1
|
Bracarda S, Iacovelli R, Baldazzi V, Zucali PA, Gernone A, Conti GN, Pappagallo G, Brunelli M, Bruzzi P, Fiorini E, Magenta L, Diomede F, Mereta F, D’Aria I, Magliano D, Liberatori M, Cantù D, Croce D, Eandi S, Colombo GL, Ferrante F, Salè EO, Marinozzi A, Lenzi D, Remiddi F, Remiddi S. U-CHANGE Project: a multidimensional consensus on how clinicians, patients and caregivers may approach together the new urothelial cancer scenario. Front Oncol 2023; 13:1186103. [PMID: 37576880 PMCID: PMC10422043 DOI: 10.3389/fonc.2023.1186103] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 06/29/2023] [Indexed: 08/15/2023] Open
Abstract
Introduction Advanced urothelial carcinoma remains aggressive and very hard to cure, while new treatments will pose a challenge for clinicians and healthcare funding policymakers alike. The U-CHANGE Project aimed to redesign the current model of care for advanced urothelial carcinoma patients to identify limitations ("as is" scenario) and recommend future actions ("to be" scenario). Methods Twenty-three subject-matter experts, divided into three groups, analyzed the two scenarios as part of a multidimensional consensus process, developing statements for specific domains of the disease, and a simplified Delphi methodology was used to establish consensus among the experts. Results Recommended actions included increasing awareness of the disease, increased training of healthcare professionals, improvement of screening strategies and care pathways, increased support for patients and caregivers and relevant recommendations from molecular tumor boards when comprehensive genomic profiling has to be provided for appropriate patient selection to ad hoc targeted therapies. Discussion While the innovative new targeted agents have the potential to significantly alter the clinical approach to this highly aggressive disease, the U-CHANGE Project experience shows that the use of these new agents will require a radical shift in the entire model of care, implementing sustainable changes which anticipate the benefits of future treatments, capable of targeting the right patient with the right agent at different stages of the disease.
Collapse
Affiliation(s)
- Sergio Bracarda
- President of Italian Society of Uro-Oncology, Department of Medical Oncology, Santa Maria Hospital, Terni, Italy
| | - Roberto Iacovelli
- Department of Medical Oncology, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Valentina Baldazzi
- Department of Medical Oncology, Santa Maria Annunziata Hospital, Florence, Italy
| | - Paolo Andrea Zucali
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Department of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Angela Gernone
- Department of Medical Oncology, Policlinico Universitario Azienda Ospedaliera (A.O), Bari, Italy
| | | | | | - Matteo Brunelli
- Pathology Unit, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Paolo Bruzzi
- Department of Clinical Epidemiology, National Institute for Cancer Research, Istituto Scientifico Tumori (IST), Genoa, Italy
| | | | | | - Francesco Diomede
- Federazione Associazioni Volontariato in Oncologia (F.A.V.O) Federation, Rome, Italy
| | | | | | | | - Monica Liberatori
- Department of Medical Oncology, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Daniela Cantù
- Italian Association of Physiotherapists, Milan, Italy
| | - Davide Croce
- Centro di Ricerca sull’Economia e il Management in Sanità e nel Sociale, Libero Istituto Universitario Cattaneo (LIUC) Business School, Castellanza (VA), Turin, Italy
| | - Simone Eandi
- Social Innovation EcosystEm Development (SEEd) Medica Publishers, Turin, Italy
| | | | - Fulvio Ferrante
- Department of Diagnostic and Pharmaceutical Assistance, Unità Operativa Complessa (UOC) Pharmacy, Local Health Unit Azienda Sanitaria Locale (ASL) Frosinone, Frosinone, Italy
| | - Emanuela Omodeo Salè
- Department Hospital Pharmacy, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Andrea Marinozzi
- Clinical Pharmacy, Azienda Ospedaliera Universitaria (AOU) Ospedali Riuniti, Ancona, Italy
| | - Daniele Lenzi
- Medical Department, Azienda Ospedaliera Università, Siena, Italy
| | | | - Stefano Remiddi
- Medical Writing & Statistics Department, NUME PLUS, Florence, Italy
| |
Collapse
|
2
|
Mejia JR, Fernandez-Chinguel JE, Dolores-Maldonado G, Becerra-Chauca N, Goicochea-Lugo S, Herrera-Añazco P, Zafra-Tanaka JH, Taype-Rondan A. Diagnostic accuracy of urine dipstick testing for albumin-to-creatinine ratio and albuminuria: A systematic review and meta-analysis. Heliyon 2021; 7:e08253. [PMID: 34765776 PMCID: PMC8571083 DOI: 10.1016/j.heliyon.2021.e08253] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 09/05/2021] [Accepted: 10/21/2021] [Indexed: 12/03/2022] Open
