltimore) 2017; 96:e5868. [PMID: 28151862 PMCID: PMC5293425 DOI: 10.1097/md.0000000000005868] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Chronic kidney disease (CKD) is gradually recognized as an independent risk factor for cardiovascular and cardio-/cerebrovascular disease. This study aimed to examine the association of the estimated glomerular filtration rate (eGFR) and clinical outcomes at 3 months after the onset of ischemic stroke in a hospitalized Chinese population.Totally, 972 patients with acute ischemic stroke were enrolled into this study. Modified of Diet in Renal Disease (MDRD) equations were used to calculate eGFR and define CKD. The site and degree of the stenosis were examined. Patients were followed-up for 3 months. Endpoint events included all-cause death and newly ischemic events. The multivariate logistic model was used to determine the association between renal dysfunction and patients' outcomes.Of all patients, 130 patients (13.4%) had reduced eGFR (<60 mL/min/1.73 m), and 556 patients had a normal eGFR (≥90 mL/min/1.73 m). A total of 694 patients suffered from cerebral artery stenosis, in which 293 patients only had intracranial artery stenosis (ICAS), 110 only with extracranial carotid atherosclerotic stenosis (ECAS), and 301 with both ICAS and ECAS. The patients with eGFR <60 mL/min/1.73m had a higher proportion of death and newly ischemic events compared with those with a relatively normal eGFR. Multivariate analysis revealed that a baseline eGFR <60 mL/min/1.73 m increased the risk of mortality by 3.089-fold and newly ischemic events by 4.067-fold. In further analysis, a reduced eGFR was associated with increased rates of mortality and newly events both in ICAS patients and ECAS patients. However, only an increased risk of newly events was found as the degree of renal function deteriorated in ICAS patients (odds ratio = 8.169, 95% confidence interval = 2.445-14.127).A low baseline eGFR predicted a high mortality and newly ischemic events at 3 months in ischemic stroke patients. A low baseline eGFR was also a strong independent predictor for newly ischemic events in ICAS patients.
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4581
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Huh JH, Yadav D, Kim JS, Son JW, Choi E, Kim SH, Shin C, Sung KC, Kim JY. An association of metabolic syndrome and chronic kidney disease from a 10-year prospective cohort study. Metabolism 2017; 67:54-61. [PMID: 28081778 DOI: 10.1016/j.metabol.2016.11.003] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 10/03/2016] [Accepted: 11/02/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Although metabolic abnormalities have been considered important risk factors of chronic kidney disease (CKD), the impact of metabolic syndrome (MS) and insulin resistance on renal function deterioration is poorly understood. We investigated the association between MS and incident CKD/rapid decline of estimated glomerular filtration rate (eGFR) in a 10-year population-based longitudinal study. MATERIAL AND METHODS Among 10,030 subjects, 6065 without history of CKD or cardiovascular disease at baseline were analyzed using data generated from the Ansan-Ansung cohort of the Korean Genome Epidemiology Study. Participants were categorized into two groups based on the presence of MS at baseline. Incident CKD was defined as eGFR <60ml/min per 1.73m2, and rapid decline of eGFR was defined as >3ml/min per 1.73m2/yr over 10years. RESULTS During the 10-year follow-up period, CKD developed in 893 subjects (14.7%). Compared to subjects without MS, the odds ratio (OR; 95% confidence interval, CI) of incident CKD in those with MS was 1.38 (1.16-1.64) after controlling for confounding factors. The risk of rapid decline of eGFR was also higher in subjects with MS than those without MS (OR: 1.20, 95% CI: 1.04-1.39). In addition, we found that higher levels of homeostatic model assessment of insulin resistance (HOMA-IR) were associated with incident CKD and rapid decline of eGFR independently of traditional CKD risk factors (OR: 1.24, 95% CI: 1.04-1.47). CONCLUSION Both MS and insulin resistance were independent risk factors of incident CKD and rapid decline of eGFR in healthy Korean population.
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Affiliation(s)
- Ji Hye Huh
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University, Wonju College of Medicine, Wonju, Republic of Korea
| | - Dhananjay Yadav
- Department of Preventive Medicine, Yonsei University, Wonju College of Medicine, Wonju, Republic of Korea
| | - Jae Seok Kim
- Division of Nephrology, Department of Internal Medicine, Yonsei University, Wonju College of Medicine, Wonju, Republic of Korea
| | - Jung-Woo Son
- Division of Cardiology, Department of Internal Medicine, Yonsei University, Wonju College of Medicine, Wonju, Republic of Korea
| | - Eunhee Choi
- Institute of Life Style Medicine, Yonsei University, Wonju College of Medicine, Wonju, Republic of Korea,.
| | - Seong Hwan Kim
- Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Gyeonggi, South Korea
| | - Chol Shin
- Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Gyeonggi, South Korea
| | - Ki-Chul Sung
- Division of Cardiology, Department of Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jang Young Kim
- Division of Cardiology, Department of Internal Medicine, Yonsei University, Wonju College of Medicine, Wonju, Republic of Korea,.
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4582
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Affiliation(s)
- F J Gifford
- Department of Renal Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - N Dhaun
- Department of Renal Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK.,University/British Heart Foundation Centre of Research Excellence, The Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
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4583
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Liu YH, Jiang L, Duan CY, He PC, Liu Y, Tan N, Chen JY. Canada Acute Coronary Syndrome Score: A Preprocedural Risk Score for Contrast-Induced Nephropathy After Primary Percutaneous Coronary Intervention. Angiology 2017; 68:782-789. [PMID: 28135823 DOI: 10.1177/0003319717690674] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
In patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention, contrast-induced nephropathy (CIN) is a serious complication associated with poor outcomes. We assessed the predictive value of the Canada Acute Coronary Syndrome (C-ACS) score for CIN in these patients. A total of 394 consecutive patients with STEMI were enrolled and divided into 3 groups according to their C-ACS scores—group 1, score 0; group 2, score 1; and group 3, score ≥2. The clinical outcomes were CIN and major adverse clinical events (MACEs) during hospital and follow-up; 8.4% of patients developed CIN. Patients with high C-ACS scores were more likely to develop CIN, in-hospital death, and MACEs ( P < .001). The C-ACS score was an independent predictor of CIN (odds ratio = 2.87; 95% confidence interval = 1.78-4.63; P < .001) and risk factor for long-term MACEs. The C-ACS score had good predictive values for CIN, in-hospital morality, MACEs, and long-term mortality. Patients with high C-ACS risk scores exhibited a worse survival rate than those with low scores (death, P = .02; MACEs, P = .006). In conclusion, in patients with STEMI, the C-ACS could predict CIN and clinical outcomes.
