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Chao CT. High versus low chloride load in adult hyperglycemic emergencies with acute kidney injury, a multicenter retrospective cohort study: COMMENT. Intern Emerg Med 2024:10.1007/s11739-024-03615-6. [PMID: 38625497 DOI: 10.1007/s11739-024-03615-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 04/09/2024] [Indexed: 04/17/2024]
Affiliation(s)
- Chia-Ter Chao
- Division of Nephrology. Department of Internal Medicine, Min-Sheng General Hospital, Taoyuan City, Taiwan.
- Nephrology Division, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
- Graduate Institute of Toxicology, National Taiwan University College of Medicine, Taipei, Taiwan.
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Alrzouq FK, Dendini F, Alsuwailem Y, Aljaafri BA, Alsuhibani AS, Al Babtain I. Incidence of Post-laparotomy Acute Kidney Injury Among Abdominal Trauma Patients and Its Associated Risk Factors at King Abdulaziz Medical City, Riyadh. Cureus 2023; 15:e44245. [PMID: 37772248 PMCID: PMC10523828 DOI: 10.7759/cureus.44245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2023] [Indexed: 09/30/2023] Open
Abstract
Background This research study investigates the prevalence of acute kidney injury (AKI) in trauma patients undergoing emergency laparotomies. AKI is a common complication in major surgeries and is associated with various adverse effects. The study aims to explore the relationship between AKI and other comorbidities in this specific context. Methodology This is a retrospective cohort study. All patients who had laparotomy after abdominal trauma at King Abdulaziz Medical City (KAMC) and met the inclusion criteria were included in the study. Nonprobability consecutive sampling was used. Data were collected by chart review using the Best-Care system at KAMC. Descriptive statistics were used to summarize and describe the characteristics of the study participants. Frequencies and percentages were calculated for categorical variables, such as comorbidities. For continuous variables, mean and standard deviations were calculated and tabulated. All statistical calculations were performed using IBM SPSS Statistics for Windows, Version 27.0 (IBM Corp., Armonk, NY, USA). Results This research study included 152 patients who underwent laparotomy, and the majority of patients (146, 96%) did not experience AKI. Several comorbidities were observed, with hypertension and diabetes being the most prevalent at 37 (24.3%) and 35 (23%), respectively. Intraoperative hypotension was experienced by 23 (15.1%) patients, while 129 (84.9%) did not have this issue. Norepinephrine was the most common vasopressor used (25.7%), followed by ephedrine and a combination of norepinephrine and epinephrine. Gender and age groups did not show significant associations with AKI, comorbidities like diabetes, heart failure, and chronic kidney disease (CKD) demonstrated significant relationships with AKI. There was no significant difference in eGFR and serum creatinine baseline levels between patients meeting AKI criteria and those who did not. Conclusions The low overall incidence of AKI in this patient population is encouraging. However, healthcare professionals must be aware of the significant impact of comorbidities such as diabetes, heart failure, and CKD on AKI development. Vigilant monitoring of postoperative kidney function, particularly serum creatinine levels within the first 48 hours, is essential for early detection and timely intervention. By understanding and addressing these risk factors, healthcare providers can take proactive steps to prevent and manage AKI in patients undergoing laparotomy, ultimately leading to improved patient outcomes and reduced healthcare costs.
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Affiliation(s)
- Fahad K Alrzouq
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
- Department of Research Office, King Abdullah International Medical Research Center, Riyadh, SAU
| | - Fares Dendini
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
- Department of Research Office, King Abdullah International Medical Research Center, Riyadh, SAU
| | - Yousef Alsuwailem
- Collage of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
- Department of Research Office, King Abdullah International Medical Research Center, Riyadh, SAU
| | - Bader A Aljaafri
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
- Department of Research Office, King Abdullah International Medical Research Center, Riyadh, SAU
| | - Abdulaziz S Alsuhibani
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences College of Medicine, Riyadh, SAU
- Department of Research Office, King Abdullah International Medical Research Center, Riyadh, SAU
| | - Ibrahim Al Babtain
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
- Department of General Surgery, King Abdulaziz Medical City Riyadh, Riyadh, SAU
- Department of Research Office, King Abdullah International Medical Research Center, Riyadh, SAU
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Shen X, Guo H, Mantica G, Yuan H. Analysis of the clinical features and risk factors of kidney injury in patients with chronic heart failure-a retrospective cohort study. J Thorac Dis 2023; 15:3934-3943. [PMID: 37559657 PMCID: PMC10407521 DOI: 10.21037/jtd-23-1016] [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: 06/27/2023] [Accepted: 07/18/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND Heart failure (HF) often leads to kidney injury and increased morbidity and mortality. Factors contributing to kidney injury in HF patients had not been elucidated completely. This study sought to comprehensively evaluate the risk factors and clinical features of kidney injury in patients with chronic heart failure (CHF) and to provide more evidence for the management of these patients. METHODS Adult patients with CHF admitted to Beijing Anzhen Hospital, Capital Medical University from January 2022 to May 2022 were included in this study. The primary endpoints were the independent risk factors for the development of kidney injury. A multivariate logistic regression model was used for the exploration of the risk factors. RESULTS A total of 193 patients were included in this study, of whom 86 (44.5%) developed kidney injury. The independent risk factors for kidney injury in patients with CHF included sex (male) [odds ratio (OR): 4.30, 95% confidence interval (CI): 1.72-10.7, P=0.001], hypertension (OR: 3.68, 95% CI: 1.64-8.29, P=0.001), and stroke (OR: 3.82, 95% CI: 1.25-11.6, P=0.01). Kidney injury was significantly positively correlated with age (OR: 1.03, 95% CI: 1.008-1.06, P=0.01) and potassium (OR: 3.70, 95% CI: 1.58-8.67, P=0.002), and significantly negatively correlated with angiotensin receptor blocker (ARB) application (OR: 0.26, 95% CI: 0.11-0.61, P=0.001), serum albumin concentration (OR: 0.88, 95% CI: 0.81-0.96, P=0.005), hemoglobin concentration (OR: 0.97, 95% CI: 0.95-0.99, P=0.006), and left ventricular ejection fraction (LVEF; OR: 0.95, 95% CI: 0.92-0.98, P=0.01). CONCLUSIONS Kidney injury occurred in more than half of the patients with CHF during hospitalization. The independent risk factors for kidney injury in the CHF patients included sex (male), hypertension, and stroke. Kidney injury was positively correlated with age and serum potassium, and negatively correlated with serum albumin, hemoglobin concentration, LVEF, and ARB application.
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Affiliation(s)
- Xiaoran Shen
- Department of Clinical Laboratory Medicine, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Hongliang Guo
- Department of Clinical Laboratory Medicine, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Guglielmo Mantica
- IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Urology, Policlinico San Martino Hospital, University of Genova, Genova, Italy
| | - Hui Yuan
- Department of Clinical Laboratory Medicine, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
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Investigation of the Effects of Stress Hyperglycemia Ratio and Preoperative Computed Tomographic Angiography on the Occurrence of Acute Kidney Injury in Diabetic Patients following Surgical Thromboembolectomy. Tomography 2023; 9:255-263. [PMID: 36828372 PMCID: PMC9967571 DOI: 10.3390/tomography9010020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 01/22/2023] [Accepted: 01/25/2023] [Indexed: 01/31/2023] Open
Abstract
Acute lower extremity ischemia (ALI) is a cardiovascular emergency resulting from embolic and thrombotic causes. Although endovascular techniques have advanced, surgical thromboembolectomy is still the gold standard. Emergency thromboembolectomy surgery involves an ischemia-reperfusion injury, which also poses a risk for acute renal injury (AKI). The stress hyperglycemia rate (SHR) has recently emerged as an important prognostic value in emergency cardiovascular events. In the present study, we aimed to analyze the impact of preoperative contrast-enhanced tomographic angiography (CTA) and the SHR value on postoperative AKI in emergency thromboembolectomy procedures in patients with insulin-dependent diabetes mellitus (DM). In this retrospective analysis, patients with DM who received emergency surgical thromboembolectomy after being hospitalized at our hospital with ALI between 20 October 2015, and 10 September 2022, were included. Patients were classified into two groups: Group 1 (N = 159), who did not develop AKI, and Group 2 (N = 45), who did. The 45 patients in Group 2 and the 159 patients in Group 1 had median ages of 59 (39-90) and 66 (37-93), respectively (p = 0.008). The percentage of patients in Group 2 with Rutherford class IIB and admission times longer than 6 h was higher (p = 0.003, p = 0.027, respectively). To determine the variables affecting AKI after surgical embolectomy procedures, multivariate logistic regression analysis was used. In multivariate analysis Model 1, age > 65 years (odds ratio [OR]: 1.425, 95% confidence interval [CI]: 1.230-1.980, p < 0.001), preoperative high creatinine (OR: 4.194, 95% CI: 2.890-6.156, p = 0.003), and Rutherford class (OR: 0.874, 95% CI: 0.692-0.990, p = 0.036) were determined as independent predictors for AKI. In Model 2, age > 65 years (OR: 1.224 CI: 1.090-1.679, p = 0.014), preoperative high creatinine (OR: 3.975, 95% CI: 2.660-5.486, p = 0.007), and SHR (OR: 2.142, CI: 1.134-3.968, p = 0.003), were determined as independent predictors for amputation. In conclusion, when an emergency thromboembolectomy operation is planned in insulin-dependent DM patients, renal risky groups can be identified, and renal protective measures can be taken. In addition, to reduce the renal risk, according to the suitability of the clinical conditions of the patients, the decision to perform a CTA with contrast can be taken by looking at the SHR value.
