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Chen T, Xiao S, Chen Z, Yang Y, Yang B, Liu N. Risk factors for peripheral artery disease and diabetic peripheral neuropathy among patients with type 2 diabetes. Diabetes Res Clin Pract 2024; 207:111079. [PMID: 38154538 DOI: 10.1016/j.diabres.2023.111079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 12/14/2023] [Accepted: 12/20/2023] [Indexed: 12/30/2023]
Abstract
AIMS To investigate the prevalence of peripheral artery disease (PAD) and diabetic peripheral neuropathy (DPN) and the associated risk factors among Chinese patients with type 2 diabetes mellitus. METHODS A cross-sectional study was conducted using data between November 1, 2018, and December 31, 2022. PAD was defined as ABI ≤ 0.9. DPN diagnosis involved specialized physician assessments using questionnaires and vibration perception threshold tests. Logistic regression analysis was used to identify related factors. We also evaluated the association between the clustering of risk factors and disease incidence. RESULTS The study population comprised 13,315 patients (mean age: 63.3 years). 4.9 % of the patients had PAD and 43.9 % had DPN. Multivariate regression analysis revealed advanced age, smoking, hypertension, coronary heart disease, dyslipidemia, elevated HbA1c, and uric acid levels as independent risk factors for PAD. For DPN, independent risk factors included advanced age, female gender, hypertension, coronary heart disease, elevated total cholesterol, triglycerides, lipoprotein(a), fasting plasma glucose, HbA1c, alkaline phosphatase, cystatin C, albumin-to-creatinine ratio, and elevated homocysteine levels, whereas apolipoprotein A was a protective factor. The clustering of risk factors was prevalent and associated with higher disease risk. CONCLUSIONS Our study contributed to identifying high-risk individuals and improving lower limb health among diabetic individuals.
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Affiliation(s)
- Tian Chen
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China
| | - Shengjue Xiao
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China
| | - Zhengdong Chen
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China
| | - Yiqing Yang
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China
| | - Bingquan Yang
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, School of Medicine, Southeast University, Nanjing, Jiangsu, China.
| | - Naifeng Liu
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China.
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Bucolo GM, D'Angelo T, Yel I, Koch V, Gruenewald LD, Othman AE, Alizadeh LS, Overhoff DP, Waldeck S, Martin SS, Mazziotti S, Ascenti G, Blandino A, Vogl TJ, Booz C. Virtual Monoenergetic Imaging of Lower Extremities Using Dual-Energy CT Angiography in Patients with Diabetes Mellitus. Diagnostics (Basel) 2023; 13:diagnostics13101790. [PMID: 37238274 DOI: 10.3390/diagnostics13101790] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/11/2023] [Accepted: 05/17/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (DM) is the most common metabolic disorder in the world and an important risk factor for peripheral arterial disease (PAD). CT angiography represents the method of choice for the diagnosis, pre-operative planning, and follow-up of vascular disease. Low-energy dual-energy CT (DECT) virtual mono-energetic imaging (VMI) has been shown to improve image contrast, iodine signal, and may also lead to a reduction in contrast medium dose. In recent years, VMI has been improved with the use of a new algorithm called VMI+, able to obtain the best image contrast with the least possible image noise in low-keV reconstructions. PURPOSE To evaluate the impact of VMI+ DECT reconstructions on quantitative and qualitative image quality in the evaluation of the lower extremity runoff. MATERIALS AND METHODS We evaluated DECT angiography of lower extremities in patients suffering from diabetes who had undergone clinically indicated DECT examinations between January 2018 and January 2023. Images were reconstructed with standard linear blending (F_0.5) and low VMI+ series were generated from 40 to 100 keV, in an interval of 15 keV. Vascular attenuation, image noise, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) were calculated for objective analysis. Subjective analysis was performed using five-point scales to evaluate image quality, image noise, and diagnostic assessability of vessel contrast. RESULTS Our final study cohort consisted of 77 patients (41 males). Attenuation values, CNR, and SNR were higher in 40-keV VMI+ reconstructions compared to the remaining VMI+ and standard F_0.5 series (HU: 1180.41 ± 45.09; SNR: 29.91 ± 0.99; CNR: 28.60 ± 1.03 vs. HU 251.32 ± 7.13; SNR: 13.22 ± 0.44; CNR: 10.57 ± 0.39 in standard F_0.5 series) (p < 0.0001). Subjective image rating was significantly higher in 55-keV VMI+ images compared to the other VMI+ and standard F_0.5 series in terms of image quality (mean score: 4.77), image noise (mean score: 4.39), and assessability of vessel contrast (mean value: 4.57) (p < 0.001). CONCLUSIONS DECT 40-keV and 55-keV VMI+ showed the highest objective and subjective parameters of image quality, respectively. These specific energy levels for VMI+ reconstructions could be recommended in clinical practice, providing high-quality images with greater diagnostic suitability for the evaluation of lower extremity runoff, and potentially needing a lower amount of contrast medium, which is particularly advantageous for diabetic patients.
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Affiliation(s)
- Giuseppe Mauro Bucolo
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany
- Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, 98122 Messina, Italy
| | - Tommaso D'Angelo
- Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, 98122 Messina, Italy
- Department of Radiology and Nuclear Medicine, Erasmus MC, 3015 GD Rotterdam, The Netherlands
| | - Ibrahim Yel
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany
| | - Vitali Koch
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany
| | - Leon D Gruenewald
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany
| | - Ahmed E Othman
- Department of Neuroradiology, University Hospital Mainz, 55131 Mainz, Germany
| | - Leona Soraja Alizadeh
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany
- Department of Diagnostic and Interventional Radiology and Neuroradiology, Bundeswehr Central Hospital Koblenz, 56072 Koblenz, Germany
| | - Daniel P Overhoff
- Department of Diagnostic and Interventional Radiology and Neuroradiology, Bundeswehr Central Hospital Koblenz, 56072 Koblenz, Germany
- Department of Radiology and Nuclear Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany
| | - Stephan Waldeck
- Department of Diagnostic and Interventional Radiology and Neuroradiology, Bundeswehr Central Hospital Koblenz, 56072 Koblenz, Germany
- Institute of Neuroradiology, University Medical Centre, Johannes Gutenberg University Mainz, 55099 Mainz, Germany
| | - Simon S Martin
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany
| | - Silvio Mazziotti
- Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, 98122 Messina, Italy
| | - Giorgio Ascenti
- Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, 98122 Messina, Italy
| | - Alfredo Blandino
- Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, 98122 Messina, Italy
| | - Thomas J Vogl
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany
| | - Christian Booz
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany
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Ovwasa H, Aiwuyo HO, Okoye CA O, Umuerri EM, Obasohan A, Unuigbe E, Rajora N. Prevalence and Predictors of Peripheral Vascular Disease Amongst Predialysis Hypertensive Chronic Kidney Disease Patients in Southern Nigeria. Cureus 2023; 15:e36752. [PMID: 37123670 PMCID: PMC10132477 DOI: 10.7759/cureus.36752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Peripheral vascular disease (PVD) is an atherosclerotic disease associated with increased morbidity and mortality among chronic kidney disease (CKD) patients. However, despite the substantial burden of PVD in CKD, local data are lacking. OBJECTIVE To determine the prevalence and predictors of PVD in predialysis CKD patients. METHOD AND MATERIALS The study was cross-sectional. One hundred fifty hypertensive CKD patients and age- and sex-matched hypertensive non-CKD subjects were consecutively enrolled at the renal unit of Delta State University Teaching Hospital (DELSUTH), Oghara. Structured questionnaires were used to obtain information on participants' demographic data and health status. PVD was defined by an ankle-brachial index of < 0.9 or > 1.4 in either lower extremity. eGFR was calculated from serum creatinine using the MDRD equation. RESULTS The mean ages of the study and control groups were 48±14 and 51±15years, respectively. The sex ratio was 3:2 in favour of males for both the study and control groups. The majority of the study group was in CKD stage 4 (44%). The prevalence of PVD was higher among the CKD group compared with controls (24.0% vs. 14.7%). Of the CKD patients with PVD, 11.1% were symptomatic. Predictors of PVD in the study group were eGFR (B=0.010, 95%CI: 0.007-0.013), diastolic BP (B=-0.005, 95%CI: -0.007- -0.002), MAP (B=-0.018, 95%CI: -0.027- -0.008), urinary ACR (B=-0.0036, 95%CI: -0.040- -0.024) and smoking history (p<0.001, OR=14.71). CONCLUSION AND RECOMMENDATION PVD is common and largely asymptomatic in CKD patients. The predictors of PVD in this study were eGFR, diastolic BP, mean arterial pressure (MAP), urinary albumin to creatinine ratio (ACR), and smoking. A proactive assessment of PVD and early intervention in CKD patients is needed.