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Affiliation(s)
- Yuan-Hui Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academic of Medical Sciences, Guangzhou, China
| | - Lei Jiang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academic of Medical Sciences, Guangzhou, China
| | - Chong-Yang Duan
- Department of Biostatistics, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, China
| | - Peng-Cheng He
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academic of Medical Sciences, Guangzhou, China
| | - Yong Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academic of Medical Sciences, Guangzhou, China
| | - Ning Tan
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academic of Medical Sciences, Guangzhou, China
| | - Ji-Yan Chen
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academic of Medical Sciences, Guangzhou, China
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4584
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Shang W, Li L, Ren Y, Ge Q, Ku M, Ge S, Xu G. History of kidney stones and risk of chronic kidney disease: a meta-analysis. PeerJ 2017; 5:e2907. [PMID: 28149686 PMCID: PMC5267565 DOI: 10.7717/peerj.2907] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 12/13/2016] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Although the relationship between a history of kidney stones and chronic kidney disease (CKD) has been explored in many studies, it is still far from being well understood. Thus, we conducted a meta-analysis of studies comparing rates of CKD in patients with a history of kidney stones. METHODS PubMed, EMBASE, and the reference lists of relevant articles were searched to identify observational studies related to the topic. A random-effects model was used to combine the study-specific risk estimates. We explored the potential heterogeneity by subgroup analyses and meta-regression analyses. RESULTS Seven studies were included in this meta-analysis. Pooled results suggested that a history of kidney stones was associated with an increased adjusted risk estimate for CKD [risk ratio (RR), 1.47 95% confidence interval (CI) [1.23-1.76])], with significant heterogeneity among these studies (I2 = 93.6%, P < 0.001). The observed positive association was observed in most of the subgroup analyses, whereas the association was not significant among studies from Asian countries, the mean age ≥50 years and male patients. CONCLUSION A history of kidney stones is associated with increased risk of CKD. Future investigations are encouraged to reveal the underlying mechanisms in the connection between kidney stones and CKD, which may point the way to more effective preventive and therapeutic measures.
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Affiliation(s)
- Weifeng Shang
- Department of Nephrology, Tongji Hospital affiliated with Tongji Medical College, Huazhong University of Science and Technology , Wuhan , China
| | - Lixi Li
- Department of Nephrology, Tongji Hospital affiliated with Tongji Medical College, Huazhong University of Science and Technology , Wuhan , China
| | - Yali Ren
- Department of Medical Affaires, Liyuan Hospital affiliated to Tongji Medical College, Huazhong University of Science and Technologyy , Wuhan , China
| | - Qiangqiang Ge
- Department of Urology, Tongji Hospital affiliated with Tongji Medical College, Huazhong University of Science and Technology , Wuhan , China
| | - Ming Ku
- Department of Nephrology, Tongji Hospital affiliated with Tongji Medical College, Huazhong University of Science and Technology , Wuhan , China
| | - Shuwang Ge
- Department of Nephrology, Tongji Hospital affiliated with Tongji Medical College, Huazhong University of Science and Technology , Wuhan , China
| | - Gang Xu
- Department of Nephrology, Tongji Hospital affiliated with Tongji Medical College, Huazhong University of Science and Technology , Wuhan , China
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4585
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Du X, Pan B, Li W, Zou Y, Hua X, Huang W, Wan X, Cao C. Albuminuria is an independent risk factor of T4 elevation in chronic kidney disease. Sci Rep 2017; 7:41302. [PMID: 28117377 PMCID: PMC5259789 DOI: 10.1038/srep41302] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 12/19/2016] [Indexed: 11/21/2022] Open
Abstract
This study was to explore the association between thyroid dysfunction and albuminuria. 581 cases with chronic kidney disease (CKD) were included in this study. The clinical characteristics consisted of sex, age, serum creatinine, urinary albumin-to-creatinine ratio (ACR), thyroid function were recorded. Estimated glomerular filtration rate (eGFR) was calculated by CKD-EPI four-level race equation. Prevalence of different thyroid diseases was calculated by chi-square test. Levels of thyroid hormone were compared among different albuminuria groups by Kruskal-Wallis test. Spearman's correlation was used to assess the association between albuminuria and thyroid hormone. Our study showed that total T4 and free T4 were significantly different among ACR < 30 mg/g, 30-300 mg/g and >300 mg/g (P < 0.001 and =0.007, respectively). Positive correlation between T4 (total T4 and free T4) and albuminuria was evaluated by correlation analysis (P = 0.001 and <0.001, respectively). Albuminuria was an independent influence factor of T4 after adjustment for age, sex, serum creatinine, albumin, hs-CRP, smoking status, systolic blood pressure, diabetes mellitus, medication use for diabetes mellitus, eGFR, LDL-cholesterol, triglycerides, hypertension, and medication use for hypercholesterinemia. In conclusion, T4 was positively correlated with albuminuria, and it was completely not consistent with our anticipation. Further study is needed to elucidate the causation association between albuminuria and T4.