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Lesão renal aguda em pacientes críticos em ventilação mecânica com pressão positiva. ACTA PAUL ENFERM 2022. [DOI: 10.37689/acta-ape/2022ao0326345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Zhang X, Chen S, Lai K, Chen Z, Wan J, Xu Y. Machine learning for the prediction of acute kidney injury in critical care patients with acute cerebrovascular disease. Ren Fail 2022; 44:43-53. [PMID: 35166177 PMCID: PMC8856083 DOI: 10.1080/0886022x.2022.2036619] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Purpose Acute kidney injury (AKI) is a common complication and associated with a poor clinical outcome. In this study, we developed and validated a model for predicting the risk of AKI through machine learning methods in critical care patients with acute cerebrovascular disease. Methods This study was a retrospective study based on two different cohorts. Five machine learning methods were used to develop AKI risk prediction models. We used six popular metrics (AUROC, F2-Score, accuracy, sensitivity, specificity and precision) to evaluate the performance of these models. Results We identified 2935 patients in the MIMIC-III database and 499 patients in our local database to develop and validate the AKI risk prediction model. The incidence of AKI in these two different cohorts was 18.3% and 61.7%, respectively. Analysis showed that several laboratory parameters (serum creatinine, hemoglobin, white blood cell count, bicarbonate, blood urea nitrogen, sodium, albumin, and platelet count), age, and length of hospital stay, were the top ten important factors associated with AKI. The analysis demonstrated that the XGBoost had higher AUROC (0.880, 95%CI: 0.831–0.929), indicating that the XGBoost model was better at predicting AKI risk in patients with acute cerebrovascular disease than other models. Conclusions This study developed machine learning methods to identify critically ill patients with acute cerebrovascular disease who are at a high risk of developing AKI. This result suggested that machine learning techniques had the potential to improve the prediction of AKI risk models in critical care.
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Affiliation(s)
- Xiaohong Zhang
- Department of Nephrology, the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Siying Chen
- Department of Nephrology, the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Kunmei Lai
- Department of Nephrology, the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Zhimin Chen
- Department of Nephrology, the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Jianxin Wan
- Department of Nephrology, the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Yanfang Xu
- Department of Nephrology, the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
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Bjornstad EC, Cutter G, Guru P, Menon S, Aldana I, House S, M Tofil N, St Hill CA, Tarabichi Y, Banner-Goodspeed VM, Christie AB, Mohan SK, Sanghavi D, Mosier JM, Vadgaonkar G, Walkey AJ, Kashyap R, Kumar VK, Bansal V, Boman K, Sharma M, Bogojevic M, Deo N, Retford L, Gajic O, Gist KM. SARS-CoV-2 infection increases risk of acute kidney injury in a bimodal age distribution. BMC Nephrol 2022; 23:63. [PMID: 35144572 PMCID: PMC8831033 DOI: 10.1186/s12882-022-02681-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 01/18/2022] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Hospitalized patients with SARS-CoV2 develop acute kidney injury (AKI) frequently, yet gaps remain in understanding why adults seem to have higher rates compared to children. Our objectives were to evaluate the epidemiology of SARS-CoV2-related AKI across the age spectrum and determine if known risk factors such as illness severity contribute to its pattern. METHODS Secondary analysis of ongoing prospective international cohort registry. AKI was defined by KDIGO-creatinine only criteria. Log-linear, logistic and generalized estimating equations assessed odds ratios (OR), risk differences (RD), and 95% confidence intervals (CIs) for AKI and mortality adjusting for sex, pre-existing comorbidities, race/ethnicity, illness severity, and clustering within centers. Sensitivity analyses assessed different baseline creatinine estimators. RESULTS Overall, among 6874 hospitalized patients, 39.6% (n = 2719) developed AKI. There was a bimodal distribution of AKI by age with peaks in older age (≥60 years) and middle childhood (5-15 years), which persisted despite controlling for illness severity, pre-existing comorbidities, or different baseline creatinine estimators. For example, the adjusted OR of developing AKI among hospitalized patients with SARS-CoV2 was 2.74 (95% CI 1.66-4.56) for 10-15-year-olds compared to 30-35-year-olds and similarly was 2.31 (95% CI 1.71-3.12) for 70-75-year-olds, while adjusted OR dropped to 1.39 (95% CI 0.97-2.00) for 40-45-year-olds compared to 30-35-year-olds. CONCLUSIONS SARS-CoV2-related AKI is common with a bimodal age distribution that is not fully explained by known risk factors or confounders. As the pandemic turns to disproportionately impacting younger individuals, this deserves further investigation as the presence of AKI and SARS-CoV2 infection increases hospital mortality risk.
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Affiliation(s)
- Erica C Bjornstad
- Department of Pediatrics, Division of Nephrology, University of Alabama at Birmingham, 1600 7th Avenue South, Lowder Suite 516, Birmingham, AL, 35233, USA.
| | - Gary Cutter
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Shina Menon
- Seattle Children's Hospital, Seattle, WA, USA
| | - Isabella Aldana
- Department of Pediatrics, Division of Nephrology, University of Alabama at Birmingham, 1600 7th Avenue South, Lowder Suite 516, Birmingham, AL, 35233, USA
| | - Scott House
- Department of Pediatrics, Division of Nephrology, University of Alabama at Birmingham, 1600 7th Avenue South, Lowder Suite 516, Birmingham, AL, 35233, USA
| | - Nancy M Tofil
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Catherine A St Hill
- Allina Health (Abbott Northwestern Hospital, United Hospital, Mercy Hospital), Minneapolis, MN, USA
| | | | | | | | | | | | - Jarrod M Mosier
- University of Arizona College of Medicine-Tucson, Tucson, AZ, USA
| | | | | | | | | | | | - Karen Boman
- Society of Critical Care Medicine, Mount Prospect, IL, USA
| | | | | | | | - Lynn Retford
- Society of Critical Care Medicine, Mount Prospect, IL, USA
| | | | - Katja M Gist
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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The effect of age on ventilation management and clinical outcomes in critically ill COVID-19 patients--insights from the PRoVENT-COVID study. Aging (Albany NY) 2022; 14:1087-1109. [PMID: 35100136 PMCID: PMC8876900 DOI: 10.18632/aging.203863] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 01/12/2022] [Indexed: 11/25/2022]
Abstract
Introduction: We analyzed the association of age with ventilation practice and outcomes in critically ill COVID–19 patients requiring invasive ventilation. Methods: Posthoc analysis of the PRoVENT–COVID study, an observational study performed in 22 ICUs in the first 3 months of the national outbreak in the Netherlands. The coprimary endpoint was a set of ventilator parameters, including tidal volume normalized for predicted bodyweight, positive end–expiratory pressure, driving pressure, and respiratory system compliance in the first 4 days of invasive ventilation. Secondary endpoints were other ventilation parameters, the use of rescue therapies, pulmonary and extrapulmonary complications in the first 28 days in the ICU, hospital– and ICU stay, and mortality. Results: 1122 patients were divided into four groups based on age quartiles. No meaningful differences were found in ventilation parameters and in the use of rescue therapies for refractory hypoxemia in the first 4 days of invasive ventilation. Older patients received more often a tracheostomy, developed more frequently acute kidney injury and myocardial infarction, stayed longer in hospital and ICU, and had a higher mortality. Conclusions: In this cohort of invasively ventilated critically ill COVID–19 patients, age had no effect on ventilator management. Higher age was associated with more complications, longer length of stay in ICU and hospital and a higher mortality.
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Pode Shakked N, de Oliveira MHS, Cheruiyot I, Benoit JL, Plebani M, Lippi G, Benoit SW, Henry BM. Early prediction of COVID-19-associated Acute Kidney Injury: Are serum NGAL and serum Cystatin C levels better than serum creatinine? Clin Biochem 2022; 102:1-8. [PMID: 35093314 PMCID: PMC8801397 DOI: 10.1016/j.clinbiochem.2022.01.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 01/03/2022] [Accepted: 01/23/2022] [Indexed: 12/23/2022]
Abstract
Background Coronavirus disease-2019 (COVID-19) is associated with a high risk of acute kidney injury (AKI), often requiring renal replacement therapy (RRT). Serum Cystatin C (sCysC) and serum Neutrophil Gelatinase-Associated Lipocalin (sNGAL) are emerging biomarkers for kidney injury, and were suggested to be superior to serum creatinine (sCr) in several clinical settings. Moreover, elevated sCysC is associated with disease severity and mortality in COVID-19. We aimed to assess the utility of sCysC and sNGAL for predicting COVID-19-associated AKI, need for RRT, and need for intensive care unit (ICU) admission, when measured at presentation to the emergency department (ED). Methods Patients presenting to the ED with laboratory-confirmed COVID-19 were included. The primary outcome was development of COVID-19-associated AKI, while the secondary outcomes were need for RRT and ICU admission. Results Among 52 COVID-19 patients, 22 (42.3%) developed AKI with 8/22 (36.4%) requiring RRT. Both sCr and sCysC demonstrated excellent performance for predicting AKI (AUC, 0.86 and 0.87, respectively) and need for RRT (AUC, 0.94 and 0.95, respectively). sNGAL displayed acceptable performance for predicting AKI (AUC, 0.81) and need for RRT (AUC, 0.87). Conclusions SCr and sCysC measured at ED presentation are both highly accurate predictors of AKI and need for RRT, whereas sNGAL demonstrated adequate diagnostic performance. While sCyC was previously shown to be superior to sCr as a diagnostic biomarker of kidney injury in certain etiologies, our findings demonstrate that sCr is comparable to sCyC in the context of predicting COVID-19-associated AKI. Given the high sensitivity of these biomarkers for predicting the need for RRT, and as sCysC is associated with mortality in COVID-19 patients, we recommend their measurement for enabling risk stratification and early intervention.