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Wang Y, Zhang Q, Ren P, Pan Y, Liu Y, Li C, Fan Z, Han F, Zhang X, Chen J. The significance of follow-up serum uric acid levels in predicting all-cause mortality and cardiovascular mortality in peritoneal dialysis patients. Ther Apher Dial 2023; 27:83-90. [PMID: 35670149 PMCID: PMC10084356 DOI: 10.1111/1744-9987.13892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 05/27/2022] [Accepted: 06/02/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND This study aimed to analyze the change of serum uric acid (SUA) level post peritoneal dialysis (PD), and the correlation between follow-up SUA and prognosis in patients with PD. METHODS A total of 1402 patients with PD were evaluated. We graded SUA levels into four grades at baseline, 6 months, 12 months, 18 months, and 24 months post PD, and then compared all-cause mortality and cardiovascular mortality among patients with different SUA grades at each time point. Kaplan-Meier and Cox proportional-hazards regression models were used in the analysis. RESULTS The SUA levels were 7.97 ± 1.79, 7.12 ± 1.48, 7.05 ± 1.33, 7.01 ± 1.30, and 6.93 ± 1.26 mg/dl at baseline, 6, 12, 18, and 24 months, respectively. There was significant difference on all-cause mortality among patients with PD with different graded SUA levels at 6 months post PD (p = 0.010), and the all-cause mortality was lowest in patients with the grade of 5.65 mg/dl ≤ SUA <7.13 mg/dl. CONCLUSION SUA level decreased after PD during follow-up. At 6 months post PD, the grade of 5.65 mg/dl ≤ SUA <7.13 mg/dl was appropriate for better patients' survival.
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Affiliation(s)
- Yaomin Wang
- Kidney Disease Center, The First Affiliated Hospital, Zhejiang University School of Medicine; Institute of Nephrology, Zhejiang University, Key Laboratory of Kidney Disease Prevention and Control Technology, Hangzhou, China
| | - Qilong Zhang
- Kidney Disease Center, The First Affiliated Hospital, Zhejiang University School of Medicine; Institute of Nephrology, Zhejiang University, Key Laboratory of Kidney Disease Prevention and Control Technology, Hangzhou, China.,Anji People's Hospital, Huzhou, China
| | - Pingping Ren
- Kidney Disease Center, The First Affiliated Hospital, Zhejiang University School of Medicine; Institute of Nephrology, Zhejiang University, Key Laboratory of Kidney Disease Prevention and Control Technology, Hangzhou, China
| | - Yixuan Pan
- Kidney Disease Center, The First Affiliated Hospital, Zhejiang University School of Medicine; Institute of Nephrology, Zhejiang University, Key Laboratory of Kidney Disease Prevention and Control Technology, Hangzhou, China
| | - Yi Liu
- Anji People's Hospital, Huzhou, China
| | | | | | - Fei Han
- Kidney Disease Center, The First Affiliated Hospital, Zhejiang University School of Medicine; Institute of Nephrology, Zhejiang University, Key Laboratory of Kidney Disease Prevention and Control Technology, Hangzhou, China
| | - Xiaohui Zhang
- Kidney Disease Center, The First Affiliated Hospital, Zhejiang University School of Medicine; Institute of Nephrology, Zhejiang University, Key Laboratory of Kidney Disease Prevention and Control Technology, Hangzhou, China
| | - Jianghua Chen
- Kidney Disease Center, The First Affiliated Hospital, Zhejiang University School of Medicine; Institute of Nephrology, Zhejiang University, Key Laboratory of Kidney Disease Prevention and Control Technology, Hangzhou, China
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Segar MW, Keshvani N, Rao S, Fonarow GC, Das SR, Pandey A. Race, Social Determinants of Health, and Length of Stay Among Hospitalized Patients With Heart Failure: An Analysis From the Get With The Guidelines-Heart Failure Registry. Circ Heart Fail 2022; 15:e009401. [PMID: 36378756 DOI: 10.1161/circheartfailure.121.009401] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Racial disparities in heart failure hospitalization and mortality are well established; however, the association between different social determinants of health (SDOH) and length of stay (LOS) and the extent to which this association may differ across racial groups is not well established. METHODS We utilized data from the Get With The Guidelines-Heart Failure registry to evaluate the association between SDOH, as determined by patients' residential ZIP Code and LOS among patients hospitalized with heart failure. We also assessed the race-specific contribution of the ZIP Code-level SDOH to LOS in patients of Black and non-Black races. Finally, we evaluated SDOH predictors of racial differences in LOS at the hospital level. RESULTS Among 301 500 patients (20.2% Black race), the median LOS was 4 days. In adjusted analysis accounting for patient-level and hospital-level factors, SDOH parameters of education, income, housing instability, and foreign-born were significantly associated with LOS after adjusting for clinical status and hospital-level factors. SDOH parameters accounted for 25.8% of the total attributable risk for prolonged LOS among Black patients compared with 10.1% in patients of non-Black race. Finally, hospitals with disproportionately longer LOS for Black versus non-Black patients were more likely to care for disadvantaged patients living in ZIP Codes with a higher percentage of foreign-born and non-English speaking areas. CONCLUSIONS ZIP Code-level SDOH markers can identify patients at risk for prolonged LOS, and the effects of SDOH parameters are significantly greater among Black adults with heart failure as compared with non-Black adults.
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Affiliation(s)
- Matthew W Segar
- Department of Cardiology, Texas Heart Institute, Houston (M.W.S.)
| | - Neil Keshvani
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (N.K., S.R., S.R.D., A.P.).,Parkland Health and Hospital System, Dallas (N.K., S.R., S.R.D., A.P.)
| | - Shreya Rao
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (N.K., S.R., S.R.D., A.P.).,Parkland Health and Hospital System, Dallas (N.K., S.R., S.R.D., A.P.)
| | - Gregg C Fonarow
- Division of Cardiology, University of California Los Angeles School of Medicine (G.C.F.)
| | - Sandeep R Das
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (N.K., S.R., S.R.D., A.P.).,Parkland Health and Hospital System, Dallas (N.K., S.R., S.R.D., A.P.)
| | - Ambarish Pandey
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (N.K., S.R., S.R.D., A.P.).,Parkland Health and Hospital System, Dallas (N.K., S.R., S.R.D., A.P.)
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Rotablation in Patients with Advanced Renal Insufficiency through End-Stage Renal Disease: Short- and Intermediate-Term Results. J Interv Cardiol 2022; 2022:7884401. [PMID: 35350479 PMCID: PMC8930227 DOI: 10.1155/2022/7884401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 02/14/2022] [Accepted: 02/16/2022] [Indexed: 11/17/2022] Open
Abstract
Objective. Patients with advanced renal insufficiency are at high risk of coronary artery disease (CAD) and complex lesions. Treating complex calcified lesion with rotational atherectomy (RA) in these patients might be associated with higher risks and poorer outcomes. This study was set to evaluate features and outcomes of RA in these patients. Method. Consecutive patients who received coronary RA from April 2010 to April 2018 were queried from the Cath Lab database. The procedural details, angiography, and clinical information were reviewed in detail. Results. A total of 411 patients were enrolled and divided into Group A (baseline serum creatinine <5 mg/dl, n = 338) and Group B (baseline serum creatinine ≥ 5 mg/dl through ESRD, n = 73). Most patients had high-risk features (65.7% of acute coronary syndrome (ACS), 14.1% of ischemic cardiomyopathy, and 5.1% of cardiogenic shock). Group B patients were significantly younger (66.8 ± 11.4 vs. 75.2 ± 10.7 years,
) and had more RCA and LCX but less LAD treated with RA. No difference was found in lesion location, vessel tortuosity, bifurcation lesions, chronic total occlusion, total lesion length, or total lesion numbers between the two groups. Less patients in Group B obtained completion of RA (95.9% vs 99.1%,
). There was no difference in the incidence of procedural complication or acute contrast-induced nephropathy. Group B patients had more deaths and MACE while in the hospital. The MACE and CV MACE were also higher in Group B patients at 180 days and one year, mostly due to TLR and TVR. Multivariate regression analysis showed that ACS, age, peripheral artery disease (PAD), advanced renal insufficiency, ischemic cardiomyopathy/shock, and high residual SYNTAX score were independent risk factors for in-hospital MACE, whereas ACS, advanced renal insufficiency, ischemic cardiomyopathy/shock, triple-vessel disease, and PAD independently predicted MACE at 6 months. Conclusions. Rotablation is feasible, safe, and could be carried out with very high success rate in very-high-risk patients with advanced renal dysfunction through ESRD without an increase in procedural complication.