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Affiliation(s)
- Xin Du
- Department of Nephrology, Nanjing First Hospital, Nanjing Medical University, Nanjing, PR China
| | - Binbin Pan
- Department of Nephrology, Nanjing First Hospital, Nanjing Medical University, Nanjing, PR China
| | - Wenwen Li
- Department of Nephrology, Sir Run Run Hospital, Nanjing Medical University, Nanjing, PR China
| | - Yonghua Zou
- Outpatient Department, Nanjing Medical University, Nanjing, PR China
| | - Xi Hua
- Department of Nephrology, Nanjing First Hospital, Nanjing Medical University, Nanjing, PR China
| | - Wenjuan Huang
- Department of Nephrology, Nanjing First Hospital, Nanjing Medical University, Nanjing, PR China
| | - Xin Wan
- Department of Nephrology, Nanjing First Hospital, Nanjing Medical University, Nanjing, PR China
| | - Changchun Cao
- Department of Nephrology, Nanjing First Hospital, Nanjing Medical University, Nanjing, PR China
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4586
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Ye C, Tang H, Zhao Z, Lei CT, You CQ, Zhang J, Gao P, He FF, Chen S, Wang YM, Zhang C, Su H. MDM2 mediates fibroblast activation and renal tubulointerstitial fibrosis via a p53-independent pathway. Am J Physiol Renal Physiol 2017; 312:F760-F768. [PMID: 28100501 DOI: 10.1152/ajprenal.00528.2016] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Revised: 01/12/2017] [Accepted: 01/14/2017] [Indexed: 01/07/2023] Open
Abstract
It is well recognized that murine double minute gene 2 (MDM2) plays a critical role in cell proliferation and inflammatory processes during tumorigenesis. It is also reported that MDM2 is expressed in glomeruli and involved in podocyte injury. However, whether MDM2 is implicated in renal fibrosis remains unclear. Here we investigated the role of MDM2 in tubulointerstitial fibrosis (TIF). By immunohistochemical staining and Western blotting we confirmed that MDM2 is upregulated in the tubulointerstitial compartment in patients with TIF and unilateral urethral obstruction (UUO) mice, which mainly originates from myofibroblasts. Consistently, in vitro MDM2 is increased in TGF-β1-treated fibroblasts, one of the major sources of collagen-producing myofibroblasts during TIF, along with fibroblast activation. Importantly, genetic deletion of MDM2 significantly attenuates fibroblast activation. We then analyzed the possible downstream signaling of MDM2 during fibroblast activation. p53-dependent pathway is the classic downstream signaling of MDM2, and Nutlin-3 is a small molecular inhibitor of MDM2-p53 interaction. To our surprise, Nutlin-3 could not ameliorate fibroblast activation in vitro and TIF in UUO mice. However, we found that Notch1 signaling is attenuated during fibroblast activation, which could be markedly rescued by MDM2 knockdown. Overexpression of intracellular domain of Notch1 (NICD) by plasmid could obviously minimize fibroblast activation induced by TGF-β1. In addition, the degradation of NICD is strikingly suppressed by PYR-41, an inhibitor of ubiquitin-activating enzyme E1, and proteasome inhibitor MG132. Taken together, our findings provide the first evidence that MDM2 is involved in fibroblast activation and TIF, which associates with Notch1 ubiquitination and proteasome degradation.
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Affiliation(s)
- Chen Ye
- Department of Nephrology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hui Tang
- Department of Nephrology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zheng Zhao
- Department of Nephrology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chun-Tao Lei
- Department of Nephrology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chao-Qun You
- Department of Nephrology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jiao Zhang
- Department of Nephrology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Pan Gao
- Department of Nephrology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Fang-Fang He
- Department of Nephrology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shan Chen
- Department of Nephrology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yu-Mei Wang
- Department of Nephrology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chun Zhang
- Department of Nephrology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hua Su
- Department of Nephrology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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4587
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Oyarzún C, Garrido W, Alarcón S, Yáñez A, Sobrevia L, Quezada C, San Martín R. Adenosine contribution to normal renal physiology and chronic kidney disease. Mol Aspects Med 2017; 55:75-89. [PMID: 28109856 DOI: 10.1016/j.mam.2017.01.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Revised: 01/11/2017] [Accepted: 01/13/2017] [Indexed: 12/12/2022]
Abstract
Adenosine is a nucleoside that is particularly interesting to many scientific and clinical communities as it has important physiological and pathophysiological roles in the kidney. The distribution of adenosine receptors has only recently been elucidated; therefore it is likely that more biological roles of this nucleoside will be unveiled in the near future. Since the discovery of the involvement of adenosine in renal vasoconstriction and regulation of local renin production, further evidence has shown that adenosine signaling is also involved in the tubuloglomerular feedback mechanism, sodium reabsorption and the adaptive response to acute insults, such as ischemia. However, the most interesting finding was the increased adenosine levels in chronic kidney diseases such as diabetic nephropathy and also in non-diabetic animal models of renal fibrosis. When adenosine is chronically increased its signaling via the adenosine receptors may change, switching to a state that induces renal damage and produces phenotypic changes in resident cells. This review discusses the physiological and pathophysiological roles of adenosine and pays special attention to the mechanisms associated with switching homeostatic nucleoside levels to increased adenosine production in kidneys affected by CKD.
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Affiliation(s)
- Carlos Oyarzún
- Institute of Biochemistry and Microbiology, Science Faculty, Universidad Austral de Chile, Valdivia, Chile
| | - Wallys Garrido
- Institute of Biochemistry and Microbiology, Science Faculty, Universidad Austral de Chile, Valdivia, Chile
| | - Sebastián Alarcón
- Institute of Biochemistry and Microbiology, Science Faculty, Universidad Austral de Chile, Valdivia, Chile
| | - Alejandro Yáñez
- Institute of Biochemistry and Microbiology, Science Faculty, Universidad Austral de Chile, Valdivia, Chile
| | - Luis Sobrevia
- Cellular and Molecular Physiology Laboratory (CMPL), Division of Obstetrics and Gynaecology, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile; Department of Physiology, Faculty of Pharmacy, Universidad de Sevilla, Seville E-41012, Spain; University of Queensland Centre for Clinical Research (UQCCR), Faculty of Medicine and Biomedical Sciences, University of Queensland, Herston QLD 4029, Queensland, Australia
| | - Claudia Quezada
- Institute of Biochemistry and Microbiology, Science Faculty, Universidad Austral de Chile, Valdivia, Chile
| | - Rody San Martín
- Institute of Biochemistry and Microbiology, Science Faculty, Universidad Austral de Chile, Valdivia, Chile.