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Affiliation(s)
- Naomi Pode Shakked
- Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, OH, USA; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | | | | | - Justin L Benoit
- Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Mario Plebani
- Department of Medicine-DIMED, University of Padova Italy
| | - Giuseppe Lippi
- Section of Clinical Biochemistry, Department of Neuroscience, Biomedicine and Movement, University of Verona, Verona, Italy
| | - Stefanie W Benoit
- Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, OH, USA; Department of Pediatrics, University of Cincinnati, College of Medicine, OH, USA
| | - Brandon Michael Henry
- Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, OH, USA; Disease Intervention & Prevention and Population Health Programs, Texas Biomedical Research Institute, San Antonio, TX, USA.
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Mo M, Gao Y, Deng L, Liang Y, Xia N, Pan L. Association Between Iron Metabolism and Acute Kidney Injury in Critically Ill Patients With Diabetes. Front Endocrinol (Lausanne) 2022; 13:892811. [PMID: 35574018 PMCID: PMC9098924 DOI: 10.3389/fendo.2022.892811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 03/24/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Iron overload plays an important role in the pathogenesis of diabetes and acute kidney injury (AKI). The aim of this present study was to explore the relationship between iron metabolism and AKI in patients with diabetes. METHODS The clinical data of diabetes patients from MIMIC-III database in intensive care unit (ICU) were retrospectively analyzed. Regression analyses were used to explore the risk factors of AKI and all-cause death in critical patients with diabetes. Area under the receiver operating characteristic curves (AUROCs) were used to analyze serum ferritin (SF), and regression model to predict AKI in critical patients with diabetes. All diabetes patients were followed up for survival at 6 months, and Kaplan-Meier curves were used to compare the survival rate in patients with different SF levels. RESULTS A total of 4,997 diabetic patients in ICU were enrolled, with a male-to-female ratio of 1.37:1 and a mean age of 66.87 ± 12.74 years. There were 1,637 patients in the AKI group (32.8%) and 3,360 patients in the non-AKI group. Multivariate logistic regression showed that congestive heart failure (OR = 2.111, 95% CI = 1.320-3.376), serum creatinine (OR = 1.342, 95% CI = 1.192-1.512), Oxford Acute Severity of Illness Score (OR = 1.075, 95% CI = 1.045-1.106), increased SF (OR = 1.002, 95% CI = 1.001-1.003), and decreased transferrin (OR = 0.993, 95% CI = 0.989-0.998) were independent risk factors for AKI in critical patients with diabetes. Multivariate Cox regression showed that advanced age (OR = 1.031, 95% CI = 1.025-1.037), AKI (OR = 1.197, 95% CI = 1.011-1.417), increased Sequential Organ Failure Assessment score (OR = 1.055, 95% CI = 1.032-1.078), and increased SF (OR = 1.380, 95% CI = 1.038-1.835) were independent risk factors for 6-month all-cause death in critical diabetic patients. The AUROCs of SF and the regression model to predict AKI in critical patients with diabetes were 0.782 and 0.851, respectively. The Kaplan-Meier curve showed that the 6-month survival rate in SF-increased group was lower than that in SF-normal group (log-rank χ2 = 16.989, P < 0.001). CONCLUSION Critically ill diabetic patients with AKI were easily complicated with abnormal iron metabolism. Increase of SF is an important risk factor for AKI and all-cause death in critically ill patients with diabetes.
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Affiliation(s)
- Manqiu Mo
- Geriatric Department of Endocrinology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yunqing Gao
- Department of Nephrology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Ling Deng
- Department of Endocrinology, The Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yuzhen Liang
- Department of Endocrinology, The Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Ning Xia
- Geriatric Department of Endocrinology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Ling Pan
- Department of Nephrology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
- *Correspondence: Ling Pan,
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van Son J, Oussaada SM, Şekercan A, Beudel M, Dongelmans DA, van Assen S, Eland IA, Moeniralam HS, Dormans TPJ, van Kalkeren CAJ, Douma RA, Rusch D, Simsek S, Liu L, Kootte RS, Wyers CE, IJzerman RG, van den Bergh JP, Stehouwer CDA, Nieuwdorp M, ter Horst KW, Serlie MJ. Overweight and Obesity Are Associated With Acute Kidney Injury and Acute Respiratory Distress Syndrome, but Not With Increased Mortality in Hospitalized COVID-19 Patients: A Retrospective Cohort Study. Front Endocrinol (Lausanne) 2021; 12:747732. [PMID: 34970220 PMCID: PMC8713548 DOI: 10.3389/fendo.2021.747732] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 11/17/2021] [Indexed: 12/23/2022] Open
Abstract
Objective To evaluate the association between overweight and obesity on the clinical course and outcomes in patients hospitalized with COVID-19. Design Retrospective, observational cohort study. Methods We performed a multicenter, retrospective, observational cohort study of hospitalized COVID-19 patients to evaluate the associations between overweight and obesity on the clinical course and outcomes. Results Out of 1634 hospitalized COVID-19 patients, 473 (28.9%) had normal weight, 669 (40.9%) were overweight, and 492 (30.1%) were obese. Patients who were overweight or had obesity were younger, and there were more women in the obese group. Normal-weight patients more often had pre-existing conditions such as malignancy, or were organ recipients. During admission, patients who were overweight or had obesity had an increased probability of acute respiratory distress syndrome [OR 1.70 (1.26-2.30) and 1.40 (1.01-1.96)], respectively and acute kidney failure [OR 2.29 (1.28-3.76) and 1.92 (1.06-3.48)], respectively. Length of hospital stay was similar between groups. The overall in-hospital mortality rate was 27.7%, and multivariate logistic regression analyses showed that overweight and obesity were not associated with increased mortality compared to normal-weight patients. Conclusion In this study, overweight and obesity were associated with acute respiratory distress syndrome and acute kidney injury, but not with in-hospital mortality nor length of hospital stay.
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Affiliation(s)
- Jamie van Son
- Department of Endocrinology and Metabolism, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam University Medical Centre (UMC), University of Amsterdam, Amsterdam, Netherlands
| | - Sabrina M. Oussaada
- Department of Endocrinology and Metabolism, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam University Medical Centre (UMC), University of Amsterdam, Amsterdam, Netherlands
| | - Aydin Şekercan
- Department of Surgery, Amsterdam University Medical Centre (UMC), University of Amsterdam, Amsterdam, Netherlands
| | - Martijn Beudel
- Department of Neurology, Amsterdam University Medical Centre (UMC), Amsterdam Neuroscience, University of Amsterdam, Amsterdam, Netherlands
| | - Dave A. Dongelmans
- Department of Intensive Care, Amsterdam University Medical Centre (UMC), University of Amsterdam, Amsterdam, Netherlands
| | - Sander van Assen
- Department of Internal Medicine/Infectious Diseases, Treant Zorggroep, Emmen, Netherlands
| | - Ingo A. Eland
- Department of Internal Medicine, St. Antonius Hospital, Nieuwegein, Netherlands
| | - Hazra S. Moeniralam
- Department of Internal Medicine, St. Antonius Hospital, Nieuwegein, Netherlands
| | - Tom P. J. Dormans
- Department of Intensive Care, Zuyderland Medical Center, Heerlen, Netherlands
| | | | - Renée A. Douma
- Department of Internal Medicine, Flevo Hospital, Almere, Netherlands
| | - Daisy Rusch
- Department of Intensive Care Medicine, Martini Hospital, Groningen, Netherlands
| | - Suat Simsek
- Department of Internal Medicine, Noordwest Ziekenhuisgroep, Alkmaar, Netherlands
- Department of Internal Medicine/Endocrinology, Amsterdam University Medical Centre (UMC), VU (Vrije Universiteit) University Medical Centre, Amsterdam, Netherlands
| | - Limmie Liu
- Department of Internal Medicine and Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, Netherlands
| | - Ruud S. Kootte
- Department of Acute Internal Medicine, Amsterdam University Medical Centre (UMC), University of Amsterdam, Amsterdam, Netherlands
| | - Caroline E. Wyers
- Department of Internal Medicine, Viecuri Medical Center, Noord-Limburg, Venlo, Netherlands
| | - Richard G. IJzerman
- Department of Internal Medicine, Amsterdam University Medical Centre (UMC), Diabetes Centre, Vrije Universiteit (VU) University Medical Centre, Amsterdam, Netherlands
| | - Joop P. van den Bergh
- Department of Internal Medicine, Viecuri Medical Center, Noord-Limburg, Venlo, Netherlands
| | - Coen D. A. Stehouwer
- Department of Internal Medicine and Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, Netherlands
| | - Max Nieuwdorp
- Department of Vascular Medicine, Amsterdam University Medical Centre (UMC), University of Amsterdam, Amsterdam, Netherlands
| | - Kasper W. ter Horst
- Department of Endocrinology and Metabolism, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam University Medical Centre (UMC), University of Amsterdam, Amsterdam, Netherlands
| | - Mireille J. Serlie
- Department of Endocrinology and Metabolism, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam University Medical Centre (UMC), University of Amsterdam, Amsterdam, Netherlands
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12
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Alfano G, Ferrari A, Fontana F, Mori G, Magistroni R, Meschiari M, Franceschini E, Menozzi M, Cuomo G, Orlando G, Santoro A, Digaetano M, Puzzolante C, Carli F, Bedini A, Milic J, Coloretti I, Raggi P, Mussini C, Girardis M, Cappelli G, Guaraldi G. Incidence, risk factors and outcome of acute kidney injury (AKI) in patients with COVID-19. Clin Exp Nephrol 2021; 25:1203-1214. [PMID: 34196877 PMCID: PMC8245663 DOI: 10.1007/s10157-021-02092-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 06/07/2021] [Indexed: 01/08/2023]
Abstract
Background Acute kidney injury (AKI) is a severe complication of coronavirus disease-2019 (COVID-19). This study aims to evaluate incidence, risk factors and case-fatality rate of AKI in patients with COVID-19. Methods We reviewed the health medical records of 307 consecutive patients with COVID-19 hospitalized at the University Hospital of Modena, Italy. Results AKI was diagnosed in 69 out of 307 (22.4%) COVID-19 patients. Stages 1, 2, or 3 AKI accounted for 57.9%, 24.6% and 17.3%, respectively. AKI patients had a mean age of 74.7 ± 9.9 years. These patients showed higher serum levels of the main markers of inflammation and higher rate of severe pneumonia than non-AKI patients. Kidney injury was associated with a higher rate of urinary abnormalities including proteinuria (0.44 ± 0.85 vs 0.18 ± 0.29 mg/mg; P = < 0.0001) and microscopic hematuria (P = 0.032) compared to non-AKI patients. Hemodialysis was performed in 7.2% of the subjects and 33.3% of the survivors did not recover kidney function after AKI. Risk factors for kidney injury were age, male sex, CKD and higher non-renal SOFA score. Patients with AKI had a mortality rate of 56.5%. Adjusted Cox regression analysis revealed that COVID-19-associated AKI was independently associated with in-hospital death (hazard ratio [HR] = 4.82; CI 95%, 1.36–17.08) compared to non-AKI patients. Conclusion AKI was a common and harmful consequence of COVID-19. It manifested with urinary abnormalities (proteinuria, microscopic hematuria) and conferred an increased risk for death. Given the well-known short-term sequelae of AKI, prevention of kidney injury is imperative in this vulnerable cohort of patients. Supplementary Information The online version contains supplementary material available at 10.1007/s10157-021-02092-x.