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Liu J, Tio MC, Verma A, Schmidt IM, Ilori TO, Knauf F, Mc Causland FR, Waikar SS. Determinants and Outcomes Associated With Urinary Calcium Excretion in Chronic Kidney Disease. J Clin Endocrinol Metab 2022; 107:e281-e292. [PMID: 34390334 PMCID: PMC8684460 DOI: 10.1210/clinem/dgab574] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Indexed: 02/08/2023]
Abstract
CONTEXT Abnormalities in calcium metabolism are common in chronic kidney disease (CKD). Diminished urinary calcium excretion may promote vascular calcification and increased urinary calcium excretion may lead to nephrolithiasis and nephrocalcinosis, conditions associated with CKD. OBJECTIVE To study predictors of urinary calcium excretion and its association with adverse clinical outcomes in CKD. DESIGN, SETTING AND PATIENTS This study assessed 3768 nondialysis participants in the Chronic Renal Insufficiency Cohort study from April 2003 to September 2008. Participants were followed up to October 2018. EXPOSURE Clinically plausible predictors of urinary calcium excretion and 24-h urinary calcium excretion at baseline. MAIN OUTCOME MEASURES Urinary calcium excretion; incident end stage kidney disease (ESKD), CKD progression [50% estimated glomerular filtration rate (eGFR) decline or incident ESKD], all-cause mortality, and atherosclerotic cardiovascular disease events. RESULTS eGFR was positive correlated with 24-h urinary calcium excretion. The variables most strongly associated with 24-h urinary calcium excretion in males and females were 24-h urinary sodium (β = 0.19 and 0.28, respectively), serum parathyroid hormone (β = -0.22 and -0.20, respectively), loop diuretics (β = 0.36 and 0.26, respectively), thiazide diuretics (β = -0.49 and -0.53, respectively), and self-identified black race (β = -0.23 and -0.27, respectively). Lower urinary calcium excretion was associated with greater risks of adverse outcomes, but these associations were greatly attenuated or nullified after adjustment for baseline eGFR. CONCLUSION Urinary calcium excretion is markedly lower in individuals with CKD compared to the general population. Determinants of urinary calcium excretion differed between sexes and levels of CKD. Associations between urinary calcium excretion and adverse clinical events were substantially confounded by eGFR.
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Affiliation(s)
- Jing Liu
- Renal Division, Kidney Research Institute, West China Hospital of Sichuan University, Chengdu, China
- Section of Nephrology, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
| | - Maria Clarissa Tio
- Renal Division, Brigham & Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Ashish Verma
- Renal Division, Brigham & Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Insa M Schmidt
- Section of Nephrology, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
- Renal Division, Brigham & Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Titilayo O Ilori
- Section of Nephrology, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
| | - Felix Knauf
- Department of Nephrology and Medical Intensive Care, Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | - Sushrut S Waikar
- Section of Nephrology, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
- Correspondence: Sushrut S. Waikar, MD, MPH, Boston Medical Center, Renal Section, Evans Biomedical Research Center, 650 Albany Street, X504, Boston, MA 02118, USA.
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8
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Keshvani N, Willis B, Leonard D, Gao A, DeFina L, McDermott MM, Berry JD, Kumbhani DJ. Midlife Cardiorespiratory Fitness and the Development of Peripheral Artery Disease in Later Life. J Am Heart Assoc 2021; 10:e020841. [PMID: 34854310 PMCID: PMC9075370 DOI: 10.1161/jaha.121.020841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Data are sparse on the prospective associations between physical activity and incidence of lower extremity peripheral artery disease (PAD). Methods and Results Linking participant data from the CCLS (Cooper Center Longitudinal Study) to Medicare claims files, we studied 19 023 participants with objectively measured midlife cardiorespiratory fitness through maximal effort on the Balke protocol who survived to receive Medicare coverage between 1999 and 2009. The study aimed to determine the association between midlife cardiorespiratory fitness and incident PAD with proportional hazards intensity models, adjusted for age, sex, body mass index, and other covariates, to PAD failure time data. During 121 288 person-years of Medicare follow-up, we observed 805 PAD-related hospitalizations/procedures among 19 023 participants (21% women, median age 50 years). Lower midlife fitness was associated with a higher rate of incident PAD in patients aged 65 years and older (low fit [quintile 1]: 11.4, moderate fit [quintile 2 to 3]: 7.8, and high fit [quintile 4 to 5]: 5.7 per 1000 person years). After multivariable adjustment for common predictors of incident PAD such as age, body mass index, hypertension, and diabetes, these findings persisted. Lower risk for PAD per greater metabolic equivalent task of fitness was observed (hazard ratio [HR], 0.93 [95% CI, 0.90-0.97]; P<0.001). Among a subset of patients with an additional fitness assessment, each 1 metabolic equivalent task increase from baseline fitness was associated with decreased risk of incident PAD (HR, 0.90 [95% CI, 0.82-0.99]; P=0.03). Conclusions Cardiorespiratory fitness in healthy, middle-aged adults is associated with lower risk of incident PAD in later life, independent of other predictors of incident PAD.
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Affiliation(s)
- Neil Keshvani
- Division of Cardiology University of Texas Southwestern Medical Center Dallas TX
| | | | | | | | | | | | - Jarett D Berry
- Division of Cardiology University of Texas Southwestern Medical Center Dallas TX
| | - Dharam J Kumbhani
- Division of Cardiology University of Texas Southwestern Medical Center Dallas TX
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Accuracy of Ankle-Brachial Index, Toe-Brachial Index, and Risk Classification Score in Discriminating Peripheral Artery Disease in Patients With Chronic Kidney Disease. Am J Cardiol 2021; 160:117-123. [PMID: 34583809 DOI: 10.1016/j.amjcard.2021.08.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 08/16/2021] [Accepted: 08/17/2021] [Indexed: 11/24/2022]
Abstract
The accuracy of ankle-brachial index (ABI) and toe-brachial index (TBI) in discriminating lower extremity peripheral artery disease (PAD) has not been evaluated in patients with chronic kidney disease (CKD). We measured ABI, TBI, and Doppler ultrasound in 100 predialysis patients with CKD without revascularization or amputation. Leg-specific ABI was calculated using higher systolic blood pressure (SBP) in posterior tibial or dorsalis pedis artery divided by higher brachial SBP; alternative ABI was calculated using lower SBP in posterior tibial or dorsalis pedis artery. PAD was defined as ≥50% stenosis detected by Doppler ultrasound. PAD risk classification score was calculated using cardiovascular disease risk factors. The area under the curve (AUC, 95% confidence interval [CI]) for discriminating ultrasound-diagnosed PAD was 0.78 (0.69 to 0.87) by ABI, 0.80 (0.71 to 0.89) by alternative ABI, and 0.74 (0.63 to 0.86) by TBI. Sensitivity and specificity were 25% and 97% for ABI ≤0.9, 41% and 95% for alternative ABI ≤0.9, and 45% and 93% for TBI ≤0.7, respectively. AUC (95% CI) of PAD risk classification score was 0.86 (0.78 to 0.94) with sensitivity and specificity of 95% and 60% for risk score ≥0.10, 76% and 76% for risk score ≥0.25, and 43% and 95% for risk score ≥0.55. Combining risk score with ABI, alternative ABI, and TBI increased AUC (95% CI) to 0.89 (0.82 to 0.96), 0.89 (0.80 to 0.98), and 0.87 (0.78 to 0.96), respectively. In conclusion, current ABI and TBI diagnostic criteria have high specificity but low sensitivity for classifying PAD in patients with CKD. PAD classification risk score based on cardiovascular disease risk factors improves the accuracy of PAD classification.
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Arinze NV, Yin W, Lotfollahzadeh S, Napoleon MA, Richards S, Walker JA, Belghasem M, Ravid JD, Hassan Kamel M, Whelan SA, Lee N, Siracuse JJ, Anderson S, Farber A, Sherr D, Francis J, Hamburg NM, Rahimi N, Chitalia VC. Tryptophan metabolites suppress Wnt pathway and promote adverse limb events in CKD patients. J Clin Invest 2021; 132:142260. [PMID: 34752422 PMCID: PMC8718145 DOI: 10.1172/jci142260] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 11/02/2021] [Indexed: 11/30/2022] Open
Abstract
Chronic kidney disease (CKD) imposes a strong and independent risk for peripheral artery disease (PAD). While solutes retained in CKD patients (uremic solutes) inflict vascular damage, their role in PAD remains elusive. Here, we show that the dietary tryptophan-derived uremic solutes including indoxyl sulfate (IS) and kynurenine (Kyn) at concentrations corresponding to those in CKD patients suppress β-catenin in several cell types, including microvascular endothelial cells (ECs), inhibiting Wnt activity and proangiogenic Wnt targets in ECs. Mechanistic probing revealed that these uremic solutes downregulated β-catenin in a manner dependent on serine 33 in its degron motif and through the aryl hydrocarbon receptor (AHR). Hindlimb ischemia in adenine-induced CKD and IS solute–specific mouse models showed diminished β-catenin and VEGF-A in the capillaries and reduced capillary density, which correlated inversely with blood levels of IS and Kyn and AHR activity in ECs. An AHR inhibitor treatment normalized postischemic angiogenic response in CKD mice to a non-CKD level. In a prospective cohort of PAD patients, plasma levels of tryptophan metabolites and plasma’s AHR-inducing activity in ECs significantly increased the risk of future adverse limb events. This work uncovers the tryptophan metabolite/AHR/β-catenin axis as a mediator of microvascular rarefaction in CKD patients and demonstrates its targetability for PAD in CKD models.