Abstract
Background The accuracy of urine dipsticks to detect increased albuminuria is uncertain. We aimed to assess the diagnostic accuracy of urine dipsticks for detecting albuminuria. Methods A systematic review of studies that assessed the diagnostic accuracy of urine dipstick testing for detecting albuminuria has been conducted (using as reference standard the albuminuria in a 24-hour sample or the albumin-to-creatinine ratio) in Scopus, PubMed, and Google Scholar. The risk of bias of the included studies has been assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. Whenever possible, we performed meta-analyses for sensitivity and specificity. The certainty of the evidence has also been assessed using the Grading of Recommendations Assessment, Development, and Evaluation methodology. Results A total of 14 studies have been included in this review, having assessed all albumin-to-creatinine ratio (ACR) as assessed standard. Each study used different dipstick types. The resulting pooled sensitivity and specificity for each cutoff point were as follows: for ACR >30 mg/g (13 studies): 0.82 (95% confidence interval: 0.76–0.87) and 0.88 (0.83–0.91); for ACR 30–300 mg/g (7 studies): 0.72 (0.68–0.77) and 0.82 (0.76–0.89); and for ACR >300 mg/g (7 studies): 0.84 (0.71–0.90) and 0.97 (0.95–0.99), respectively. An overall high risk of bias, an important heterogeneity in all pooled analysis, and a very low certainty of the evidence have been found. Conclusions Pooled sensitivity and specificity of urine dipsticks have been calculated for different ACR cutoff points. However, the dipstick types differed across studies, and the certainty of the evidence was very low. Thus, further well-designed studies are needed to reach more confident estimates and to assess accuracy differences across dipstick types. Registration PROSPERO (CRD42019124637).
Collapse
Affiliation(s)
- Jhonatan R. Mejia
- Universidad Nacional del Centro del Perú, Sociedad Científica de Estudiantes de Medicina del Centro, Huancayo, Peru
| | | | | | | | | | - Percy Herrera-Añazco
- Instituto de Evaluación de Tecnologías en Salud e Investigación-IETSI, Lima, Peru
- Universidad Privada San Juan Bautista, Lima, Peru
| | | | - Alvaro Taype-Rondan
- Universidad San Ignacio de Loyola, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Lima, Peru
- Corresponding author.
| |
Collapse
|
3
|
Giribaldi G, Filippini C, Viberti C, Khadjavi A, Finesso N, Ulliers D, Turini S, Bressan BE, Pecoraro F, Prato M, Allione A, Bellis MD, Montefusco G, Bonomessi G, Allasia M, Matullo G, Soria F, Gontero P. Combination of urinary fibrinogen β-chain and tyrosine-phosphorylated proteins for the detection of bladder cancer. Future Sci OA 2021; 7:FSO758. [PMID: 34737890 PMCID: PMC8558871 DOI: 10.2144/fsoa-2021-0060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 08/30/2021] [Indexed: 11/23/2022] Open
Abstract
Aim: To evaluate the performance of urinary fibrinogen β-chain (FBC) – either alone or associated with urinary tyrosine-phosphorylated proteins (UPY) – as bladder cancer (BCa) diagnostic biomarker. Materials & methods: 164 subjects were tested. Results: Significantly different FBC and UPY levels were found between BCa patients and controls, as well as between low-grade and high-grade cancers. The diagnostic accuracy was 0.84 for FBC and 0.87 for UPY. The combination of FBC and UPY improved the accuracy to 0.91. The addition of clinical variables (age, gender, and smoking habit) to FBC and UPY into a model for BCa prediction significantly improved the accuracy to 0.99. The combination of FBC and UPY adjusted for clinical variables associates with the highest sensitivity and good specificity. Conclusion: Urinary FBC and UPY could be used as biomarkers for BCa diagnosis. This research has developed and validated a highly accurate predictive model for BCa diagnosis based on the combination of two urinary biomarkers, fibrinogen β-chain (FBC), and urinary tyrosine-phosphorylated proteins (UPY), and some clinical variables (age, gender and smoking habit). If the preliminary promising results will be confirmed by external validations and prospective trials in selected clinical scenarios, our model could be transferred to clinical practice for screening of high-risk population.