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Affiliation(s)
- Gaetano Alfano
- Nephrology Dialysis and Transplant Unit, University Hospital of Modena, Modena, Italy.
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy.
| | - Annachiara Ferrari
- Surgical, Medical and Dental Department of Morphological Sciences, Section of Nephrology, University of Modena and Reggio Emilia, Modena, Italy
| | - Francesco Fontana
- Nephrology Dialysis and Transplant Unit, University Hospital of Modena, Modena, Italy
| | - Giacomo Mori
- Nephrology Dialysis and Transplant Unit, University Hospital of Modena, Modena, Italy
| | - Riccardo Magistroni
- Nephrology Dialysis and Transplant Unit, University Hospital of Modena, Modena, Italy
- Surgical, Medical and Dental Department of Morphological Sciences, Section of Nephrology, University of Modena and Reggio Emilia, Modena, Italy
| | - Marianna Meschiari
- Department of Infectious Diseases, University Hospital of Modena, Modena, Italy
| | - Erica Franceschini
- Department of Infectious Diseases, University Hospital of Modena, Modena, Italy
| | - Marianna Menozzi
- Department of Infectious Diseases, University Hospital of Modena, Modena, Italy
| | - Gianluca Cuomo
- Department of Infectious Diseases, University Hospital of Modena, Modena, Italy
| | - Gabriella Orlando
- Department of Infectious Diseases, University Hospital of Modena, Modena, Italy
| | - Antonella Santoro
- Department of Infectious Diseases, University Hospital of Modena, Modena, Italy
| | | | - Cinzia Puzzolante
- Department of Infectious Diseases, University Hospital of Modena, Modena, Italy
| | - Federica Carli
- Department of Infectious Diseases, University Hospital of Modena, Modena, Italy
| | - Andrea Bedini
- Department of Infectious Diseases, University Hospital of Modena, Modena, Italy
| | - Jovana Milic
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
- Surgical, Medical and Dental Department of Morphological Sciences, Section of Nephrology, University of Modena and Reggio Emilia, Modena, Italy
| | - Irene Coloretti
- Department of Anesthesia and Intensive Care Unit, University Hospital of Modena, Modena, Italy
| | - Paolo Raggi
- Department of Medicine, Division of Cardiology, Mazankowski Alberta Heart Institute, Alberta, Canada
| | - Cristina Mussini
- Surgical, Medical and Dental Department of Morphological Sciences, Section of Nephrology, University of Modena and Reggio Emilia, Modena, Italy
- Department of Infectious Diseases, University Hospital of Modena, Modena, Italy
| | - Massimo Girardis
- Department of Anesthesia and Intensive Care Unit, University Hospital of Modena, Modena, Italy
| | - Gianni Cappelli
- Nephrology Dialysis and Transplant Unit, University Hospital of Modena, Modena, Italy
- Surgical, Medical and Dental Department of Morphological Sciences, Section of Nephrology, University of Modena and Reggio Emilia, Modena, Italy
| | - Giovanni Guaraldi
- Surgical, Medical and Dental Department of Morphological Sciences, Section of Nephrology, University of Modena and Reggio Emilia, Modena, Italy
- Department of Infectious Diseases, University Hospital of Modena, Modena, Italy
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13
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Identification of Potential Gene and MicroRNA Biomarkers of Acute Kidney Injury. BIOMED RESEARCH INTERNATIONAL 2021; 2021:8834578. [PMID: 33506037 PMCID: PMC7810567 DOI: 10.1155/2021/8834578] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 11/30/2020] [Accepted: 12/16/2020] [Indexed: 12/27/2022]
Abstract
Acute kidney injury (AKI) is a disease that seriously endangers human health. At present, AKI lacks effective treatment methods, so it is particularly important to find effective treatment measures and targets. Bioinformatics analysis has become an important method to identify significant processes of disease occurrence and development. In this study, we analyzed the public expression profile with bioinformatics analysis to identify differentially expressed genes (DEGs) in two types of common AKI models (ischemia-reperfusion injury and cisplatin). DEGs were predicted in four commonly used microRNA databases, and it was found that miR-466 and miR-709 may play important roles in AKI. Then, we found key nodes through protein-protein interaction (PPI) network analysis and subnetwork analysis. Finally, by detecting the expression levels in the renal tissues of the two established AKI models, we found that Myc, Mcm5, E2f1, Oip5, Mdm2, E2f8, miR-466, and miR-709 may be important genes and miRNAs in the process of AKI damage repair. The findings of our study reveal some candidate genes, miRNAs, and pathways potentially involved in the molecular mechanisms of AKI. These data improve the current understanding of AKI and provide new insight for AKI research and treatment.
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14
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Révész C, Wasik AA, Godó M, Tod P, Lehtonen S, Szénási G, Hamar P. Cold Saline Perfusion before Ischemia-Reperfusion Is Harmful to the Kidney and Is Associated with the Loss of Ezrin, a Cytoskeletal Protein, in Rats. Biomedicines 2021; 9:biomedicines9010030. [PMID: 33401597 PMCID: PMC7824567 DOI: 10.3390/biomedicines9010030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 12/27/2020] [Accepted: 12/28/2020] [Indexed: 11/30/2022] Open
Abstract
Background: Organ protection for transplantation is perfusion with ice-cold preservation solutions, although saline is also used in animal experiments and living donor transplantations. However, ice-cold perfusion can contribute to initial graft injury. Our aim was to test if cytoskeletal damage of parenchymal cells is caused by saline itself or by the ice-cold solution. Methods: F344 rat kidneys were flushed with cold (4 °C) saline, ischemic and sham kidneys were not perfused. In a separate set, F344 kidneys were flushed with saline or preservation solution at 4 or 15 °C. Ischemia time was 30 min. Results: Renal injury was significantly more severe following cold ischemia (CI) than after ischemia-reperfusion without flushing (ischemia/reperfusion (I/R)). Functional and morphologic damage was accompanied by severe loss of ezrin from glomerular and tubular epithelial cells after CI. Moreover, saline caused serious injury independently from its temperature, while the perfusion solution was more beneficial, especially at 4 °C. Conclusions: Flushing the kidney with ice-cold saline can cause more severe injury than ischemia-reperfusion at body temperature even during a short (30 min) ischemia. Saline perfusion can prolong recovery from ischemia in kidney transplantation, which can be prevented by using preservation solutions.