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Affiliation(s)
- Nkiruka V Arinze
- Department of Surgery, Boston University School of Medicine, Boston, United States of America
| | - Wenqing Yin
- Department of Medicine, Boston University School of Medicine, Boston, United States of America
| | - Saran Lotfollahzadeh
- Department of Medicine, Boston University School of Medicine, Boston, United States of America
| | - Marc Arthur Napoleon
- Department of Medicine, Boston University School of Medicine, Boston, United States of America
| | - Sean Richards
- Department of Medicine, Boston University School of Medicine, Boston, United States of America
| | - Joshua A Walker
- Department of Medicine, Boston University School of Medicine, Boston, United States of America
| | - Mostafa Belghasem
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, United States of America
| | - Jonathan D Ravid
- School of Medicine, Boston University School of Medicine, Boston, United States of America
| | - Mohamed Hassan Kamel
- Department of Medicine, Boston University School of Medicine, Boston, United States of America
| | - Stephen A Whelan
- Department of Chemistry, Boston University, Boston, United States of America
| | - Norman Lee
- Department of Chemistry, Boston University, Boston, United States of America
| | - Jeffrey J Siracuse
- Department of Surgery, Boston University School of Medicine, Boston, United States of America
| | - Stephan Anderson
- Department of Radiology, Boston University School of Medicine, Boston, United States of America
| | - Alik Farber
- Department of Surgery, Boston University School of Medicine, Boston, United States of America
| | - David Sherr
- Boston University, Boston, United States of America
| | - Jean Francis
- Department of Medicine, Boston University School of Medicine, Boston, United States of America
| | - Naomi M Hamburg
- Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, United States of America
| | - Nader Rahimi
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, United States of America
| | - Vipul C Chitalia
- Department of Medicine, Boston University School of Medicine, Boston, United States of America
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11
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Patel NJ, Heuser RR. It is all about the beans: How chronic kidney disease can affect outcomes in peripheral intervention. Catheter Cardiovasc Interv 2021; 98:317-318. [PMID: 34369063 DOI: 10.1002/ccd.29850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 06/18/2021] [Indexed: 11/08/2022]
Affiliation(s)
- Nachiket J Patel
- University of Arizona College of Medicine, Phoenix, Arizona, USA.,Cardiovascular and Arrhythmia Institute, Mesa, Arizona, USA
| | - Richard R Heuser
- University of Arizona College of Medicine, Phoenix, Arizona, USA.,Vascular Heart and Lung Associates, Mesa, Arizona, USA
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12
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Salim M. Clinical outcomes among patients with chronic kidney disease hospitalized with diabetic foot disorders: A nationwide retrospective study. Endocrinol Diabetes Metab 2021; 4:e00277. [PMID: 34277993 PMCID: PMC8279616 DOI: 10.1002/edm2.277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 05/18/2021] [Accepted: 05/22/2021] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION Diabetic foot ulcerations or infections (DFUs/DFIs) are common complications of patients with diabetes. This study aimed to explore the impact of non-dialysis and dialysis CKD on hospitalized patients with DFUs/DFIs. METHODS A retrospective cohort study was conducted using the National Inpatient Sample database for the years 2017 and 2018. Patients hospitalized for DFUs/DFIs were included in the study. The primary outcome was lower limb amputations. The secondary outcomes were inpatient mortality, sepsis, length of stay (LOS), total hospitalization charges (THC) and disposition. RESULTS A total of 121,815 hospitalizations were included (26.1% non-dialysis CKD; 8.4% dialysis CKD). There was no significant difference in amputation rates between those on non-dialysis CKD (adjusted odds ratio [aOR]: 0.96; 95% confidence interval [CI]: 0.87-1.06) and dialysis CKD (aOR: 1.04, [95% CI: 0.91-1.12]) when compared to non-CKD group. Dialysis CKD group had increased odds of undergoing major amputation (aOR: 1.74, [95% CI: 1.32-2.29]), in-hospital mortality (aOR: 3.77 [95% CI: 1.94-7.31]), sepsis (aOR: 1.83 [95% CI: 1.27-2.62]), longer LOS (adjusted mean difference [aMD]: 1.46 [95 CI: 1.12-1.80) and higher THC (adjusted mean difference [aMD]: $20,148 [95% CI: $15,968-$24,327]). Non-dialysis CKD group had increased odds of sepsis (aOR: 1.36 [95% CI: 1.02-1.82]), less likely to be discharged home (aOR: 0.87 [95% CI: 0.80-0.95]), longer LOS (aMD: 0.91 [95% CI 0.69-1.13]) and higher THC (aMD: $20,148 [95% CI: $15,968-$24,327]). CONCLUSION Patients with CKD on dialysis had higher odds of undergoing major amputation. CKD increased the odds of in-hospital morbidity and resource utilization, with the most significant is for those on dialysis.
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Affiliation(s)
- Michael Salim
- Department of Internal MedicineMount Sinai HospitalChicagoILUSA
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13
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Memtsas VP, Arachchillage DRJ, Gorog DA. Role, Laboratory Assessment and Clinical Relevance of Fibrin, Factor XIII and Endogenous Fibrinolysis in Arterial and Venous Thrombosis. Int J Mol Sci 2021; 22:ijms22031472. [PMID: 33540604 PMCID: PMC7867291 DOI: 10.3390/ijms22031472] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 01/27/2021] [Accepted: 01/28/2021] [Indexed: 02/06/2023] Open
Abstract
Diseases such as myocardial infarction, ischaemic stroke, peripheral vascular disease and venous thromboembolism are major contributors to morbidity and mortality. Procoagulant, anticoagulant and fibrinolytic pathways are finely regulated in healthy individuals and dysregulated procoagulant, anticoagulant and fibrinolytic pathways lead to arterial and venous thrombosis. In this review article, we discuss the (patho)physiological role and laboratory assessment of fibrin, factor XIII and endogenous fibrinolysis, which are key players in the terminal phase of the coagulation cascade and fibrinolysis. Finally, we present the most up-to-date evidence for their involvement in various disease states and assessment of cardiovascular risk.
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Affiliation(s)
- Vassilios P. Memtsas
- Cardiology Department, East and North Hertfordshire NHS Trust, Stevenage, Hertfordshire SG1 4AB, UK;
| | - Deepa R. J. Arachchillage
- Centre for Haematology, Department of Immunology and Inflammation, Imperial College London, London SW7 2AZ, UK;
- Department of Haematology, Imperial College Healthcare NHS Trust, London W2 1NY, UK
- Department of Haematology, Royal Brompton Hospital, London SW3 6NP, UK
| | - Diana A. Gorog
- Cardiology Department, East and North Hertfordshire NHS Trust, Stevenage, Hertfordshire SG1 4AB, UK;
- School of Life and Medical Sciences, Postgraduate Medical School, University of Hertfordshire, Hertfordshire AL10 9AB, UK
- Faculty of Medicine, National Heart and Lung Institute, Imperial College, London SW3 6LY, UK
- Correspondence: ; Tel.: +44-207-0348841
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14
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Karanam LP, Baddam S, Ravikanti SP, Kumar KSS. Role of CO 2 angioplasty as a safe option in endovascular treatment of peripheral arterial disease in high-risk patients using dedicated automated OptiMed CO 2 delivery system. INDIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 2021. [DOI: 10.4103/ijves.ijves_20_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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15
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Lin TY, Chou HH, Huang HL, Hung SC. Indoxyl Sulfate and Incident Peripheral Artery Disease in Hemodialysis Patients. Toxins (Basel) 2020; 12:toxins12110696. [PMID: 33147880 PMCID: PMC7693838 DOI: 10.3390/toxins12110696] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 10/28/2020] [Accepted: 10/31/2020] [Indexed: 11/17/2022] Open
Abstract
Peripheral artery disease (PAD) is highly prevalent among patients with chronic kidney disease (CKD) and portends a very poor prognosis. Indoxyl sulfate has been shown to induce atherothrombosis and impaired neovascularization in uremic mice. However, there is no clinical evidence regarding the role of indoxyl sulfate in PAD associated with CKD. We examined associations between indoxyl sulfate and incident symptomatic lower extremity PAD events as well as major adverse cardiovascular events (MACE) and all-cause mortality using Cox proportional hazards models in a prospective cohort of 200 hemodialysis patients free of PAD at baseline. Patients were considered as having PAD if they developed PAD symptoms confirmed by an ankle-brachial index with waveforms, duplex ultrasound or angiography, and/or major adverse limb events including revascularization and amputation. During a median follow-up of 6.5 years, 37 patients (18.5%) experienced incident symptomatic PAD. MACE occurred in 52 patients, and a total of 85 patients died. After adjusting for traditional risk factors for PAD, including age, current smoking, diabetes, and cardiovascular disease, indoxyl sulfate was significantly associated with the risk of PAD (hazard ratio (HR), 1.19 for every 10-μg/mL increase in indoxyl sulfate; 95% confidence interval (CI), 1.05–1.35). However, indoxyl sulfate was not associated with risk of MACE (HR, 1.00; 95% CI, 0.90–1.12) or death from any cause (HR, 0.98; 95% CI, 0.90–1.07). Indoxyl sulfate was associated with incident symptomatic PAD but not with MACE or all-cause mortality, suggesting that indoxyl sulfate toxicity may be unique to PAD among hemodialysis patients.