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4588
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Nkuipou-Kenfack E, Zürbig P, Mischak H. The long path towards implementation of clinical proteomics: Exemplified based on CKD273. Proteomics Clin Appl 2017; 11. [DOI: 10.1002/prca.201600104] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 11/28/2016] [Accepted: 12/22/2016] [Indexed: 12/26/2022]
Affiliation(s)
| | | | - Harald Mischak
- Mosaiques Diagnostics GmbH; Hannover Germany
- BHF Glasgow Cardiovascular Research Centre; University of Glasgow; Glasgow United Kingdom
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4589
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Yao K, Ricardo SD. Mesenchymal stem cells as novel micro-ribonucleic acid delivery vehicles in kidney disease. Nephrology (Carlton) 2017; 21:363-71. [PMID: 26437381 DOI: 10.1111/nep.12643] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Revised: 08/19/2015] [Accepted: 09/30/2015] [Indexed: 12/11/2022]
Abstract
MicroRNAs (miRNAs) are short single strands of RNA responsible for post-transcriptional regulation of gene expression and have been implicated in the pathogenesis of chronic kidney disease (CKD). Emerging evidence reports that miRNAs can reduce kidney fibrosis through regulation of targets associated with collagen and extracellular matrix accumulation. However, the development of miRNA therapies has been hampered by the lack of targeted and sustainable methods of systemic miRNA delivery. Mesenchymal stem cells (MSCs) provide a promising miRNA delivery platform to overcome toxicity, the potential for insertional mutations and the low efficiency of previous methods. MSCs are endogenously immunoprivileged and home to sites of inflammation. They also release trophic growth factors to modulate the immune system, alter the polarization of macrophages and provide renal protection and repair. The potential to engineer MSCs to express or overexpress miRNAs, released by exosomes, may enhance their natural functions. Clinical studies are already being conducted individually for the use of miRNAs in cancer and MSCs in diseases associated with CKD. Hence, the combination of miRNAs and MSCs may provide an unparalleled cell-based therapy for treating CKD.
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Affiliation(s)
- Kevin Yao
- Department of Anatomy and Developmental Biology, Monash University, Melbourne, Victoria, Australia
| | - Sharon D Ricardo
- Department of Anatomy and Developmental Biology, Monash University, Melbourne, Victoria, Australia
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4590
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Ye X, Liu X, Song D, Zhang X, Zhu B, Wei L, Pei X, Wu J, Lou T, Zhao W. Estimating glomerular filtration rate by serum creatinine or/and cystatin C equations: An analysis of multi-centre Chinese subjects. Nephrology (Carlton) 2017; 21:372-8. [PMID: 26427030 DOI: 10.1111/nep.12636] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 08/31/2015] [Accepted: 09/28/2015] [Indexed: 01/02/2023]
Abstract
AIM Various equations based on serum creatinine or/and cystatin C, required further validation in a Chinese population. We compared the performance of six Chinese equations (Mascr, Peiscr, Macys, Fengcys, Mascr-cys and Fengscr-cys) with the CKD-EPI equations in multi-centre Chinese subjects and evaluated their applicability in clinical practice. METHODS A total of 1522 adult patients from four different hospitals of China were enrolled in the study. (99m) Tc-DTPA renal dynamic imaging was used as the reference GFR (rGFR), and serum creatinine and cystatin C were measured by standardized assays. An optimal score system was implemented in the study. RESULTS The average rGFR of recruited subjects was 67.30±28.89 mL/min per 1.73m(2) . All estimated GFR (eGFR) correlated well with rGFR. In accordance with Bland-Altman analysis, the Fengscr-cys equations achieved optimal overall performance (score 14 vs 0-6), with least bias (median difference, -0.57 mL/min per 1.73m(2) ; median absolute difference, 8.83 mL/min per 1.73m(2) ), best precision (17.99 mL/min per 1.73m(2) ), highest accuracy (percentage of eGFR within 15%, 30% and 50% of the rGFR (P15 , P30 and P50 ; 49.7%, 78.7% and 91.8%, respectively); root-mean-square-error (RMSE, 16.28)). The Fengcys equation, a typical cystatin C based equation, was another well-behaved formula with an impressive performance. The Ma equations performed much poorer than the CKD-EPI equations. Consistent results can be observed in the GFR- /age- and sex-specific subgroups, while none equation yielded ideal accuracy in GFR<60 mL/min per 1.73 m(2) subgroup. CONCLUSION The Fengscr-cys equation appeared to achieve the best performance for GFR estimation in overall Chinese adult patients. However, further research is warranted to improve the accuracy of available equations in GFR less than 60 mL/min per 1.73 m(2) individuals.
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Affiliation(s)
- Xiaoshuang Ye
- Department of Nephrology, Jiangsu Geriatric Hospital, Nanjing, Jiangsu, China.,Division of Nephrology, Department of Geriatrics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xun Liu
- Division of Nephrology, Department of Internal Medicine, The Third Affiliated hospital of sun Yat-sen University, Guangzhou, China
| | - Dan Song
- Department of Nephrology, The Second Affiliated hospital of Wuxi Hospital, Nanjing Medical University, Wuxi, China
| | - Xiaoxuan Zhang
- Department of Nephrology, The FAW General Hospital, The Fourth Affiliated hospital of JiLin University, Changchun, China
| | - Bei Zhu
- Division of Nephrology, Department of Geriatrics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Lu Wei
- Division of Nephrology, Department of Geriatrics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xiaohua Pei
- Division of Nephrology, Department of Geriatrics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jianqing Wu
- Division of Respiration, Department of Geriatrics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Tanqi Lou
- Division of Nephrology, Department of Internal Medicine, The Third Affiliated hospital of sun Yat-sen University, Guangzhou, China
| | - Weihong Zhao
- Department of Nephrology, Jiangsu Geriatric Hospital, Nanjing, Jiangsu, China
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4591
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Huang J, Weinfurter S, Daniele C, Perciaccante R, Federica R, Della Ciana L, Pill J, Gretz N. Zwitterionic near infrared fluorescent agents for noninvasive real-time transcutaneous assessment of kidney function. Chem Sci 2017; 8:2652-2660. [PMID: 28553500 PMCID: PMC5431684 DOI: 10.1039/c6sc05059j] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 01/08/2017] [Indexed: 12/28/2022] Open
Abstract
Zwitterionic near infrared fluorescent agents were developed for non-invasive real-time transcutaneous assessment of kidney function.
We developed novel zwitterionic near infrared (NIR) fluorescent agents (ABZWCY-HPβCD and AAZWCY-HPβCD), which exhibit favorable hydrophilicity, low plasma protein binding, high stability and non-toxicity. These attractive characteristics ensure that they are excreted rapidly, without any skin accumulation or metabolism in vivo. More importantly, zwitterionic HPβCD based agents can be efficiently filtrated by the glomerulus and completely excreted through the kidneys into urine without reabsorption or secretion in the kidney proximal tubule. Relying on these novel zwitterionic NIR agents and a transcutaneous device, we demonstrate a rapid, robust and biocompatible approach for assessing kidney function in rat models of both healthy rats and those with kidney disease, without the need for time-consuming blood/urine sample preparation. Our work provides a promising tool for in vivo real-time non-invasive kidney function assessment in preclinical applications.