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Affiliation(s)
- Csaba Révész
- Institute of Translational Medicine, Faculty of Medicine, Semmelweis University, 1143 Budapest, Hungary; (C.R.); (M.G.); (P.T.); (G.S.)
| | - Anita A. Wasik
- Department of Pathology, Faculty of Medicine, University of Helsinki, FIN-00014 Helsinki, Finland; (A.A.W.); (S.L.)
| | - Mária Godó
- Institute of Translational Medicine, Faculty of Medicine, Semmelweis University, 1143 Budapest, Hungary; (C.R.); (M.G.); (P.T.); (G.S.)
| | - Pál Tod
- Institute of Translational Medicine, Faculty of Medicine, Semmelweis University, 1143 Budapest, Hungary; (C.R.); (M.G.); (P.T.); (G.S.)
| | - Sanna Lehtonen
- Department of Pathology, Faculty of Medicine, University of Helsinki, FIN-00014 Helsinki, Finland; (A.A.W.); (S.L.)
- Research Program for Clinical and Molecular Metabolism, University of Helsinki, FIN-00014 Helsinki, Finland
| | - Gábor Szénási
- Institute of Translational Medicine, Faculty of Medicine, Semmelweis University, 1143 Budapest, Hungary; (C.R.); (M.G.); (P.T.); (G.S.)
| | - Péter Hamar
- Institute of Translational Medicine, Faculty of Medicine, Semmelweis University, 1143 Budapest, Hungary; (C.R.); (M.G.); (P.T.); (G.S.)
- Correspondence: ; Tel.: +36-20-825-9751; Fax: +36-1-210-0100
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15
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Frailty modifies the association between opioid use and mortality in chronic kidney disease patients with diabetes: a population-based cohort study. Aging (Albany NY) 2020; 12:21730-21746. [PMID: 33176279 PMCID: PMC7695426 DOI: 10.18632/aging.103978] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 08/14/2020] [Indexed: 02/06/2023]
Abstract
The prevalence of chronic pain in patients with chronic kidney disease (CKD) and diabetes mellitus is high and correlates with higher frailty risk, but satisfactory pain control frequently fails, necessitating opioid initiation. We aimed to examine whether opioid use affected their outcomes and whether such a relationship was modified by frailty. From the longitudinal cohort of diabetes patients (n = 840,000), we identified opioid users with CKD (n = 26,029) and propensity score-matched them to opioid-naïve patients in a 1:1 ratio. We analyzed the associations between opioid use and long-term mortality according to baseline frailty status, defined by the modified FRAIL scale. Among all, 20.3% did not have any FRAIL items, while 57.2%, 20.6%, and 1.9% had 1, 2, and at least 3 positive FRAIL items, respectively. After 4.2 years, 16.4% died. Cox proportional hazard regression showed that opioid users exhibited an 18% higher mortality risk (HR 1.183, 95% CI 1.13-1.24) with a dose- and duration-responsive relationship, compared to opioid-naive ones. Furthermore, the mortality risk posed by opioids was observed only in CKD patients without frailty but not in those with frailty. In conclusion, opioid use increased mortality among patients with CKD, while this negative outcome influence was not observed among frail ones.
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16
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Advani A. Acute Kidney Injury: A Bona Fide Complication of Diabetes. Diabetes 2020; 69:2229-2237. [PMID: 33082271 DOI: 10.2337/db20-0604] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 08/07/2020] [Indexed: 11/13/2022]
Abstract
The landscape of kidney disease in diabetes has shifted. The classical dogma of "diabetic nephropathy" progressing through stages of albuminuria, leading to decline in glomerular filtration rate and end-stage kidney disease (ESKD), has been replaced by a more nuanced understanding of the complex and heterogeneous nature of kidney disease in diabetes. Paralleling this evolution, standardized definitions have resulted in a growing appreciation that acute kidney injury (AKI) is increasing in its incidence rapidly and that people with diabetes are much more likely to develop AKI than people without diabetes. Here, I propose that AKI should be considered a complication of diabetes alongside other complications that similarly do not fit neatly into the historical microvascular/macrovascular paradigm. In this article, we take a look at the evidence indicating that diabetes is a major risk factor for AKI and we review the causes of this increased risk. We consider the long-term implications of AKI in diabetes and its potential contribution to the future development of chronic kidney disease, ESKD, and mortality. Finally, we look toward the future at strategies to better identify people at risk for AKI and to develop new approaches to improve AKI outcomes. Recognizing AKI as a bona fide complication of diabetes should open up new avenues for investigation that may ultimately improve the outlook for people living with diabetes and at risk for kidney disease.
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Affiliation(s)
- Andrew Advani
- Keenan Research Centre for Biomedical Science and Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
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17
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Hepatocyte Growth Factor Mimetic ANG-3777 for Cardiac Surgery-Associated Acute Kidney Injury. Kidney Int Rep 2020; 5:2325-2332. [PMID: 33305126 PMCID: PMC7710816 DOI: 10.1016/j.ekir.2020.09.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 09/02/2020] [Accepted: 09/08/2020] [Indexed: 12/28/2022] Open
Abstract
Introduction Nearly one-third of patients undergoing cardiac surgery involving cardiopulmonary bypass (CPB) experience cardiac surgery–associated (CSA) acute kidney injury (AKI); 5% require renal replacement therapy. ANG-3777 is a hepatocyte growth factor mimetic. In vitro, ANG-3777 reduces apoptosis and increases cell proliferation, migration, morphogenesis, and angiogenesis in injured kidneys. In animal models, ANG-3777 mitigates the effects of renal damage secondary to ischemia reperfusion injury and nephrotoxic chemicals. Phase 2 data in AKI of renal transplantation have shown improved renal function and comparable safety relative to placebo. The Guard Against Renal Damage (GUARD) study is a phase 2 proof of concept trial of ANG-3777 in CSA-AKI. Methods GUARD is a 240-patient, multicenter, double-blind, randomized placebo-controlled trial to assess the efficacy and safety of ANG-3777 in patients at elevated pre-surgery risk for AKI undergoing coronary artery bypass graft (CABG) or heart valve repair/replacement requiring CPB. Subjects are randomized 1:1 to receive ANG-3777 (2 mg/kg) or placebo. Study drug is dosed via 4 daily intravenous 30-minute infusions. The first dose is administered less than 4 hours after completing CPB, second at 24 ± 2 hours post-CPB, with two subsequent doses at 24 ± 2 hours after the previous dose. Results The primary efficacy endpoint is percent change from baseline serum creatinine to mean area under the curve from days 2 through 6. Secondary endpoints include change in estimated glomerular filtration rate from baseline to day 30, the proportion of patients diagnosed with AKI by stage through day 5, and the length of CSA-AKI hospitalization. Safety will include adverse events and laboratory measures. Conclusion This phase 2 study of ANG-3777 provides data to develop a phase 3 registrational study in this medically complex condition.
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18
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Wu L, Hu Y, Zhang X, Chen W, Yu ASL, Kellum JA, Waitman LR, Liu M. Changing relative risk of clinical factors for hospital-acquired acute kidney injury across age groups: a retrospective cohort study. BMC Nephrol 2020; 21:321. [PMID: 32741377 PMCID: PMC7397647 DOI: 10.1186/s12882-020-01980-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 07/23/2020] [Indexed: 12/14/2022] Open
Abstract
Background Likelihood of developing acute kidney injury (AKI) increases with age. We aimed to explore whether the predictability of AKI varies between age groups and assess the volatility of risk factors using electronic medical records (EMR). Methods We constructed a retrospective cohort of adult patients from all inpatient units of a tertiary care academic hospital and stratified it into four age groups: 18–35, 36–55, 56–65, and > 65. Potential risk factors collected from EMR for the study cohort included demographics, vital signs, medications, laboratory values, past medical diagnoses, and admission diagnoses. AKI was defined based on the Kidney Disease Improving Global Outcomes (KDIGO) serum creatinine criteria. We analyzed relative importance of the risk factors in predicting AKI using Gradient Boosting Machine algorithm and explored the predictability of AKI across age groups using multiple machine learning models. Results In our cohort, older patients showed a significantly higher incidence of AKI than younger adults: 18–35 (7.29%), 36–55 (8.82%), 56–65 (10.53%), and > 65 (10.55%) (p < 0.001). However, the predictability of AKI decreased with age, where the best cross-validated area under the receiver operating characteristic curve (AUROC) achieved for age groups 18–35, 36–55, 56–65, and > 65 were 0.784 (95% CI, 0.769–0.800), 0.766 (95% CI, 0.754–0.777), 0.754 (95% CI, 0.741–0.768), and 0.725 (95% CI, 0.709–0.737), respectively. We also observed that the relative risk of AKI predictors fluctuated between age groups. Conclusions As complexity of the cases increases with age, it is more difficult to quantify AKI risk for older adults in inpatient population.
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Affiliation(s)
- Lijuan Wu
- Big Data Decision Institute (BDDI), Jinan University, Guangzhou, 510632, China.,Guangdong Engineering Technology Research Center for Big Data Precision Healthcare, Guangzhou, 510632, China
| | - Yong Hu
- Big Data Decision Institute (BDDI), Jinan University, Guangzhou, 510632, China.,Guangdong Engineering Technology Research Center for Big Data Precision Healthcare, Guangzhou, 510632, China
| | - Xiangzhou Zhang
- Big Data Decision Institute (BDDI), Jinan University, Guangzhou, 510632, China.,Guangdong Engineering Technology Research Center for Big Data Precision Healthcare, Guangzhou, 510632, China
| | - Weiqi Chen
- Big Data Decision Institute (BDDI), Jinan University, Guangzhou, 510632, China.,Guangdong Engineering Technology Research Center for Big Data Precision Healthcare, Guangzhou, 510632, China
| | - Alan S L Yu
- Division of Nephrology and Hypertension and the Kidney Institute, University of Kansas Medical Center, Kansas City, 66160, USA
| | - John A Kellum
- Center for Critical Care Nephrology, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, 15260, USA
| | - Lemuel R Waitman
- Department of Internal Medicine, Division of Medical Informatics, University of Kansas Medical Center, Kansas City, 66160, USA
| | - Mei Liu
- Department of Internal Medicine, Division of Medical Informatics, University of Kansas Medical Center, Kansas City, 66160, USA.