Collapse
Affiliation(s)
| | | | - Clara Viberti
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Amina Khadjavi
- Department of Oncology, University of Turin, Turin, Italy
| | - Nicole Finesso
- Department of Oncology, University of Turin, Turin, Italy
| | | | - Stefano Turini
- Department of Neurosciences, University of Turin, Turin, Italy
| | | | | | - Mauro Prato
- Department of Neurosciences, University of Turin, Turin, Italy
| | | | - Matteo De Bellis
- Division of Urology, Department of Surgical Sciences, AOU Città della Salute e della Scienza, Torino School of Medicine, Turin, Italy
| | - Gabriele Montefusco
- Division of Urology, Department of Surgical Sciences, AOU Città della Salute e della Scienza, Torino School of Medicine, Turin, Italy
| | - Giulia Bonomessi
- Division of Urology, Department of Surgical Sciences, AOU Città della Salute e della Scienza, Torino School of Medicine, Turin, Italy
| | - Marco Allasia
- Division of Urology, Department of Surgical Sciences, AOU Città della Salute e della Scienza, Torino School of Medicine, Turin, Italy
| | - Giuseppe Matullo
- Department of Medical Sciences, University of Turin, Turin, Italy.,SC Medical Genetics, AOU Città della Salute e della Scienza, Turin, Italy
| | - Francesco Soria
- Division of Urology, Department of Surgical Sciences, AOU Città della Salute e della Scienza, Torino School of Medicine, Turin, Italy
| | - Paolo Gontero
- Division of Urology, Department of Surgical Sciences, AOU Città della Salute e della Scienza, Torino School of Medicine, Turin, Italy
| |
Collapse
|
4
|
Trail M, Cullen J, Fulton E, Clayton F, McGregor E, McWilliam F, Dick L, Kalima P, Donat R, Mariappan P. Evaluating the Safety of Performing Flexible Cystoscopy When Urinalysis Suggests Presence of "Infection": Results of a Prospective Clinical Study in 2350 patients. EUR UROL SUPPL 2021; 31:28-36. [PMID: 34467238 PMCID: PMC8385291 DOI: 10.1016/j.euros.2021.06.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2021] [Indexed: 11/28/2022] Open
Abstract
Background There is significant underutilisation of allocated health service resources when a scheduled flexible cystoscopy (FC) is cancelled because a pre-cystoscopy urinalysis (PCU) suggests “infection”, despite patients being asymptomatic for urinary tract infection (UTI). Objective To evaluate the risk of UTI or urinary sepsis when FC is performed in asymptomatic patients with a PCU positive for leucocyte esterase and/or nitrites. Design, setting, and participants A prospective cohort study was conducted in a high-volume UK centre recruiting all patients undergoing outpatient FC. Intervention A protocol was developed to guide response to PCU performed prior to FC, which was performed regardless of the result, unless patients were symptomatic for UTI. All patients completed a questionnaire to identify risk factors and were followed up via a telephone survey and a review of electronic clinical records. Outcome measurements and statistical analysis Post-FC UTI was defined as hospital admission with UTI/urinary sepsis or if patients were symptomatic for UTI with receipt of antibiotics or with positive urine culture and sensitivity. An analysis of the association was performed. Results and limitations An initial pilot study confirmed the safety and feasibility of our protocol. Of 1996 patients, 136 (6.8%) developed a UTI by our definition, with 51 (2.6%) having a culture-proven infection. The risk was higher in patients with a positive PCU (odds ratio [OR] 1.61, 95% confidence interval [CI] = 1.07–2.40, p = 0.02), history of UTI (OR 1.72, 95% CI = 1.09–2.73, p = 0.02), or a bladder tumour on FC (OR 2.22, 95% CI = 1.27–3.90, p = 0.005). No patient with a positive PCU developed urinary sepsis. The main limitation of this study was the lack of pre-protocol control. Conclusions