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Affiliation(s)
- Jiaguo Huang
- Medical Research Center , Medical Faculty Mannheim , University of Heidelberg , Theodor-Kutzer-Ufer 1-3 , 68167 , Mannheim , Germany .
| | - Stefanie Weinfurter
- Medical Research Center , Medical Faculty Mannheim , University of Heidelberg , Theodor-Kutzer-Ufer 1-3 , 68167 , Mannheim , Germany .
| | - Cristina Daniele
- Medical Research Center , Medical Faculty Mannheim , University of Heidelberg , Theodor-Kutzer-Ufer 1-3 , 68167 , Mannheim , Germany .
| | | | - Rodeghiero Federica
- Cyanagen S.r.l. , Via degli Stradelli Guelfi 40/C , 40138 Bologna , BO , Italy
| | | | - Johannes Pill
- Medical Research Center , Medical Faculty Mannheim , University of Heidelberg , Theodor-Kutzer-Ufer 1-3 , 68167 , Mannheim , Germany .
| | - Norbert Gretz
- Medical Research Center , Medical Faculty Mannheim , University of Heidelberg , Theodor-Kutzer-Ufer 1-3 , 68167 , Mannheim , Germany .
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4592
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Tan BK, Yu Z, Fang W, Lin A, Ni Z, Qian J, Woodrow G, Jenkins SB, Wilkie ME, Davies SJ. Longitudinal bioimpedance vector plots add little value to fluid management of peritoneal dialysis patients. Kidney Int 2017; 89:487-97. [PMID: 26466321 DOI: 10.1038/ki.2015.294] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 08/07/2015] [Accepted: 08/13/2015] [Indexed: 01/30/2023]
Abstract
Bioimpedance (BI) has the potential to enable better management of fluid balance, which can worsen over time on peritoneal dialysis (PD) due to loss of residual kidney function and progressive muscle wasting. We undertook a prospective, randomized, open-label, blinded end-point controlled trial to determine whether availability of longitudinal BI measures as vector plots helped clinicians maintain stable fluid status over 12 months in 308 peritoneal dialysis patients from the United Kingdom and Shanghai, China. Patients were recruited into 4 groups nested within a single trial design according to country and residual kidney function. Nonanuric subjects from both countries demonstrated stable fluid volumes irrespective of randomization. Hydration worsened in control anuric patients in Shanghai with increased extracellular/total body water (ECW/TBW) ratio (0.04; 95% CI: 0.01, 0.06) and reduced TBW (-1.76 L 95% CI: -2.70, -0.82), but was stable in the BI intervention group whose dialysate glucose prescription was increased. However, multilevel analysis incorporating data from both countries showed worsening ECW/TBW in active and control anuric patients. Clinicians in the United Kingdom reduced target weight in the nonanuric BI intervention group causing a reduction in TBW without beneficial effects on ECW or blood pressure. Thus, routine use of longitudinal BI vector plots to improve clinical management of fluid status is not supported.
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4593
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Ene-Iordache B, Perico N, Bikbov B, Carminati S, Remuzzi A, Perna A, Islam N, Bravo RF, Aleckovic-Halilovic M, Zou H, Zhang L, Gouda Z, Tchokhonelidze I, Abraham G, Mahdavi-Mazdeh M, Gallieni M, Codreanu I, Togtokh A, Sharma SK, Koirala P, Uprety S, Ulasi I, Remuzzi G. Chronic kidney disease and cardiovascular risk in six regions of the world (ISN-KDDC): a cross-sectional study. Lancet Glob Health 2017; 4:e307-19. [PMID: 27102194 DOI: 10.1016/s2214-109x(16)00071-1] [Citation(s) in RCA: 273] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 03/02/2016] [Accepted: 03/04/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND Chronic kidney disease is an important cause of global mortality and morbidity. Data for epidemiological features of chronic kidney disease and its risk factors are limited for low-income and middle-income countries. The International Society of Nephrology's Kidney Disease Data Center (ISN-KDDC) aimed to assess the prevalence and awareness of chronic kidney disease and its risk factors, and to investigate the risk of cardiovascular disease, in countries of low and middle income. METHODS We did a cross-sectional study in 12 countries from six world regions: Bangladesh, Bolivia, Bosnia and Herzegovina, China, Egypt, Georgia, India, Iran, Moldova, Mongolia, Nepal, and Nigeria. We analysed data from screening programmes in these countries, matching eight general and four high-risk population cohorts collected in the ISN-KDDC database. High-risk cohorts were individuals at risk of or with a diagnosis of either chronic kidney disease, hypertension, diabetes, or cardiovascular disease. Participants completed a self-report questionnaire, had their blood pressure measured, and blood and urine samples taken. We defined chronic kidney disease according to modified KDIGO (Kidney Disease: Improving Global Outcomes) criteria; risk of cardiovascular disease development was estimated with the Framingham risk score. FINDINGS 75,058 individuals were included in the study. The prevalence of chronic kidney disease was 14·3% (95% CI 14·0-14·5) in general populations and 36·1% (34·7-37·6) in high-risk populations. Overall awareness of chronic kidney disease was low, with 409 (6%) of 6631 individuals in general populations and 150 (10%) of 1524 participants from high-risk populations aware they had chronic kidney disease. Moreover, in the general population, 5600 (44%) of 12,751 individuals with hypertension did not know they had the disorder, and 973 (31%) of 3130 people with diabetes were unaware they had that disease. The number of participants at high risk of cardiovascular disease, according to the Framingham risk score, was underestimated compared with KDIGO guidelines. For example, all individuals with chronic kidney disease should be considered at high risk of cardiovascular disease, but the Framingham risk score detects only 23% in the general population, and only 38% in high-risk cohorts. INTERPRETATION Prevalence of chronic kidney disease was high in general and high-risk populations from countries of low and middle income. Moreover, awareness of chronic kidney disease and other non-communicable diseases was low, and a substantial number of individuals who knew they were ill did not receive treatment. Prospective programmes with repeat testing are needed to confirm the diagnosis of chronic kidney disease and its risk factors. Furthermore, in general, health-care workforces in countries of low and middle income need strengthening. FUNDING International Society of Nephrology.