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Affiliation(s)
- Ting-Yun Lin
- Division of Nephrology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, and School of Medicine, Tzu Chi University, Hualien 970, Taiwan;
| | - Hsin-Hua Chou
- Division of Cardiology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, and School of Medicine, Tzu Chi University, Hualien 970, Taiwan;
| | - Hsuan-Li Huang
- Division of Cardiology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, and School of Medicine, Tzu Chi University, Hualien 970, Taiwan;
- Correspondence: (H.-L.H.); (S.-C.H.); Tel.: +886-2-6628-9779 (H.-L.H. & S.-C.H.)
| | - Szu-Chun Hung
- Division of Nephrology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, and School of Medicine, Tzu Chi University, Hualien 970, Taiwan;
- Correspondence: (H.-L.H.); (S.-C.H.); Tel.: +886-2-6628-9779 (H.-L.H. & S.-C.H.)
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16
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Peripheral Artery Disease in Vulnerable Patient Populations: Outcomes of Orbital Atherectomy in Native Americans Compared to Non-Native Americans. A Single-Center Experience in Rural Oklahoma. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 22:71-77. [PMID: 32651160 DOI: 10.1016/j.carrev.2020.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 06/08/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND/PURPOSE Although the incidence of peripheral artery disease (PAD) and amputations is higher in Native Americans (NA) than Caucasians, the study of revascularization NA is limited, resulting in their under representation in clinical studies. Orbital atherectomy (OA) is widely utilized for endovascular revascularization of significantly calcified peripheral arteries and has been shown to improve limb salvage rates. METHODS/MATERIALS A cohort of 74 consecutive PAD subjects undergoing OA treatment was retrospectively analyzed via Kaplan Meier (KM) and Propensity Score Matched (PSM) analysis. RESULTS A significant proportion of the subjects were NA (16.2%). Compared to the non-NA, the NA had higher numerical baseline rates of wounds, dialysis, chronic kidney disease (CKD), and critical limb ischemia, but were numerically less likely to smoke and had similar rates of diabetes. There were very high rates of severe calcification (100% vs. 87%) and pre-procedure diameter stenosis (99% vs. 95%) in both groups. The NA and non-NA had good angiographic outcomes, resulting in low rates of post-procedure residual diameter stenosis (10% vs. 11%). Lastly, KM analysis indicated high freedom from amputation in both groups at 1 year (89% vs. 95%), as well as in the PSM subjects (89% vs. 100%). CONCLUSIONS Despite numerically higher rates of co-morbidities at baseline (e.g., CKD, dialysis, and presence of non-healing wounds), the NA underwent successful revascularization with OA, resulting in high freedom from amputation at 1-year. Given the small sample size of NA, these results may not be generalizable-thus, larger studies on NA are warranted.
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17
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Grunwald JE, Pistilli M, Ying GS, Maguire MG, Daniel E, Whittock-Martin R, Parker-Ostroff C, Jacoby D, Go AS, Townsend RR, Gadegbeku CA, Lash JP, Fink JC, Rahman M, Feldman H, Kusek JW, Xie D. Progression of retinopathy and incidence of cardiovascular disease: findings from the Chronic Renal Insufficiency Cohort Study. Br J Ophthalmol 2020; 105:246-252. [PMID: 32503932 DOI: 10.1136/bjophthalmol-2019-315333] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 03/31/2020] [Accepted: 04/01/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE Chronic kidney disease (CKD) patients often develop cardiovascular disease (CVD) and retinopathy. The purpose of this study was to assess the association between progression of retinopathy and concurrent incidence of CVD events in participants with CKD. DESIGN We assessed 1051 out of 1936 participants in the Chronic Renal Insufficiency Cohort Study that were invited to have fundus photographs obtained at two timepoints separated by 3.5 years, on average. METHODS Using standard protocols, presence and severity of retinopathy (diabetic, hypertensive or other) and vessel diameter calibre were assessed at a retinal image reading centre by trained graders masked to study participants' information. Participants with a self-reported history of CVD were excluded. Incident CVD events were physician adjudicated using medical records and standardised criteria. Kidney function and proteinuria measurements along with CVD risk factors were obtained at study visits. RESULTS Worsening of retinopathy by two or more steps in the EDTRS retinopathy grading scale was observed in 9.8% of participants, and was associated with increased risk of incidence of any CVD in analysis adjusting for other CVD and CKD risk factors (OR 2.56, 95% CI 1.25 to 5.22, p<0.01). After imputation of missing data, these values were OR=1.66 (0.87 to 3.16), p=0.12. CONCLUSION Progression of retinopathy is associated with higher incidence of CVD events, and retinal-vascular pathology may be indicative of macrovascular disease even after adjustment for kidney diseases and CVD risk factors. Assessment of retinal morphology may provide important information when assessing CVD in patients with CKD.
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Affiliation(s)
- Juan E Grunwald
- Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Maxwell Pistilli
- Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Gui-Shuang Ying
- Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Maureen G Maguire
- Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ebenezer Daniel
- Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | | | - Douglas Jacoby
- Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Alan S Go
- Department of Research, Kaiser Permanente, Oakland, California, USA
| | - Raymond R Townsend
- Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - James P Lash
- Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Jeffrey Craig Fink
- Department of Medicine, University of Maryland Baltimore County, Baltimore, Maryland, USA
| | - Mahboob Rahman
- Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Harold Feldman
- Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - John W Kusek
- Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Dawei Xie
- Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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18
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Allison GM, Flanagin E. How ESKD complicates the management of diabetic foot ulcers: The vital role of the dialysis team in prevention, early detection, and support of multidisciplinary treatment to reduce lower extremity amputations. Semin Dial 2020; 33:245-253. [PMID: 32277523 DOI: 10.1111/sdi.12875] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Diabetic foot ulcers do not heal as well in ESKD as in the absence of kidney failure, and rates of recurrent foot ulcers, as well as lower extremity amputation, are higher. This review of the literature highlights the vital role of the dialysis team in prevention, early detection, and support of treatment of diabetic foot ulcers. Our review has five goals-(a) increase nephrologists' understanding of the high morbidity and mortality associated with chronic foot ulcers and (lower extrimity) LE amputations in ESKD; (b) promote nephrologists' understanding of grading systems for diabetic foot ulcer severity, in order to expedite communication with local diabetic foot experts; (c) promote collaboration between nephrologists and infectious disease specialists regarding the dose, route, and delivery logistics of intravenous antibiotics for infected chronic foot ulcers, in particular in the presence of osteomyelitis and other deep-seated infections; (d) increase the awareness of dialysis nurses, technicians, dietitians, social workers and administrators regarding evidence-based and multidisciplinary approaches to patients' diabetic foot ulcers; (e) encourage the application of published works integrating patient-centered diabetic foot education into the dialysis setting to reduce lower extremity amputations.