We observed a clinically low and acceptable risk of UTI, with no incidence of sepsis, when FC was performed in asymptomatic patients with a PCU suggesting “infection”. Routine cancellation of these patients is unnecessary and may worsen the burden on health service resources. Patient summary We evaluated the safety of performing flexible cystoscopy when the urine dipstick on the day suggested presence of an “infection” but the patient had no symptoms of urinary tract infection (UTI). Our study in over 2000 patients demonstrated a low incidence of UTI, and none of these patients developed sepsis. We therefore recommend that flexible cystoscopy should not be cancelled automatically on the basis of the dipstick result alone, as it might delay a time-sensitive crucial diagnosis.
Collapse
Affiliation(s)
- Matthew Trail
- Department of Urology, Western General Hospital, Edinburgh, UK
| | - Julia Cullen
- Department of Urology, Western General Hospital, Edinburgh, UK
| | - Emma Fulton
- Department of Urology, Western General Hospital, Edinburgh, UK
| | - Faye Clayton
- Department of Urology, Western General Hospital, Edinburgh, UK
| | - Ewan McGregor
- Department of Urology, Western General Hospital, Edinburgh, UK
| | - Faye McWilliam
- Department of Urology, Western General Hospital, Edinburgh, UK
| | - Lachlan Dick
- Department of Urology, Western General Hospital, Edinburgh, UK
| | - Pota Kalima
- Department of Medical Microbiology, Western General Hospital, Edinburgh, UK
| | - Roland Donat
- Department of Urology, Western General Hospital, Edinburgh, UK
| | - Paramananthan Mariappan
- Department of Urology, Western General Hospital, Edinburgh, UK.,University of Edinburgh, Edinburgh, UK
| |
Collapse
|
5
|
Tonelli M, Dickinson JA. Early Detection of CKD: Implications for Low-Income, Middle-Income, and High-Income Countries. J Am Soc Nephrol 2020; 31:1931-1940. [PMID: 32839279 PMCID: PMC7461685 DOI: 10.1681/asn.2020030277] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
CKD is common, costly, and associated with adverse health outcomes. Because inexpensive treatments can slow the rate of kidney function loss, and because CKD is asymptomatic until its later stages, the idea of early detection of CKD to improve outcomes ignites enthusiasm, especially in low- and middle-income countries where renal replacement is often unavailable or unaffordable. Available data and prior experience suggest that the benefits of population-based screening for CKD are uncertain; that there is potential for harms; that screening is not a wise use of resources, even in high-income countries; and that screening has substantial opportunity costs in low- and middle-income countries that offset its hypothesized benefits. In contrast, some of the factors that diminish the value of population-based screening (such as markedly higher prevalence of CKD in people with diabetes, hypertension, and cardiovascular disease, as well as high preexisting use of kidney testing in such patients) substantially increase the appeal of searching for CKD in people with known kidney risk factors (case finding) in high-income countries as well as in low- and middle-income countries. For both screening and case finding, detection of new cases is the easiest component; the real challenge is ensuring appropriate management for a chronic disease, usually for years or even decades. This review compares and contrasts the benefits, harms, and opportunity costs associated with these two approaches to early detection of CKD. We also suggest criteria (discussed separately for high-income countries and for low- and middle-income countries) to use in assessing when countries should consider case finding versus when they should consider foregoing systematic attempts at early detection and focus on management of known cases.