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Affiliation(s)
- Bogdan Ene-Iordache
- IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Clinical Research Center for Rare Diseases "Aldo e Cele Daccò", Ranica, Italy.
| | - Norberto Perico
- IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Clinical Research Center for Rare Diseases "Aldo e Cele Daccò", Ranica, Italy
| | - Boris Bikbov
- Department of Nephrology, A I Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia; Department of Nephrology Issues of Transplanted Kidney, Academician V I Shumakov Federal Research Center of Transplantology and Artificial Organs, Moscow, Russia
| | - Sergio Carminati
- IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Clinical Research Center for Rare Diseases "Aldo e Cele Daccò", Ranica, Italy
| | - Andrea Remuzzi
- IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Clinical Research Center for Rare Diseases "Aldo e Cele Daccò", Ranica, Italy; Department of Management, Information and Production and Engineering, University of Bergamo, Dalmine, Italy
| | - Annalisa Perna
- IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Clinical Research Center for Rare Diseases "Aldo e Cele Daccò", Ranica, Italy
| | - Nazmul Islam
- Department of Nephrology, North East Medical College Hospital, Sylhet, Bangladesh
| | | | - Mirna Aleckovic-Halilovic
- Department of Nephrology, Dialysis and Kidney Transplantation, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
| | - Hequn Zou
- Department of Nephrology, Institute of Nephrology and Urology, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Luxia Zhang
- Renal Division, Department of Medicine, Peking University First Hospital, Peking University Institute of Nephrology, Beijing, China
| | - Zaghloul Gouda
- Department of Nephrology, Damanhour Medical National Institute, General Organization of Teaching Hospitals and Institutes, Damanhour, Egypt
| | - Irma Tchokhonelidze
- Nephrology Development Clinical Center, Tbilisi State Medical University, Tbilisi, Georgia
| | | | - Mitra Mahdavi-Mazdeh
- Department of Nephrology, Tehran University of Medical Sciences, Research Center of Iranian Tissue Bank, Tehran, Iran
| | - Maurizio Gallieni
- Nephrology and Dialysis Unit, San Carlo Borromeo Hospital, University of Milan, Milan, Italy
| | | | - Ariunaa Togtokh
- Department of Nephrology, University of Mongolia, Ulaan Bataar, Mongolia
| | - Sanjib Kumar Sharma
- Department of Internal Medicine, BP Koirala Institute of Health Sciences, Dharan, Nepal
| | - Puru Koirala
- Department of Internal Medicine, BP Koirala Institute of Health Sciences, Dharan, Nepal
| | - Samyog Uprety
- School of Public Health and Department of Community Medicine, BP Koirala Institute of Health Sciences, Dharan, Nepal
| | - Ifeoma Ulasi
- Renal Unit, Department of Medicine, College of Medicine, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Giuseppe Remuzzi
- IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Clinical Research Center for Rare Diseases "Aldo e Cele Daccò", Ranica, Italy; Department of Medicine, Unit of Nephrology and Dialysis, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy; Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
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4594
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Wei XB, Liu YH, He PC, Yu DQ, Zhou YL, Tan N, Chen JY. Prognostic value of N-terminal prohormone brain natriuretic peptide for in-hospital and long-term outcomes in patients with infective endocarditis. Eur J Prev Cardiol 2017; 24:676-684. [PMID: 28067531 DOI: 10.1177/2047487316686436] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Xue-biao Wei
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academic of Medical Sciences, Guangdong, China
| | - Yuan-hui Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academic of Medical Sciences, Guangdong, China
| | - Peng-cheng He
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academic of Medical Sciences, Guangdong, China
| | - Dan-qing Yu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academic of Medical Sciences, Guangdong, China
| | - Ying-ling Zhou
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academic of Medical Sciences, Guangdong, China
| | - Ning Tan
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academic of Medical Sciences, Guangdong, China
| | - Ji-yan Chen
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academic of Medical Sciences, Guangdong, China
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4595
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Affiliation(s)
- Mariëlle Kloosterman
- 1 Department of Cardiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Michiel Rienstra
- 1 Department of Cardiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Harry J Crijns
- 2 Department of Cardiology, Maastricht University Medical Centre, Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Jeff S Healey
- 3 Population Health Research Institute, McMaster University, Ontario, Canada
| | - Isabelle C Van Gelder
- 1 Department of Cardiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
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4596
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Shi Z, Taylor AW, Riley M, Byles J, Liu J, Noakes M. Association between dietary patterns, cadmium intake and chronic kidney disease among adults. Clin Nutr 2018; 37:276-84. [PMID: 28094058 DOI: 10.1016/j.clnu.2016.12.025] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 12/01/2016] [Accepted: 12/28/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND & AIMS Almost one in ten Chinese adults has chronic kidney disease (CKD). However, the link between dietary patterns, dietary cadmium intake and CKD has not been studied in China. METHOD Adults (n = 8429) in the China Health and Nutrition Survey who had at least one 3-day 24 h food record in combination with household food inventory in 1991, 1993, 1997, 2000, 2004, 2006, and 2009 and estimated glomerular filtration rate (eGFR) measured in 2009. Dietary pattern was identified using factor analysis. CKD was defined as eGFR <60 mL/min/1.73 m2. RESULTS There were 641 (7.6%) cases of CKD in the sample. After adjustment for demographic, lifestyle factors (i.e. smoking, alcohol drinking, physical activity) and chronic conditions, the odds ratio (OR) for CKD was 4.05 (95%CI 2.91-5.63, p for trend <0.001) for extreme quartiles of estimated cumulative cadmium intake. A traditional southern dietary pattern (high intake of rice, pork, and vegetables, and low intake of wheat) was associated with more than four times increased prevalence of CKD (comparing extreme quartiles, OR 4.56, 95%CI 3.18-6.56). A modern dietary pattern (high intake of fruit, soy milk, egg, milk and deep fried products) was inversely associated with CKD (for extreme quartiles, OR 0.5, 95%CI 0.36-0.71). The association between dietary patterns and CKD were attenuated by cadmium intake. CONCLUSION Traditional southern dietary pattern is positively associated, and modern dietary pattern is inversely associated, with CKD among Chinese adults. However, these associations can be partly attributed to cadmium contamination in parts of the food supply.