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Affiliation(s)
- Genève M Allison
- Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, MA, USA.,Center for Wound Healing and Hyperbaric Medicine, Tufts Medical Center, Boston, MA, USA
| | - Erin Flanagin
- Division of Nephrology, Tufts Medical Center, Boston, MA, USA
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19
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Ozgur Y, Akin S, Parmaksiz E, Meşe M, Bahcebasi ZB, Keskin O. Peripheral arterial disease diagnosed by ankle-brachial index: Predictor for early renal replacement therapy in chronic kidney disease. SAUDI JOURNAL OF KIDNEY DISEASES AND TRANSPLANTATION 2020; 31:90-99. [PMID: 32129201 DOI: 10.4103/1319-2442.279965] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Our study aimed to investigate the relationship between ankle-brachial index (ABI) and need for early renal replacement therapy (RRT) in predialysis patients with chronic kidney disease (CKD). A total of 112 patients (62% men) with pre-dialysis CKD, seen in the outpatient clinic, were included, and ABI was obtained as per standard protocol. Peripheral arterial disease (PAD) was defined as ABI <0.9 or >1.3 in either leg. The clinical data were analyzed, and the risk factors for early RRT were determined by multivariate logistic regression analysis. The prevalence of PAD was 44% in predialysis CKD patients. Over three years' follow- up, 14.2% required RRT; 11.3% developed major cardiovascular event (myocardial infarction, stroke, or death). A total of 26 events occurred. The incidence of all events was significantly higher in patients with abnormal ABI than in those with normal ABI (34.7% vs. 12.7%; log rank P = 0.02). PAD was associated with all events [hazard ratio (HR): 2.72; 95% CI: 1.04-7.17; P = 0.042] as also the need for RRT (HR 3.2; 95% Cl: 1.005-10.23; P = 0.049), on univariate cox proportional hazard analysis. Multivariate logistic regression analysis adjusted for other risk factors identified that PAD remained an independent predictor for the need for early RRT (HR: 12.2; 95%Cl: 2.2-66.5; P = 0.004) and all events (HR: 3.5; 95% Cl: 0.9-13.5; P = 0.032). PAD was an independent predictor for RRT requirement in predialysis CKD.
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Affiliation(s)
- Yasemin Ozgur
- Department of Internal Medicine, University of Health Sciences, Kartal Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
| | - Seydahmet Akin
- Department of Internal Medicine, University of Health Sciences, Kartal Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
| | - Ergun Parmaksiz
- Department of Nephrology, University of Health Sciences, Kartal Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
| | - Meral Meşe
- Department of Nephrology, University of Health Sciences, Kartal Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
| | - Zerrin Bicik Bahcebasi
- Department of Nephrology, University of Health Sciences, Kartal Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
| | - Ozcan Keskin
- Department of Internal Medicine, University of Health Sciences, Kartal Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
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20
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High serum uric acid level is a mortality risk factor in peritoneal dialysis patients: a retrospective cohort study. Nutr Metab (Lond) 2019; 16:52. [PMID: 31388342 PMCID: PMC6670192 DOI: 10.1186/s12986-019-0379-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 07/19/2019] [Indexed: 02/07/2023] Open
Abstract
Background The results remain controversial with regards to the impact of serum uric acid on clinical outcomes from peritoneal dialysis population. The aim of our study was to investigate the influence of serum uric acid levels on mortality in peritoneal dialysis patients. Methods Data on 9405 peritoneal dialysis patients from the Zhejiang Renal Data system were retrospectively analyzed. All demographic and laboratory data were recorded at baseline. The study cohort was divided into quintiles according to baseline uric acid level (mg/dL): Q1 (< 6.06), Q2 (6.06–6.67), Q3 (6.68–7.27) (reference), Q4 (7.28–8.03), and Q5 (≥8.04). Hazards ratio (HR) of all-cause and cardiovascular mortality was calculated. Results Mean serum uric acid was 7.07 ± 1.25 mg/dL. During a median follow-up of 29.4 (range, 3.0 to 115.4) months, 1226 (13.0%) patients died, of which 515 (5.5%) died of cardiovascular events. The Kaplan-Meier survival curves showed that patients in the middle uric acid quintile (Q3: 6.68–7.27) exhibited the highest patient and cardiovascular survival rates (log-rank test P < 0.05). Multivariate Cox regression analysis showed that, using Q3 as the reference, in the fully adjusted model, a higher uric acid level (Q4: 7.28–8.03, and Q5: ≥8.04) was significantly associated with higher all-cause mortality (Model 3; Q4: HR, 1.335, 95% CI, 1.073 to 1.662, P = 0.009; Q5: HR, 1.482, 95% CI, 1.187 to 1.849, P = 0.001), but not with cardiovascular mortality. The adverse effect of higher uric acid level (≥7.28 mg/dL) on all-cause mortality was more prominent in groups such as male, hypoalbuminemia, normal weight, non-diabetes mellitus at baseline rather than in their counterparts respectively. Conclusions A higher uric acid level was an independent risk factor for all-cause mortality in peritoneal dialysis patients. Electronic supplementary material The online version of this article (10.1186/s12986-019-0379-y) contains supplementary material, which is available to authorized users.
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21
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Heikkilä K, Coughlin PA, Pentti J, Kivimäki M, Halonen JI. Physical activity and peripheral artery disease: Two prospective cohort studies and a systematic review. Atherosclerosis 2019; 286:114-120. [DOI: 10.1016/j.atherosclerosis.2019.05.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 04/26/2019] [Accepted: 05/08/2019] [Indexed: 11/24/2022]
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22
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Arinze NV, Gregory A, Francis JM, Farber A, Chitalia VC. Unique aspects of peripheral artery disease in patients with chronic kidney disease. Vasc Med 2019; 24:251-260. [PMID: 30823859 DOI: 10.1177/1358863x18824654] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Peripheral artery disease (PAD) represents a major health care burden. Despite the advent of screening and interventional procedures, the long-term clinical outcomes remain suboptimal, especially in patients with chronic kidney disease (CKD). While CKD and PAD share common predisposing factors, emerging studies indicate that their co-existence is not merely an association; instead, CKD represents a strong, independent risk factor for PAD. These findings implicate CKD-specific mediators of PAD that remain incompletely understood. Moreover, there is a need to understand the mechanisms underlying poor outcomes after interventions for PAD in CKD. This review discusses unique clinical aspects of PAD in patients with CKD, including high prevalence and worse outcomes after vascular interventions and the influence of renal allograft transplantation. In doing so, it also highlights underappreciated aspects of PAD in patients with CKD, such as disparities in revascularization and higher peri-procedural mortality. While previous reviews have discussed general mechanisms of PAD pathogenesis, focusing on PAD in CKD, this review underscores a need to probe for CKD-specific pathogenic pathways that may unravel novel biomarkers and therapeutic targets in PAD and ultimately improve the risk stratification and management of patients with CKD and PAD.
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Affiliation(s)
- Nkiruka V Arinze
- 1 Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA.,2 Renal Section, Department of Medicine, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | | | - Jean M Francis
- 2 Renal Section, Department of Medicine, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Alik Farber
- 1 Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Vipul C Chitalia
- 2 Renal Section, Department of Medicine, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA.,4 Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, MA, USA.,5 Veterans Affairs Boston Healthcare System, Boston, MA, USA
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Mohapatra A, Boitet A, Malak O, Henry JC, Avgerinos ED, Makaroun MS, Hager ES, Chaer RA. Peroneal bypass versus endovascular peroneal intervention for critical limb ischemia. J Vasc Surg 2019; 69:148-155. [PMID: 30580779 PMCID: PMC6310052 DOI: 10.1016/j.jvs.2018.04.049] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 04/11/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE The peroneal artery is a well-established target for bypass in patients with critical limb ischemia (CLI). The objective of this study was to evaluate the outcomes of peroneal artery revascularization in terms of wound healing and limb salvage in patients with CLI. METHODS Patients presenting between 2006 and 2013 with CLI (Rutherford 4-6) and isolated peroneal runoff were included in the study. They were divided into patients who underwent bypass to the peroneal artery and those who underwent endovascular peroneal artery intervention. Demographics, comorbidities, and follow-up data were recorded. Wounds were classified by Wound, Ischemia, foot Infection (WIfI) score. The primary outcome was wound healing; secondary outcomes included mortality, major amputation, and patency. RESULTS There were 200 limbs with peroneal bypass and 138 limbs with endovascular peroneal intervention included, with mean follow-up of 24.0 ± 26.3 and 14.5 ± 19.1 months, respectively (P = .0001). The two groups were comparable in comorbidities, with the exception of the endovascular group's having more patients with cardiac and renal disease and diabetes mellitus but fewer patients with smoking history. Based on WIfI criteria, ischemia scores were worse in bypass patients, but wound and foot infection scores were worse in endovascular patients. Perioperatively, bypass patients had higher rates of myocardial infarction (4.5% vs 0%; P = .012) and incisional complications (13.0% vs 4.4%; P = .008). At 12 months, the bypass group compared with the endovascular group had better primary patency (47.9% vs 23.4%; P = .002) and primary assisted patency (63.6% vs 42.2%; P = .003) and a trend toward better secondary patency (74.2% vs 63.5%; P = .11). There were no differences in the rate of wound healing (52.6% vs 37.7% at 1 year; P = .09) or freedom from major amputation (81.5% vs 74.7% at 1 year; P = .37). In a multivariate analysis, neuropathy was associated with improved wound healing, whereas WIfI wound score, cancer, chronic renal insufficiency, and smoking were associated with decreased wound healing. Treatment modality was not a significant predictor (P = .15). CONCLUSIONS Endovascular peroneal artery intervention results in poorer primary and primary assisted patency rates than surgical bypass to the peroneal artery but provides similar wound healing and limb salvage rates with a lower rate of complications. In appropriately selected patients, endovascular intervention to treat the peroneal artery is a low-risk intervention that may be sufficient to heal ischemic foot wounds.