Collapse
Affiliation(s)
- Marcello Tonelli
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - James A Dickinson
- Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| |
Collapse
|
6
|
Lin G, Sheng H, Xie H, Zheng Q, Shen Y, Shi G, Ye D. circLPAR1 is a novel biomarker of prognosis for muscle-invasive bladder cancer with invasion and metastasis by miR-762. Oncol Lett 2019; 17:3537-3547. [PMID: 30867795 DOI: 10.3892/ol.2019.9970] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 11/29/2018] [Indexed: 12/11/2022] Open
Abstract
Circular RNAs (circRNAs) are a specific form of non-coding RNAs, that serve a pivotal role in the development of human diseases, including Alzheimer's disease and cancer; however, only a few are known with respect to cancer. The present study identified a novel circRNA, circ lysophosphatidic acid receptor 1 (LPAR1) (hsa_circ_0087960), derived from two exons 226 base pairs in length, in muscle-invasive bladder cancer (MIBC) tissues. circLPAR1 was identified to be lowly expressed in MIBC tissues in a cohort of 125 cases, and predicted a poor disease-specific survival time, compared with patients with high circLPAR1 expression (52.4 vs. 56.0 months; P=0.001) by univariate and multivariate Cox regression analyses. Matrigel and wound healing assays also demonstrated that the invasion of 5637 and T24 bladder cancer cells were significantly enhanced following the knockdown of circLPAR1 by small interfering RNA (si-circLPAR1-1 in T24 cell line, P=0.01; si-circLPAR1-2 in 5637 cell line, P=0.003; si-circLPAR1-2 in T24 cell line, P=0.002; si-circLPAR1-2 in 5637 cell line, P=0.006). The bioinformatics analysis indicated that circLPAR1 may harbor specific microRNAs (miRNAs) according to the miRNAs seed sequence matching. A luciferase reporter assay revealed that miR-762 can inhibit the activity of the transfected luciferase gene when inserted in a circLPAR1 wild-type fragment, and this inhibition could be alleviated when the luciferase gene was inserted in a circLPAR1 fragment with the mutated miR-762 target site. In conclusion, the circLPAR1 may function as a potential novel and stable biomarker for the prognosis of MIBC and may be associated with the invasion and metastasis by miR-762.
Collapse
Affiliation(s)
- Guowen Lin
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai 200032, P.R. China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, P.R. China
| | - Haoyue Sheng
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai 200032, P.R. China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, P.R. China
| | - Huyang Xie
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai 200032, P.R. China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, P.R. China
| | - Qiupeng Zheng
- Institute of Biomedical Sciences, Fudan University Shanghai Cancer Center, Shanghai 200032, P.R. China
| | - Yijun Shen
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai 200032, P.R. China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, P.R. China
| | - Guohai Shi
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai 200032, P.R. China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, P.R. China
| | - Dingwei Ye
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai 200032, P.R. China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, P.R. China
| |
Collapse
|
7
|
Malmström PU, Skaaheim Haug E, Boström PJ, Gudjónsson S, Bjerggaard Jensen J. Progress towards a Nordic standard for the investigation of hematuria: 2019. Scand J Urol 2019; 53:1-6. [PMID: 30636472 DOI: 10.1080/21681805.2018.1555187] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: To describe the management of patients with hematuria in the Nordic countries in relation to bladder cancer epidemiology, especially in the context of introducing fast track pathways with the aim of proposing a common guideline. Materials and methods: Epidemiological data on bladder cancer from each country, and the combined cancer registry, Nordcan, were analyzed. The evolution of the different national recommendations and the introduction of fast track pathways were assessed. Patients' demographics, type of hematuria and cancer detection rates were analysed if available. Results: The crude incidence of bladder cancer has increased substantially since the 1960s, while the age standardized incidence has been stable during recent decades. The relative survival has increased in all countries, while the mortality has been stable. For those with microscopic hematuria there has been a clear trend towards less rigorous investigations. In the fast track pathways, introduced in three of five countries, about one in five patients with macroscopic hematuria had a cancer diagnosis. Data show that time to diagnosis has been reduced. Conclusions: The number of patients with bladder cancer is increasing in the Nordic region. The introduction of fast track pathways has been important in improving the management of patients with suspicion of the disease. Our recommendation is to focus on macroscopic hematuria in the fast track pathways. Microhematuria without any symptoms should not be an indication for cystoscopy. However, urinary tract symptoms accompanied by microhematuria can still be investigated according to respective guidelines but not necessarily within fast track pathways.