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4597
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Wearne N, Kilonzo K, Effa E, Davidson B, Nourse P, Ekrikpo U, Okpechi IG. Continuous ambulatory peritoneal dialysis: perspectives on patient selection in low- to middle-income countries. Int J Nephrol Renovasc Dis 2017; 10:1-9. [PMID: 28115864 PMCID: PMC5221809 DOI: 10.2147/ijnrd.s104208] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Chronic kidney disease is a major public health problem that continues to show an unrelenting global increase in prevalence. The prevalence of chronic kidney disease has been predicted to grow the fastest in low- to middle-income countries (LMICs). There is evidence that people living in LMICs have the highest need for renal replacement therapy (RRT) despite the lowest access to various modalities of treatment. As continuous ambulatory peritoneal dialysis (CAPD) does not require advanced technologies, much infrastructure, or need for dialysis staff support, it should be an ideal form of RRT in LMICs, particularly for those living in remote areas. However, CAPD is scarcely available in many LMICs, and even where available, there are several hurdles to be confronted regarding patient selection for this modality. High cost of CAPD due to unavailability of fluids, low patient education and motivation, low remuneration for nephrologists, lack of expertise/experience for catheter insertion and management of complications, presence of associated comorbid diseases, and various socio-demographic factors contribute significantly toward reduced patient selection for CAPD. Cost of CAPD fluids seems to be a major constraint given that many countries do not have the capacity to manufacture fluids but instead rely heavily on fluids imported from developed countries. There is need to invest in fluid manufacturing (either nationally or regionally) in LMICs to improve uptake of patients treated with CAPD. Workforce training and retraining will be necessary to ensure that there is coordination of CAPD programs and increase the use of protocols designed to improve CAPD outcomes such as insertion of catheters, treatment of peritonitis, and treatment of complications associated with CAPD. Training of nephrology workforce in CAPD will increase workforce experience and make CAPD a more acceptable RRT modality with improved outcomes.
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Affiliation(s)
- Nicola Wearne
- Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa
| | - Kajiru Kilonzo
- Department of Medicine, Kilimanjaro Christian Medical College, Moshi, Tanzania
| | - Emmanuel Effa
- Department of Medicine, University of Calabar, Calabar, Nigeria
| | - Bianca Davidson
- Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa
| | - Peter Nourse
- Division of Paediatric Nephrology, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | - Udeme Ekrikpo
- Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa; Department of Internal Medicine, University of Uyo, Uyo, Nigeria
| | - Ikechi G Okpechi
- Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa
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4598
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Tsai IT, Wang CP, Lu YC, Hung WC, Wu CC, Lu LF, Chung FM, Hsu CC, Lee YJ, Yu TH. The burden of major adverse cardiac events in patients with coronary artery disease. BMC Cardiovasc Disord 2017; 17:1. [PMID: 28052754 PMCID: PMC5210314 DOI: 10.1186/s12872-016-0436-7] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 12/07/2016] [Indexed: 12/30/2022] Open
Abstract
Background Patients with a history of cardiovascular disease are at high risk of developing secondary major adverse cardiac events (MACE). This study aimed to identify independent predictors of MACE after hospital admission which could be used to identify of high-risk patients who may benefit from preventive strategies. Methods This study included 1,520 consecutive patients with coronary artery disease (CAD) (654 with acute coronary syndrome (ACS) and 866 with elective percutaneous coronary intervention (PCI) patients) who received PCI and/or stenting. MACE was defined as all-cause mortality or rehospitalization for a cardiovascular- related illness. Cardiovascular-related illnesses included heart failure, reinfarction (nonfatal), recurrence of angina pectoris and repeat PCI or coronary artery bypass graft. Results During a mean follow-up period of 32 months, 558 of the 1,520 patients developed at least one MACE. Cox regression analysis showed that the baseline clinical and biochemical variables which associated with MACE were age, being illiterate, a widow or widower, and/or economically dependent, having triple vessel disease, stent implantation, anemia, and/or diabetes mellitus, waist to hip ratio (WHR), diastolic blood pressure, fasting glucose, total cholesterol, high-density lipoprotein cholesterol (HDL-C), creatinine, estimated glomerular filtration rate (eGFR), red blood cell count, hemoglobin, hematocrit, and mean corpuscular-hemoglobin concentration (MCHC) in ACS patients, and age, malnourished, and/or economically dependent, taking hypoglycemic medication, having triple vessel disease, stent implantation, anemia, diabetes mellitus, and/or hypertension, WHR, fasting glucose, HDL-C, uric acid, creatinine, eGFR, high-sensitivity C-reactive protein, mean corpuscular volume, and MCHC in elective PCI patients. Using multivariate Cox regression analysis, we found the MACE’s independent factors are triple vessel disease, stent implantation, hypertension, and eGFR in ACS patients, and having triple vessel disease, stent implantation, hypertension, and uric acid in elective PCI patients. Conclusions Having triple vessel disease, stent implantation, hypertension, and eGFR or uric acid independently predicted MACE in patients with CAD after long-term follow-up. Fortunately, these factors are modifiable and should be identified and monitored early.
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Affiliation(s)
- I-Ting Tsai
- Department of Emergency, E-Da Hospital, I-Shou University, Kaohsiung, 82445, Taiwan.,Department of Nursing, I-Shou University, Kaohsiung, 82445, Taiwan
| | - Chao-Ping Wang
- Division of Cardiology, E-Da Hospital, I-Shou University, No. 1, Yi-Da Rd, Jiau-Shu Village, Yan-Chao District, Kaohsiung, 82445, Taiwan.,School of Medicine for International Students, E-Da Hospital, I-Shou University, Kaohsiung, 82445, Taiwan
| | - Yung-Chuan Lu
- Division of Endocrinology and Metabolism, E-Da Hospital, I-Shou University, Kaohsiung, 82445, Taiwan.,School of Medicine for International Students, E-Da Hospital, I-Shou University, Kaohsiung, 82445, Taiwan
| | - Wei-Chin Hung
- Division of Cardiology, E-Da Hospital, I-Shou University, No. 1, Yi-Da Rd, Jiau-Shu Village, Yan-Chao District, Kaohsiung, 82445, Taiwan
| | - Cheng-Ching Wu
- Division of Cardiology, E-Da Hospital, I-Shou University, No. 1, Yi-Da Rd, Jiau-Shu Village, Yan-Chao District, Kaohsiung, 82445, Taiwan.,Department of Biomedical Engineering, National Cheng Kung University, Tainan, 70101, Taiwan
| | - Li-Fen Lu
- Division of Cardiac Surgery, Department of Surgery, E-Da Hospital, I-Shou University, Kaohsiung, 82445, Taiwan
| | - Fu-Mei Chung
- Division of Cardiology, E-Da Hospital, I-Shou University, No. 1, Yi-Da Rd, Jiau-Shu Village, Yan-Chao District, Kaohsiung, 82445, Taiwan
| | - Chia-Chang Hsu
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung, 82445, Taiwan
| | | | - Teng-Hung Yu
- Division of Cardiology, E-Da Hospital, I-Shou University, No. 1, Yi-Da Rd, Jiau-Shu Village, Yan-Chao District, Kaohsiung, 82445, Taiwan.