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19
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Hounkpatin HO, Fraser SDS, Johnson MJ, Harris S, Uniacke M, Roderick PJ. The association of socioeconomic status with incidence and outcomes of acute kidney injury. Clin Kidney J 2020; 13:245-252. [PMID: 32297881 PMCID: PMC7147309 DOI: 10.1093/ckj/sfz113] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 08/02/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Acute kidney injury (AKI) is common and is associated with significant morbidity and mortality. Socioeconomic status may be negatively associated with AKI as some risk factors for AKI such as chronic kidney disease, diabetes and heart failure are socially distributed. This study explored the socioeconomic gradient of the incidence and mortality of AKI, after adjusting for important mediators such as comorbidities. METHODS Linked primary care and laboratory data from two large acute hospitals in the south of England, sourced from the Care and Health Information Analytics database, were used to identify AKI cases over a 1-year period (2017-18) from a population of 580 940 adults. AKI was diagnosed from serum creatinine patterns using a Kidney Disease: Improving Global Outcomes-based definition. Multivariable logistic regression and Cox proportional hazard models adjusting for age, sex, comorbidities and prescribed medication (in incidence analyses) and AKI severity (in mortality analyses), were used to assess the association of area deprivation (using Index of Multiple Deprivation for place of residence) with AKI risk and all-cause mortality over a median (interquartile range) of 234 days (119-356). RESULTS Annual incidence rate of first AKI was 1726/100 000 (1.7%). The risk of AKI was higher in the most deprived compared with the least deprived areas [adjusted odds ratio = 1.79, 95% confidence interval (CI) 1.59-2.01 and 1.33, 95% CI 1.03-1.72 for <65 and >65 year old, respectively] after controlling for age, sex, comorbidities and prescribed medication. Adjusted risk of mortality post first AKI was higher in the most deprived areas (adjusted hazard ratio = 1.20, 95% CI 1.07-1.36). CONCLUSIONS Social deprivation was associated with higher incidence of AKI and poorer survival even after adjusting for the higher presence of comorbidities. Such social inequity should be considered when devising strategies to prevent AKI and improve care for AKI patients.
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Affiliation(s)
- Hilda O Hounkpatin
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) Wessex, School of Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Simon D S Fraser
- School of Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Matthew J Johnson
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Scott Harris
- School of Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | | | - Paul J Roderick
- School of Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
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20
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Chao CT, Wang J, Huang JW, Chan DC, Hung KY, Chien KL. Chronic kidney disease-related osteoporosis is associated with incident frailty among patients with diabetic kidney disease: a propensity score-matched cohort study. Osteoporos Int 2020; 31:699-708. [PMID: 32103279 DOI: 10.1007/s00198-020-05353-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 02/17/2020] [Indexed: 12/11/2022]
Abstract
UNLABELLED Chronic kidney disease (CKD)-related osteoporosis is a major complication in patients with CKD, conferring a higher risk of adverse outcomes. We found that among those with diabetic kidney disease, this complication increased the risk of incident frailty, an important mediator of adverse outcomes. INTRODUCTION Renal osteodystrophy and chronic kidney disease (CKD)-related osteoporosis increases complications for patients with diabetic kidney disease (DKD). Since musculoskeletal degeneration is central to frailty development, we investigated the relationship between baseline osteoporosis and the subsequent frailty risk in patients with DKD. METHODS From the Longitudinal Cohort of Diabetes Patients in Taiwan (n = 840,000), we identified 12,027 patients having DKD with osteoporosis and 24,054 propensity score-matched controls having DKD but without osteoporosis. The primary endpoint was incident frailty on the basis of a modified FRAIL scale. Patients were prospectively followed-up until the development of endpoints or the end of this study. The Kaplan-Meier technique and Cox proportional hazard regression were used to analyze the association between osteoporosis at baseline and incident frailty in these patients. RESULTS The mean age of the DKD patients was 67.2 years, with 55.4% female and a 12.6% prevalence of osteoporosis at baseline. After 3.5 ± 2.2 years of follow up, the incidence rate of frailty in patients having DKD with osteoporosis was higher than that in DKD patients without (6.6 vs. 5.7 per 1000 patient-year, p = 0.04). A Cox proportional hazard regression showed that after accounting for age, gender, obesity, comorbidities, and medications, patients having DKD with osteoporosis had a significantly higher risk of developing frailty (hazard ratio, 1.19; 95% confidence interval, 1.02-1.38) than those without osteoporosis. CONCLUSIONS CKD-related osteoporosis is associated with a higher risk of incident frailty in patients with DKD.
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Affiliation(s)
- C-T Chao
- Department of Internal Medicine, National Taiwan University Hospital BeiHu Branch, Taipei, Taiwan
- Geriatric and Community Medicine Research Center, National Taiwan University Hospital BeiHu Branch, Taipei, Taiwan
- Graduate Institute of Toxicology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - J Wang
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - J-W Huang
- Nephrology division, Department of Internal Medicine, National Taiwan University Hospital YunLin branch, Douliou, YunLin County, Taiwan.
| | - D-C Chan
- Department of Internal Medicine, National Taiwan University Hospital ChuTung branch, Zhudong, HsinChu County, Taiwan
| | - K-Y Hung
- Department of Internal Medicine, National Taiwan University Hospital HsinChu branch, HsinChu City, Taiwan
| | - K-L Chien
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
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Accelerated cerebral vascular injury in diabetes is associated with vascular smooth muscle cell dysfunction. GeroScience 2020; 42:547-561. [PMID: 32166556 DOI: 10.1007/s11357-020-00179-z] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 03/04/2020] [Indexed: 12/20/2022] Open
Abstract
Individuals with diabetes are more susceptible to cerebral vascular aging. However, the underlying mechanisms are not well elucidated. The present study examined whether the myogenic response of the middle cerebral artery (MCA) is impaired in diabetic rats due to high glucose (HG)-induced cerebral vascular smooth muscle cell (CVSMC) dysfunction, and whether this is associated with ATP depletion and changes in mitochondrial dynamics and membrane potential. The diameters of the MCA of diabetic rats increased to 135.3 ± 11.3% when perfusion pressure was increased from 40 to 180 mmHg, while it fell to 85.1 ± 3.1% in non-diabetic controls. The production of ROS and mitochondrial-derived superoxide were enhanced in cerebral arteries of diabetic rats. Levels of mitochondrial superoxide were significantly elevated in HG-treated primary CVSMCs, which was associated with decreased ATP production, mitochondrial respiration, and membrane potential. The expression of OPA1 was reduced, and MFF was elevated in HG-treated CVSMCs in association with fragmented mitochondria. Moreover, HG-treated CVSMCs displayed lower contractile and proliferation capabilities. These results demonstrate that imbalanced mitochondrial dynamics (increased fission and decreased fusion) and membrane depolarization contribute to ATP depletion in HG-treated CVSMCs, which promotes CVSMC dysfunction and may play an essential role in exacerbating the impaired myogenic response in the cerebral circulation in diabetes and accelerating vascular aging.
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Chao CT, Wang J, Huang JW, Chan DC, Chien KL. Hypoglycemic episodes are associated with an increased risk of incident frailty among new onset diabetic patients. J Diabetes Complications 2020; 34:107492. [PMID: 31806427 DOI: 10.1016/j.jdiacomp.2019.107492] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 11/13/2019] [Accepted: 11/13/2019] [Indexed: 12/16/2022]
Abstract
AIMS Patients with diabetes mellitus (DM) are at risk for developing frailty due to the complex interplay between different cardiometabolic factors. We examined whether hypoglycemia could independently increase frailty risk besides these factors. METHODS From the Longitudinal Cohort of Diabetic Patients, 210,254 patients with new onset DM between 2004 and 2011 were identified, among whom 2119 non-frail patients had at least 1 hypoglycemic episode within 3 years of DM diagnosis. They were propensity score-matched to 8432 non-frail ones without hypoglycemia throughout the study period. Both groups were followed up longitudinally for incident physical frailty according to a modified FRAIL scale (Fatigue, Resistance, Ambulation, Illness, and Loss of weight). We analyzed the risk of frailty (primary) and mortality (secondary outcome) introduced by hypoglycemia, adjusted for known risk factors of frailty. RESULTS The mean age of patients (46.2% male) was 65.9 ± 14 years; diabetic patients with hypoglycemia had significantly higher comorbidity burden than those without. After 2.68 years, 172 (1.6%) patients with hypoglycemia developed incident frailty, representing a 60% higher risk (hazard ratio [HR] 1.599, 95% confidence interval [CI] 1.14-2.42). After adjusting for other risk factors, those with hypoglycemia had a significantly higher risk of frailty than those without (HR 1.443, 95% CI 1.01-2.05). Additionally, the mortality of those with hypoglycemia was 2-fold higher than those without, and the risk persisted despite confounder adjustment (HR 1.462, 95% CI 1.3-1.65). CONCLUSION In this population-based cohort, hypoglycemic episodes among diabetic patients increased the risk of incident frailty and mortality.