Collapse
Affiliation(s)
- Per-Uno Malmström
- a Department of Urology, Division of Surgical Sciences , Uppsala University , Uppsala , Sweden
| | - Erik Skaaheim Haug
- b Department of Urology , Vestfold Hospital Trust , Tønsberg , Norway.,c Institute of Cancer Genetics and Informatics , Oslo University Hospital , Oslo , Norway
| | - Peter J Boström
- d Department of Urology , Turku University Hospital , Turku , Finland
| | - Sigidur Gudjónsson
- e Department of Urology , Landspitali University Hospital , Reykjavik , Iceland
| | - Jørgen Bjerggaard Jensen
- f Department of Clinical Medicine , Aarhus University , Aarhus , Denmarkl.,g Department of Urology , Aarhus University Hospital , Aarhus , Denmark
| |
Collapse
|
8
|
Orlandi PF, Fujii N, Roy J, Chen HY, Lee Hamm L, Sondheimer JH, He J, Fischer MJ, Rincon-Choles H, Krishnan G, Townsend R, Shafi T, Hsu CY, Kusek JW, Daugirdas JT, Feldman HI. Hematuria as a risk factor for progression of chronic kidney disease and death: findings from the Chronic Renal Insufficiency Cohort (CRIC) Study. BMC Nephrol 2018; 19:150. [PMID: 29940877 PMCID: PMC6020240 DOI: 10.1186/s12882-018-0951-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 06/17/2018] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Hematuria is associated with chronic kidney disease (CKD), but has rarely been examined as a risk factor for CKD progression. We explored whether individuals with hematuria had worse outcomes compared to those without hematuria in the CRIC Study. METHODS Participants were a racially and ethnically diverse group of adults (21 to 74 years), with moderate CKD. Presence of hematuria (positive dipstick) from a single urine sample was the primary predictor. Outcomes included a 50% or greater reduction in eGFR from baseline, ESRD, and death, over a median follow-up of 7.3 years, analyzed using Cox Proportional Hazards models. Net reclassification indices (NRI) and C statistics were calculated to evaluate their predictive performance. RESULTS Hematuria was observed in 1145 (29%) of a total of 3272 participants at baseline. Individuals with hematuria were more likely to be Hispanic (22% vs. 9.5%, respectively), have diabetes (56% vs. 48%), lower mean eGFR (40.2 vs. 45.3 ml/min/1.73 m2), and higher levels of urinary albumin > 1.0 g/day (36% vs. 10%). In multivariable-adjusted analysis, individuals with hematuria had a greater risk for all outcomes during the first 2 years of follow-up: Halving of eGFR or ESRD (HR Year 1: 1.68, Year 2: 1.36), ESRD (Year 1: 1.71, Year 2: 1.39) and death (Year 1:1.92, Year 2: 1.77), and these associations were attenuated, thereafter. Based on NRIs and C-statistics, no clear improvement in the ability to improve prediction of study outcomes was observed when hematuria was included in multivariable models. CONCLUSION In a large adult cohort with CKD, hematuria was associated with a significantly higher risk of CKD progression and death in the first 2 years of follow-up but did not improve risk prediction.
Collapse
Affiliation(s)
- Paula F Orlandi
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, 824 Guardian Drive, Blockley Hall, Philadelphia, Pennsylvania, 19104-6021, USA.