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4599
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Li D, Zhang L, Zuo L, Jin CG, Li WG, Chen JB. Association of CKD-MBD Markers with All-Cause Mortality in Prevalent Hemodialysis Patients: A Cohort Study in Beijing. PLoS One 2017; 12:e0168537. [PMID: 28045985 PMCID: PMC5207661 DOI: 10.1371/journal.pone.0168537] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 12/03/2016] [Indexed: 02/05/2023] Open
Abstract
The relationships between all-cause mortality and serum intact parathyroid hormone (iPTH), calcium, and phosphate are fairly diverse in patients on maintenance hemodialysis according to prior studies. This study evaluated the association of chronic kidney disease-mineral and bone disorder (CKD-MBD) markers with all-cause mortality in prevalent hemodialysis patients from 2007 to 2012 in Beijing, China. A cohort, involving 8530 prevalent hemodialysis patients who had undergone a 6-70 months follow-up program (with median as 40 months) was formed. Related data was recorded from the database in 120 hemodialysis centers of Beijing Health Bureau (2007 to 2012). Information regarding baseline demographics, blood CKD-MBD markers and all-cause mortality was retrospectively reviewed. By using multivariate Cox regression model analysis, patients with a low iPTH level at baseline were found to have greater risk of mortality (<75pg/ml, HR = 1.36, 95% confidence interval (CI) 1.16-1.60) than those with a baseline iPTH level within 150-300 pg/ml. Similarly, death risk showed an increase when the baseline serum calcium presented a low level (<2.1mmol/L, HR = 1.54; 95% CI 1.37-1.74). Levels of baseline serum phosphorus were not associated with the risk of death. Similar results appeared through the baseline competing risks regression analysis. Patients with a lower level of serum iPTH or calcium are at a higher risk of all-cause mortality compared with those within the range recommended by Kidney Disease Outcome Quality Initiative (KDOQI) guidelines.
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Affiliation(s)
- Duo Li
- Department of Nephrology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Ling Zhang
- Department of Nephrology, China-Japan Friendship Hospital, Beijing, China
| | - Li Zuo
- Department of Nephrology, People’s hospital, Peking University, Beijing, China
| | - Cheng Gang Jin
- School of Social Development and Public Policy, Beijing Normal University
| | - Wen Ge Li
- Department of Nephrology, China-Japan Friendship Hospital, Beijing, China
| | - Jin-Bor Chen
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
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4600
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Caplin B, Jakobsson K, Glaser J, Nitsch D, Jha V, Singh A, Correa-Rotter R, Pearce N. International Collaboration for the Epidemiology of eGFR in Low and Middle Income Populations - Rationale and core protocol for the Disadvantaged Populations eGFR Epidemiology Study (DEGREE). BMC Nephrol 2017; 18:1. [PMID: 28049448 PMCID: PMC5210224 DOI: 10.1186/s12882-016-0417-1] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 12/09/2016] [Indexed: 11/10/2022] Open
Abstract
Background There is an increasing recognition of epidemics of primarily tubular-interstitial chronic kidney disease (CKD) clustering in agricultural communities in low- and middle-income countries (LMICs). Although it is currently unclear whether there is a unified underlying aetiology, these conditions have been collectively termed CKD of undetermined cause (CKDu). CKDu is estimated to have led to the premature deaths of tens to hundreds of thousands of young men and women over the last 2 decades. Thus, there is an urgent need to understand the aetiology and pathophysiology of these condition (s). International comparisons have provided the first steps in understanding many chronic diseases, but such comparisons rely on the availability of standardised tools to estimate disease prevalence. This is a particular problem with CKD, since the disease is asymptomatic until the late stages, and the biases inherent in the methods used to estimate the glomerular filtration rate (GFR) in population studies are highly variable across populations. Method We therefore propose a simple standardised protocol to estimate the distribution of GFR in LMIC populations – The Disadvantaged Populations eGFR Epidemiology (DEGREE) Study. This involves the quantification of renal function in a representative adult population-based sample and a requirement for standardisation of serum creatinine measurements, along with storage of samples for future measurements of cystatin C and ascertainment of estimates of body composition, in order to obtain valid comparisons of estimated GFR (eGFR) within and between populations. Discussion The methodology we present is potentially applicable anywhere, but our particular focus is on disadvantaged populations in LMICs, since these appear to be most susceptible to CKDu. Although the protocol could also be used in specific groups (e.g. occupational groups, thought to be at excess risk of CKDu) the primary aim of the DEGREE project is characterise the population distribution of eGFR in multiple regions so that international comparisons can be performed. It is only with a standardised approach that it will be possible to estimate the scale of, and variation in, impaired kidney function between affected areas. These data should then provide insights into important social, demographic and environmental risk factors for this increasingly recognised disease. Electronic supplementary material The online version of this article (doi:10.1186/s12882-016-0417-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ben Caplin
- Centre for Nephrology, UCL Medical School Royal Free, London, NW3 2PF, UK.
| | - Kristina Jakobsson
- Division of Occupational and Environmental Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.,Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
| | | | - Dorothea Nitsch
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Vivekanand Jha
- George Institute for Global Health India, New Delhi, India.,University of Oxford, Oxford, UK
| | - Ajay Singh
- Department of Global and Continuing Education, Harvard Medical School, Boston, USA
| | - Ricardo Correa-Rotter
- Department of Nephrology and Mineral Metabolism at the Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubirán, Mexico City, Mexico
| | - Neil Pearce
- Department of Non-Communicable Disease Epidemiology and Centre for Global NCDs, London School of Hygiene and Tropical Medicine, London, UK
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