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Affiliation(s)
- Abhisekh Mohapatra
- Division of Vascular Surgery, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa.
| | - Aureline Boitet
- Division of Vascular Surgery, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Othman Malak
- Division of Vascular Surgery, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Jon C Henry
- Division of Vascular Surgery, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Efthimios D Avgerinos
- Division of Vascular Surgery, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Michel S Makaroun
- Division of Vascular Surgery, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Eric S Hager
- Division of Vascular Surgery, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Rabih A Chaer
- Division of Vascular Surgery, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa
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Mohapatra A, Henry JC, Avgerinos ED, Chaer RA, Leers SA, Boitet A, Singh MJ, Hager ES. Heel Wounds Predict Mortality but Not Amputation after Infrapopliteal Revascularization. Ann Vasc Surg 2018; 51:78-85. [PMID: 29501595 DOI: 10.1016/j.avsg.2017.11.072] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 11/10/2017] [Accepted: 11/30/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Ischemic heel ulcerations are generally thought to carry a poor prognosis for limb salvage. We hypothesized that patients undergoing infrapopliteal revascularization for heel wounds, either bypass or endovascular intervention, would have lower wound healing rates and amputation-free survival (AFS) than patients with forefoot wounds. METHODS A retrospective chart review was performed on patients who presented between 2006 and 2013 to our institution with ischemic foot wounds and infrapopliteal arterial disease and underwent either pedal bypass or endovascular tibial artery intervention. Data were collected on patient demographics, comorbidities, wound characteristics, procedural details, and postoperative outcomes then analyzed by initial wound classification. The primary outcome was major amputation or death. RESULTS Three hundred ninety-eight limbs underwent treatment for foot wounds; accurate wound data were available in 380 cases. There were 101 bypasses and 279 endovascular interventions, with mean follow-up of 24.6 and 19.9 months, respectively (P = 0.02). Heel wounds comprised 12.1% of the total with the remainder being forefoot wounds; there was no difference in treatment modality by wound type (P = 0.94). Of 46 heel wounds, 5 (10.9%) had clinical or radiographic evidence of calcaneal osteomyelitis. Patients with heel wounds were more likely to have diabetes mellitus (DM) (P = 0.03) and renal insufficiency (P = 0.004). 43.1% of wounds healed within 1 year, with no difference by wound location (P = 0.30). Major amputation rate at 1 year was 17.8%, with no difference by wound location (P = 0.81) or treatment type (P = 0.33). One- and 3-year AFS was 66.2% and 44.0% for forefoot wounds and 45.7% and 17.6% for heel wounds, respectively (P = 0.001). In a multivariate analysis, heel wounds and endovascular intervention were both predictors of death; however, there was significant interaction such that endovascular intervention was associated with higher mortality in patients with forefoot wounds (hazard ratio 2.25, P < 0.001) but not those with heel wounds (hazard ratio 0.67, P = 0.31). CONCLUSIONS Patients presenting with heel ulceration who undergo infrapopliteal revascularization are prone to higher mortality despite equivalent rates of amputation and wound healing and regardless of treatment modality. These patients may benefit from an endovascular-first strategy.
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Affiliation(s)
- Abhisekh Mohapatra
- Division of Vascular Surgery, Heart & Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA.
| | - Jon C Henry
- Division of Vascular Surgery, Heart & Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Efthimios D Avgerinos
- Division of Vascular Surgery, Heart & Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Rabih A Chaer
- Division of Vascular Surgery, Heart & Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Steven A Leers
- Division of Vascular Surgery, Heart & Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Aureline Boitet
- Division of Vascular Surgery, Heart & Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Michael J Singh
- Division of Vascular Surgery, Heart & Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Eric S Hager
- Division of Vascular Surgery, Heart & Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA
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Mohapatra A, Henry JC, Avgerinos ED, Boitet A, Chaer RA, Makaroun MS, Leers SA, Hager ES. Bypass versus endovascular intervention for healing ischemic foot wounds secondary to tibial arterial disease. J Vasc Surg 2018; 68:168-175. [PMID: 29336904 DOI: 10.1016/j.jvs.2017.10.076] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 10/16/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Pedal (inframalleolar) bypass is a long-standing therapy for tibial arterial disease in patients with ischemic tissue loss. Endovascular tibial intervention is an appealing alternative with lower risks of perioperative mortality or complications. Our objective was to compare the effectiveness of these two treatment modalities with respect to patency and limb-related clinical outcomes. METHODS We performed a retrospective chart review of patients presenting between 2006 and 2013 with ischemic foot wounds and infrapopliteal arterial disease who underwent a revascularization procedure (either open surgical bypass to an inframalleolar target or endovascular tibial intervention). Data were collected on baseline demographics and comorbidities, procedural details, and postprocedure outcomes. The primary outcome was successful healing of the index wound, with mortality, major amputation, and patency assessed as secondary outcomes. RESULTS We identified 417 patients who met our eligibility criteria; 105 underwent surgical bypass and 312 underwent endovascular intervention, with mean follow-up of 25.0 and 20.2 months, respectively (P = .08). The endovascular patients were older at baseline (P = .009), with higher rates of hyperlipidemia (P = .02), prior cerebrovascular accidents (P = .04), and smoking history (P = .04). Within 30 days postoperatively, there was no difference in mortality (P = .31), but bypass patients had longer hospital length of stay (P < .0001), higher rate of discharge to nursing facility (P < .001), and higher rates of myocardial infarctions (P = .03) and wound complications (P < .001). At 6 months, the rate of wound healing was 22.4% in the bypass group compared with 29.0% in the endovascular group (P = .02). At 1 year, survival was higher after bypass (86.2% vs 70.4%; P < .0001), but freedom from major amputation was similar (84.9% vs 82.8%; P = .42). Primary patency (53.1% vs 38.2%; P = .002) and primary assisted patency (76.6% vs 51.7%; P < .0001) were higher in the bypass group, but there was no difference in secondary patency (77.3% vs 73.8%; P = .13). CONCLUSIONS Endovascular tibial intervention is associated with poorer primary patency but similar secondary patency and wound healing rates compared with the "gold standard" of surgical bypass to a pedal target. In patients with tibial arterial disease, endovascular intervention should be considered a lower risk alternative to pedal bypass that provides similar clinical outcomes.
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Affiliation(s)
- Abhisekh Mohapatra
- Division of Vascular Surgery, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa.
| | - Jon C Henry
- Division of Vascular Surgery, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Efthimios D Avgerinos
- Division of Vascular Surgery, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Aureline Boitet
- Division of Vascular Surgery, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Rabih A Chaer
- Division of Vascular Surgery, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Michel S Makaroun
- Division of Vascular Surgery, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Steven A Leers
- Division of Vascular Surgery, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Eric S Hager
- Division of Vascular Surgery, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa
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Cornejo del Río V, Mostaza J, Lahoz C, Sánchez-Arroyo V, Sabín C, López S, Patrón P, Fernández-García P, Fernández-Puntero B, Vicent D, Montesano-Sánchez L, García-Iglesias F, González-Alegre T, Estirado E, Laguna F, de Burgos-Lunar C, Gómez-Campelo P, Abanades-Herranz JC, de Miguel-Yanes JM, Salinero-Fort MA. Prevalence of peripheral artery disease (PAD) and factors associated: An epidemiological analysis from the population-based Screening PRE-diabetes and type 2 DIAbetes (SPREDIA-2) study. PLoS One 2017; 12:e0186220. [PMID: 29073236 PMCID: PMC5657631 DOI: 10.1371/journal.pone.0186220] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 09/27/2017] [Indexed: 11/20/2022] Open
Abstract
AIM To describe the prevalence of Peripheral Artery Disease (PAD) in a random population sample and to evaluate its relationship with Mediterranean diet and with other potential cardiovascular risk factors such as serum uric acid and pulse pressure in individuals ranged 45 to 74 years. METHODS Cross-sectional analysis of 1568 subjects (mean age 6.5 years, 43% males), randomly selected from the population. A fasting blood sample was obtained to determine glucose, lipids, and HbA1C levels. An oral glucose tolerance test was performed in non-diabetic subjects. PAD was evaluated by ankle-brachial index and/or having a prior diagnosis. RESULTS PAD prevalence was 3.81% (95% CI, 2.97-4.87) for all participants. In men, PAD prevalence was significantly higher than in women [5.17% (95% CI, 3.74-7.11) vs. 2.78% (95% CI, 1.89-4.07); p = 0.014]. Serum uric acid in the upper quartile was associated with the highest odds ratio (OR) of PAD (for uric acid > 6.1 mg/dl, OR = 4.31; 95% CI, 1.49-12.44). The remaining variables more strongly associated with PAD were: Heart rate >90 bpm (OR = 4.16; 95%CI, 1.62-10.65), pulse pressure in the upper quartile (≥ 54 mmHg) (OR = 3.82; 95%CI, 1.50-9.71), adherence to Mediterranean diet (OR = 2.73; 95% CI, 1.48-5.04), and former smoker status (OR = 2.04; 95%CI, 1.00-4.16). CONCLUSIONS Our results show the existence of a low prevalence of peripheral artery disease in a population aged 45-74 years. Serum uric acid, pulse pressure and heart rate >90 bpm were strongly associated with peripheral artery disease. The direct association between Mediterranean diet and peripheral artery disease that we have found should be evaluated through a follow-up study under clinical practice conditions.