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
| | - Naohiko Fujii
- Hyogo Prefectural Nishinomiya Hospital, Hyogo, Japan
| | - Jason Roy
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, 824 Guardian Drive, Blockley Hall, Philadelphia, Pennsylvania, 19104-6021, USA
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Hsiang-Yu Chen
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, 824 Guardian Drive, Blockley Hall, Philadelphia, Pennsylvania, 19104-6021, USA
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - L Lee Hamm
- School of Medicine, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | | | - Jiang He
- School of Medicine, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Michael J Fischer
- Medicine Service, Jesse Brown VA Medical Center, Chicago, Illinois, USA
- Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Hernan Rincon-Choles
- Cleveland Clinic Foundation, Case Western Reserve University, Cleveland, Ohio, USA
| | - Geetha Krishnan
- Cleveland Clinic Foundation, Case Western Reserve University, Cleveland, Ohio, USA
| | - Raymond Townsend
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Tariq Shafi
- John Hopkins University, School of Medicine, Baltimore, Maryland, USA
| | - Chi-Yuan Hsu
- School of Medicine, University of California, San Francisco, California, USA
| | - John W Kusek
- National Institutes of Health, Bethesda, Maryland, USA
| | - John T Daugirdas
- Renal Division, University of Illinois Hospital and Health Sciences Center, Chicago, Illinois, USA
| | - Harold I Feldman
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, 824 Guardian Drive, Blockley Hall, Philadelphia, Pennsylvania, 19104-6021, USA
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| |
Collapse
|
9
|
Colorimetric recognition for urinalysis dipsticks based on quadratic discriminant analysis. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2017; 2017:3902-3905. [PMID: 29060750 DOI: 10.1109/embc.2017.8037709] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Detection of biomarkers in urine sample is often conducted by use of dipsticks, which provides a qualitative result. Urinalysis involving image recognition and data processing has becoming one of the powerful tools in clinical diagnosis. This paper presents colorimetric recognition of urinalysis dipsticks based on quadratic discriminant analysis (QDA) in order to overcome the drawbacks, such as, limited detection area, seriously affected by the external light conditions etc. It can decrease the error of color space conversion by directly processing the data from the captured image using QDA. The correlation of the sRGB color space and the difference of covariance matrix of the acquired data were took into account in this discriminant analysis. The results of validation experiments by Matlab simulation show that it can effectively identify the similarity between the test and reference color on the dipsticks with the color recognition accuracy at 97.33%.
Collapse
|
10
|
Abstract
Bladder cancer is a complex disease associated with high morbidity and mortality rates if not treated optimally. Awareness of haematuria as the major presenting symptom is paramount, and early diagnosis with individualised treatment and follow-up is the key to a successful outcome. For non-muscle-invasive bladder cancer, the mainstay of treatment is complete resection of the tumour followed by induction and maintenance immunotherapy with intravesical BCG vaccine or intravesical chemotherapy. For muscle-invasive bladder cancer, multimodal treatment involving radical cystectomy with neoadjuvant chemotherapy offers the best chance for cure. Selected patients with muscle-invasive tumours can be offered bladder-sparing trimodality treatment consisting of transurethral resection with chemoradiation. Advanced disease is best treated with systemic cisplatin-based chemotherapy; immunotherapy is emerging as a viable salvage treatment for patients in whom first-line chemotherapy cannot control the disease. Developments in the past 2 years have shed light on genetic subtypes of bladder cancer that might differ from one another in response to various treatments.
Collapse
Affiliation(s)
- Ashish M Kamat
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Noah M Hahn
- Departments of Oncology and Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jason A Efstathiou
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Seth P Lerner
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | - Per-Uno Malmström
- Department of Surgical Sciences, Urology, Uppsala University, Uppsala, Sweden
| | - Woonyoung Choi
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Charles C Guo
- Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yair Lotan
- Department of Urology, University of Texas Southwestern, Dallas, TX, USA
| | - Wassim Kassouf
- Department of Surgery (Urology), McGill University Health Center, Montreal, QC, Canada
| |
Collapse
|