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Affiliation(s)
- Chia-Ter Chao
- Department of Medicine, National Taiwan University Hospital BeiHu Branch, College of Medicine, National Taiwan University, Taipei, Taiwan; Geriatric and Community Medicine Research Center, National Taiwan University Hospital BeiHu Branch, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Jui Wang
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taiwan
| | - Jenq-Wen Huang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Ding-Cheng Chan
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei, Taiwan; Department of Medicine, National Taiwan University Hospital ChuTung branch, HsinChu County, Taiwan
| | - Kuo-Liong Chien
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taiwan.
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Chao CT, Wang J, Huang JW, Hung KY, Chien KL. Frailty predicts a higher risk of incident urolithiasis in 525 368 patients with diabetes mellitus: a population-based study. BMJ Open Diabetes Res Care 2020; 8:8/1/e000755. [PMID: 31958301 PMCID: PMC7039606 DOI: 10.1136/bmjdrc-2019-000755] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 10/09/2019] [Accepted: 11/23/2019] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Patients with diabetes have an increased risk for urolithiasis, but the associated risk factors remain an active area of research. We investigated whether frailty influenced the probability of patients with diabetes developing urolithiasis. RESEARCH DESIGN AND METHODS Using data from the Longitudinal Cohort of Diabetic Patients from 2004 to 2010, we identified those without and with frailty based on a validated, modified FRAIL scale. Patients were followed until they developed urolithiasis, and we used Kaplan-Meier and Cox proportional hazard regression analyses to examine the relationship between frailty, its severity, and the risk of urolithiasis, accounting for demographic profiles, comorbidities, frailty status changes over follow-up, and medications, with risk competition by mortality. RESULTS Among 525 368 patients with diabetes, 64.4% were not frail, while 28.5%, 6.6%, and 0.6% had 1, 2, and ≥3 FRAIL items at baseline. After 4.2 years of follow-up, 13.4% experienced incident urolithiasis. Cox proportional hazard regression analysis showed that patients with diabetes having at least one FRAIL criterion exhibited a significantly higher risk for urolithiasis compared with non-frail patients (for 1, 2, and ≥3 items, hazard ratio (HR)s: 1.04, 1.23, and 1.46; 95% confidence intervals (CIs) 0.99 to 1.09, 1.12 to 1.35, and 1.12 to 1.91, respectively). This increase in urolithiasis risk remained significant if we restricted analyses to renal stones or recurrent urolithiasis as the study outcomes. CONCLUSIONS Frailty may pose a risk for incident urolithiasis in patients with diabetes. Treating frailty may potentially reduce their risk for urolithiasis.
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Affiliation(s)
- Chia-Ter Chao
- Nephrology division, Department of Internal Medicine, National Taiwan University Hospital Beihu Branch, Taipei, Taiwan
- Graduate Institute of Toxicology, National Taiwan University, Taipei, Taiwan
- Geriatric and Community Medicine Research Center, National Taiwan University Hospital Beihu branch, Taipei, Taiwan
| | - Jui Wang
- Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan
| | - Jenq-Wen Huang
- Nephrology division, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital Yun Lin Branch, Douliou, Yunlin, Taiwan
| | - Kuan-Yu Hung
- Nephrology division, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | - Kuo-Liong Chien
- Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan
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Ungvari Z, Tarantini S, Nyúl-Tóth Á, Kiss T, Yabluchanskiy A, Csipo T, Balasubramanian P, Lipecz A, Benyo Z, Csiszar A. Nrf2 dysfunction and impaired cellular resilience to oxidative stressors in the aged vasculature: from increased cellular senescence to the pathogenesis of age-related vascular diseases. GeroScience 2019; 41:727-738. [PMID: 31655958 PMCID: PMC6925097 DOI: 10.1007/s11357-019-00107-w] [Citation(s) in RCA: 75] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 09/13/2019] [Indexed: 01/29/2023] Open
Abstract
Aging is associated with increased oxidative stress in vascular endothelial and smooth muscle cells, which contribute to the development of a wide range of diseases affecting the circulatory system in older adults. There is growing evidence that in addition to increased production of reactive oxygen species (ROS), aging critically impairs pathways determining cellular resilience to oxidative stressors. In young organisms, the evolutionarily conserved nuclear factor-erythroid-2-related factor 2 (Nrf2)-mediated antioxidant response pathway maintains cellular reduction-oxidation homeostasis and promotes a youthful cellular phenotype by regulating the transcription of an array of cytoprotective (antioxidant, pro-survival, anti-inflammatory and macromolecular damage repair) genes. A critical mechanism by which increased ROS production and Nrf2 dysfunction promote vascular aging and exacerbate pathogenesis of age-related vascular diseases is induction of cellular senescence, an evolutionarily conserved cellular stress response mechanism. Senescent cells cease dividing and undergo distinctive phenotypic alterations, contributing to impairment of angiogenic processes, chronic sterile inflammation, remodeling of the extracellular matrix, and barrier dysfunction. Herein, we review mechanisms contributing to dysregulation of Nrf2-driven cytoprotective responses in the aged vasculature and discuss the multifaceted role of Nrf2 dysfunction in the genesis of age-related pathologies affecting the circulatory system, including its role in induction of cellular senescence. Therapeutic strategies that restore Nrf2 signaling and improve vascular resilience in aging are explored to reduce cardiovascular mortality and morbidity in older adults.
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Affiliation(s)
- Zoltan Ungvari
- Vascular Cognitive Impairment and Neurodegeneration Program, Reynolds Oklahoma Center on Aging, Oklahoma Center for Geroscience, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
- Department of Health Promotion Sciences, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine, Department of Public Health, Semmelweis University, Budapest, Hungary.
- International Training Program in Geroscience, Theoretical Medicine Doctoral School, Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary.
- Reynolds Oklahoma Center on Aging, Department of Geriatric Medicine, University of Oklahoma HSC, 975 N. E. 10th Street - BRC 1303, Oklahoma City, OK, 73104, USA.
| | - Stefano Tarantini
- Vascular Cognitive Impairment and Neurodegeneration Program, Reynolds Oklahoma Center on Aging, Oklahoma Center for Geroscience, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine, Department of Public Health, Semmelweis University, Budapest, Hungary
| | - Ádám Nyúl-Tóth
- Vascular Cognitive Impairment and Neurodegeneration Program, Reynolds Oklahoma Center on Aging, Oklahoma Center for Geroscience, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Biological Research Centre, Institute of Biophysics, Szeged, Hungary
| | - Tamas Kiss
- Vascular Cognitive Impairment and Neurodegeneration Program, Reynolds Oklahoma Center on Aging, Oklahoma Center for Geroscience, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- International Training Program in Geroscience, Theoretical Medicine Doctoral School, Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary
| | - Andriy Yabluchanskiy
- Vascular Cognitive Impairment and Neurodegeneration Program, Reynolds Oklahoma Center on Aging, Oklahoma Center for Geroscience, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Tamas Csipo
- Vascular Cognitive Impairment and Neurodegeneration Program, Reynolds Oklahoma Center on Aging, Oklahoma Center for Geroscience, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine, Department of Public Health, Semmelweis University, Budapest, Hungary
- International Training Program in Geroscience, Division of Clinical Physiology, Department of Cardiology, Kalman Laki Doctoral School, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Priya Balasubramanian
- Vascular Cognitive Impairment and Neurodegeneration Program, Reynolds Oklahoma Center on Aging, Oklahoma Center for Geroscience, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Agnes Lipecz
- Vascular Cognitive Impairment and Neurodegeneration Program, Reynolds Oklahoma Center on Aging, Oklahoma Center for Geroscience, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Zoltan Benyo
- Doctoral School of Basic and Translational Medicine, Institute of Clinical Experimental Research, Semmelweis University, Budapest, Hungary
| | - Anna Csiszar
- Vascular Cognitive Impairment and Neurodegeneration Program, Reynolds Oklahoma Center on Aging, Oklahoma Center for Geroscience, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- International Training Program in Geroscience, Theoretical Medicine Doctoral School, Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary
- Doctoral School of Basic and Translational Medicine, Institute of Clinical Experimental Research, Semmelweis University, Budapest, Hungary
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Han L, Ren RR, Wan KL, Yang L, Kang JQ. Plasma inflammatory factors in older people predict acute kidney injury: a case–control study. Eur Geriatr Med 2019; 10:905-911. [DOI: 10.1007/s41999-019-00250-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 10/01/2019] [Indexed: 12/13/2022]
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The Neuropeptide Pituitary Adenylate Cyclase-Activating Polypeptide (PACAP) is Protective in Inflammation and Oxidative Stress-Induced Damage in the Kidney. Int J Mol Sci 2019; 20:ijms20194944. [PMID: 31591326 PMCID: PMC6801442 DOI: 10.3390/ijms20194944] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 09/20/2019] [Accepted: 10/01/2019] [Indexed: 12/11/2022] Open
Abstract
Pituitary adenylate cyclase-activating polypeptide (PACAP) is a pleiotropic neuropeptide with a widespread distribution throughout the entire body including the urinary system. PACAP exerts protective actions in different injury models related to several organ systems. Its protective effect is mainly based on its antiapoptotic, anti-inflammatory and antioxidant effects. The present review aims to summarize the effects of PACAP in pathologies associated with inflammation and oxidative stress-induced damage in the kidney. Both in vitro and in vivo data are available proving its protective actions against oxidative stress, hypoxia, renal ischemia/reperfusion, diabetic nephropathy, myeloma kidney injury, amyloidosis and different types of drug-induced nephropathies. Data showing the nephroprotection by PACAP emphasize the potential of PACAP’s therapeutic use in various renal pathologies.
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N-Terminal Pro-Brain Natriuretic Peptide Predicts Long-Term Technique Failure in Patients Undergoing Peritoneal Dialysis. J Clin Med 2018; 7:jcm7120557. [PMID: 30558385 PMCID: PMC6306793 DOI: 10.3390/jcm7120557] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Revised: 12/06/2018] [Accepted: 12/13/2018] [Indexed: 12/29/2022] Open
Abstract
It is unclear whether N-terminal pro-brain type natriuretic peptide (NT-proBNP) level can be a biomarker for technique failure among long-term peritoneal dialysis (PD) patients. We prospectively included end-stage renal disease patients undergoing PD from a single center between December 2011 and December 2017. We divided the cohort into high or low NT-proBNP groups and analyzed the risk factors associated with the incidence of technique failure using Cox proportional hazard regression analysis. A total of 258 chronic PD patients (serum NT-proBNP, 582 ± 1216 ng/mL) were included. After a mean follow-up of 3.6 years, 49.6% of PD patients developed technique failure and switched to hemodialysis, while 15.5% died. Cox proportional hazard regression analyses accounting for age, gender, diabetes, renal clearance, C-reactive protein, and hydration status, showed that higher natural log transformed NT-proBNP levels (hazard ratio [HR] 1.13, p < 0.01) were predictive of an increased risk of technique failure, and were also predictive of an increased risk of mortality (HR 1.56, p < 0.01). Consequently, NT-proBNP might be an under-recognized biomarker for estimating the risk of technique failure, and regular monitoring NT-proBNP levels among PD patients may assist in their care.
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Chao CT, Chen YM, Ho FH, Lin KP, Chen JH, Yen CJ. 10-Year Renal Function Trajectories in Community-Dwelling Older Adults: Exploring the Risk Factors for Different Patterns. J Clin Med 2018; 7:jcm7100373. [PMID: 30347853 PMCID: PMC6210637 DOI: 10.3390/jcm7100373] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Revised: 10/15/2018] [Accepted: 10/19/2018] [Indexed: 12/16/2022] Open
Abstract
Longitudinal changes of renal function help inform patients’ clinical courses and improve risk stratification. Rare studies address risk factors predicting changes in estimated glomerular filtration rate (eGFR) over time in older adults, particularly of Chinese ethnicity. We identified prospectively enrolled community-dwelling older adults (≥65 years) receiving annual health examinations between 2005 and 2015 with serum creatinine available continuously in a single institute, and used linear regression to derive individual’s annual eGFR changes, followed by multivariate logistic regression analyses to identify features associated with different eGFR change patterns. Among 500 elderly (71.3 ± 4.2 years), their mean annual eGFR changes were 0.84 ± 1.67 mL/min/1.73 m2/year, with 136 (27.2%) and 238 (47.6%) classified as having downward (annual eGFR change <0 mL/min/1.73 m2/year) and upward eGFR (≥1 mL/min/1.73 m2/year) trajectories, respectively. Multivariate logistic regression showed that higher age (odds ratio (OR) 1.08), worse renal function (OR 13.2), and more severe proteinuria (OR 9.86) or hematuria (OR 3.39) were predictive of a declining eGFR while greater waist circumference (OR 1.06) and higher leukocyte counts (OR 1.21) were predictive of an uprising 10-year eGFR. These findings elucidate important features associated with geriatric renal function variations, which are expected to improve their renal care.
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Affiliation(s)
- Chia-Ter Chao
- Department of Medicine, National Taiwan University Hospital BeiHu Branch, College of Medicine, National Taiwan University, Taipei 10617, Taiwan.
- Geriatric and Community Medicine Research Center, National Taiwan University Hospital BeiHu Branch, Taipei 10617, Taiwan.
| | - Yung-Ming Chen
- Department of Internal Medicine; National Taiwan University, Taipei 10617, Taiwan.
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei 10617, Taiwan.
| | - Fu-Hui Ho
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei 10617, Taiwan.
| | - Kun-Pei Lin
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei 10617, Taiwan.
| | - Jen-Hau Chen
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei 10617, Taiwan.
| | - Chung-Jen Yen
- Department of Internal Medicine; National Taiwan University, Taipei 10617, Taiwan.
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Chao CT, Wang J, Chien KL. Both pre-frailty and frailty increase healthcare utilization and adverse health outcomes in patients with type 2 diabetes mellitus. Cardiovasc Diabetol 2018; 17:130. [PMID: 30261879 PMCID: PMC6158921 DOI: 10.1186/s12933-018-0772-2] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 09/17/2018] [Indexed: 12/15/2022] Open
Abstract
Background Diabetes mellitus (DM) correlates with accelerated aging and earlier appearance of geriatric phenotypes, including frailty. However, whether pre-frailty or frailty predicts greater healthcare utilization in diabetes patients is unclear. Methods From the Longitudinal Cohort of Diabetes Patients in Taiwan (n = 840,000) between 2004 and 2010, we identified 560,795 patients with incident type 2 DM, categorized into patients without frailty, or with 1, 2 (pre-frail) and ≥ 3 frailty components, based on FRAIL scale (Fatigue, Resistance, Ambulation, Illness, and body weight Loss). We examined their long-term mortality, cardiovascular risk, all-cause hospitalization, and intensive care unit (ICU) admission. Results Among all participants (56.4 ± 13.8 year-old, 46.1% female, and 84.8% community-dwelling), 77.8% (n = 436,521), 19.2% (n = 107,757), 2.7% (n = 15,101), and 0.3% (n = 1416) patients did not have or had 1, 2 (pre-frail), and ≥ 3 frailty components (frail), respectively, with Fatigue and Illness being the most common components. After 3.14 years of follow-up, 7.8% patients died, whereas 36.6% and 9.1% experienced hospitalization and ICU stay, respectively. Cox proportional hazard modeling discovered that patients with 1, 2 (pre-frail), and ≥ 3 frailty components (frail) had an increased risk of mortality (for 1, 2, and ≥ 3 components, hazard ratio [HR] 1.05, 1.13, and 1.25; 95% confidence interval [CI] 1.02–1.07, 1.08–1.17, and 1.15–1.36, respectively), cardiovascular events (HR 1.05, 1.15, and 1.13; 95% CI 1.02–1.07, 1.1–1.2, and 1.01–1.25, respectively), hospitalization (HR 1.06, 1.16, and 1.25; 95% CI 1.05–1.07, 1.14–1.19, and 1.18–1.33, respectively), and ICU admission (HR 1.05, 1.13, and 1.17; 95% CI 1.03–1.07, 1.08–1.14, and 1.06–1.28, respectively) compared to non-frail ones. Approximately 6–7% risk elevation in mortality and healthcare utilization was noted for every frailty component increase. Conclusion Pre-frailty and frailty increased the risk of mortality and cardiovascular events, and entailed greater healthcare utilization in patients with type 2 DM. Electronic supplementary material The online version of this article (10.1186/s12933-018-0772-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Chia-Ter Chao
- Department of Medicine, National Taiwan University Hospital BeiHu Branch, Taipei, Taiwan.,Nephrology Division, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Geriatric and Community Medicine Research Center, National Taiwan University Hospital BeiHu Branch, Taipei, Taiwan
| | - Jui Wang
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, No. 1, Sec. 4, Roosevelt Road, Taipei, 10617, Taiwan
| | - Kuo-Liong Chien
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, No. 1, Sec. 4, Roosevelt Road, Taipei, 10617, Taiwan.
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Oweis AO, Alshelleh SA. Incidence and outcomes of acute kidney injury in octogenarians in Jordan. BMC Res Notes 2018; 11:279. [PMID: 29739428 PMCID: PMC5941475 DOI: 10.1186/s13104-018-3397-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 05/03/2018] [Indexed: 12/18/2022] Open
Abstract
Objective Improvements in the health care system, resulted in a greater number of geriatric patients diagnosed with acute kidney injury (AKI). We evaluated the incidence and outcome of AKI in octogenarians, as studies in the Middle-East region are few; moreover, treatment approaches, in addition to medical decisions, may require special consideration for advanced age to improve the outcomes. Results At King Abdullah II teaching and referral hospital, we recruited patients aged 80–90 years who were admitted to the medical floor between January 2010 and December 2013. Patients were followed-up for at least 1 year after discharge.850 patients were admitted during the study period. Of these, 135 were excluded from our analysis. The most common admission diagnoses were uncontrolled diabetes mellitus and acute coronary syndrome. AKI occurred in 216 patients (30.2%). Using the acute kidney injury network classification; stage 1, stage 2, and stage 3 disease were present in 59, 17.5, and 23.5% of patients, respectively. Of the 115 patients who died before discharge (16.1%), 87 (75.6%) had developed AKI. Hypertension, the use of angiotensin receptor blockers and non-steroidal anti-inflammatory drugs, heart failure, and exposure to radiologic contrast media were significant risk factors for AKI.
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Affiliation(s)
- Ashraf O Oweis
- Division of Nephrology, Department of Medicine, Jordan University of Science and Technology, Irbid, Jordan.
| | - Sameeha A Alshelleh
- Division of Nephrology, Department of Medicine, University of Jordan, Amman, Jordan
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