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Affiliation(s)
- V. Cornejo del Río
- Hospital Carlos III, Madrid, Spain
- Grupo de Investigación en cuidados IdIPAZ, Hospital La Paz, Madrid, Spain
| | | | - C. Lahoz
- Hospital Carlos III, Madrid, Spain
| | | | - C. Sabín
- Hospital Carlos III, Madrid, Spain
| | - S. López
- Hospital Carlos III, Madrid, Spain
| | | | | | | | - D. Vicent
- Hospital Carlos III, Madrid, Spain
- Instituto de Investigación Sanitaria del Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
| | | | | | | | | | | | - C. de Burgos-Lunar
- Dirección General de Salud Pública, Subdirección de Promoción, Prevención y Educación de la Salud, Consejería de Sanidad, Madrid, Spain
- Red de Investigación en servicios de salud en enfermedades crónicas (REDISSEC), Madrid, Spain
| | - P. Gómez-Campelo
- Instituto de Investigación Sanitaria del Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
- Plataforma de Apoyo al Investigador Novel, IdiPAZ, Madrid, Spain
| | | | | | - M. A. Salinero-Fort
- Red de Investigación en servicios de salud en enfermedades crónicas (REDISSEC), Madrid, Spain
- Subdirección General de Investigación Sanitaria, Consejería de Sanidad, Madrid, Spain
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Matsushita K, Ballew SH, Coresh J, Arima H, Ärnlöv J, Cirillo M, Ebert N, Hiramoto JS, Kimm H, Shlipak MG, Visseren FLJ, Gansevoort RT, Kovesdy CP, Shalev V, Woodward M, Kronenberg F. Measures of chronic kidney disease and risk of incident peripheral artery disease: a collaborative meta-analysis of individual participant data. Lancet Diabetes Endocrinol 2017; 5:718-728. [PMID: 28716631 PMCID: PMC5649254 DOI: 10.1016/s2213-8587(17)30183-3] [Citation(s) in RCA: 104] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 05/11/2017] [Accepted: 05/15/2017] [Indexed: 01/14/2023]
Abstract
BACKGROUND Some evidence suggests that chronic kidney disease is a risk factor for lower-extremity peripheral artery disease. We aimed to quantify the independent and joint associations of two measures of chronic kidney disease (estimated glomerular filtration rate [eGFR] and albuminuria) with the incidence of peripheral artery disease. METHODS In this collaborative meta-analysis of international cohorts included in the Chronic Kidney Disease Prognosis Consortium (baseline measurements obtained between 1972 and 2014) with baseline measurements of eGFR and albuminuria, at least 1000 participants (this criterion not applied to cohorts exclusively enrolling patients with chronic kidney disease), and at least 50 peripheral artery disease events, we analysed adult participants without peripheral artery disease at baseline at the individual patient level with Cox proportional hazards models to quantify associations of creatinine-based eGFR, urine albumin-to-creatinine ratio (ACR), and dipstick proteinuria with the incidence of peripheral artery disease (including hospitalisation with a diagnosis of peripheral artery disease, intermittent claudication, leg revascularisation, and leg amputation). We assessed discrimination improvement through c-statistics. FINDINGS We analysed 817 084 individuals without a history of peripheral artery disease at baseline from 21 cohorts. 18 261 cases of peripheral artery disease were recorded during follow-up across cohorts (median follow-up was 7·4 years [IQR 5·7-8·9], range 2·0-15·8 years across cohorts). Both chronic kidney disease measures were independently associated with the incidence of peripheral artery disease. Compared with an eGFR of 95 mL/min per 1·73 m2, adjusted hazard ratios (HRs) for incident study-specific peripheral artery disease was 1·22 (95% CI 1·14-1·30) at an eGFR of 45 mL/min per 1·73 m2 and 2·06 (1·70-2·48) at an eGFR of 15 mL/min per 1·73 m2. Compared with an ACR of 5 mg/g, the adjusted HR for incident study-specific peripheral artery disease was 1·50 (1·41-1·59) at an ACR of 30 mg/g and 2·28 (2·12-2·44) at an ACR of 300 mg/g. The adjusted HR at an ACR of 300 mg/g versus 5 mg/g was 3·68 (95% CI 3·00-4·52) for leg amputation. eGFR and albuminuria contributed multiplicatively (eg, adjusted HR 5·76 [4·90-6·77] for incident peripheral artery disease and 10·61 [5·70-19·77] for amputation in eGFR <30 mL/min per 1·73 m2 plus ACR ≥300 mg/g or dipstick proteinuria 2+ or higher vs eGFR ≥90 mL/min per 1·73 m2 plus ACR <10 mg/g or dipstick proteinuria negative). Both eGFR and ACR significantly improved peripheral artery disease risk discrimination beyond traditional predictors, with a substantial improvement prediction of amputation with ACR (difference in c-statistic 0·058, 95% CI 0·045-0·070). Patterns were consistent across clinical subgroups. INTERPRETATION Even mild-to-moderate chronic kidney disease conferred increased risk of incident peripheral artery disease, with a strong association between albuminuria and amputation. Clinical attention should be paid to the development of peripheral artery disease symptoms and signs in people with any stage of chronic kidney disease. FUNDING American Heart Association, US National Kidney Foundation, and US National Institute of Diabetes and Digestive and Kidney Diseases.
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Affiliation(s)
| | | | - Josef Coresh
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Hisatomi Arima
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Johan Ärnlöv
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Science and Society, Karolinska Institutet, Huddinge, Sweden; School of Health and Social Studies, Dalarna University, Falun, Sweden
| | | | - Natalie Ebert
- Charité University Medicine, Institute of Public Health, Berlin, Germany
| | - Jade S Hiramoto
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Heejin Kimm
- Institute for Health Promotion, Department of Epidemiology and Health Promotion, Graduate School of Public Health, Yonsei University, Seoul, South Korea
| | - Michael G Shlipak
- San Francisco VA Medical Center, San Francisco, USA; University of California, San Francisco, USA
| | - Frank L J Visseren
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, Netherlands
| | - Ron T Gansevoort
- Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Csaba P Kovesdy
- Memphis Veterans Affairs Medical Center, Memphis, TN, USA; University of Tennessee Health Science Center, Memphis, TN, USA
| | - Varda Shalev
- Maccabi Institute for Research and Innovation, Maccabi Healthcare Services, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mark Woodward
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; The George Institute for Global Health, University of Sydney, Sydney, NSW, Australia; The George Institute for Global Health, University of Oxford, Oxford, UK
| | - Florian Kronenberg
- Division of Genetic Epidemiology, Department of Medical Genetics, Molecular and Clinical Pharmacology, Medical University of Innsbruck, Innsbruck, Austria
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Yu JS, Ho CH, Wang HY, Chen YH, Hsieh CL. Acupuncture on Renal Function in Patients with Chronic Kidney Disease: A Single-Blinded, Randomized, Preliminary Controlled Study. J Altern Complement Med 2017; 23:624-631. [DOI: 10.1089/acm.2016.0119] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Jung-Sheng Yu
- Graduate Institute of Integrated Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan
- Department of Chinese Medicine, Chi-Mei Medical Center, Tainan, Taiwan
- Department of Cosmetic Science, College of Pharmacy and Science, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Chung-Han Ho
- Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan
- Department of Pharmacy, College of Pharmacy and Science, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Hsien-Yi Wang
- Division of Nephrology, Department of Medicine, Chi-Mei Medical Center, Tainan, Taiwan
- Department of Sports Management, College of Leisure and Recreation Management, Chia-Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Yung-Hsiang Chen
- Graduate Institute of Integrated Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan
| | - Ching-Liang Hsieh
- Graduate Institute of Integrated Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan
- Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan
- Graduate Institute of Acupuncture Science, College of Chinese Medicine, China Medical University, Taichung, Taiwan
- Research Center for Chinese Medicine and Acupuncture, China Medical University, Taichung, Taiwan
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Chang CT, Shen MY, Lee AS, Wang CC, Chen WY, Chang CM, Chang KC, Stancel N, Chen CH. Electronegative low-density lipoprotein increases the risk of ischemic lower-extremity peripheral artery disease in uremia patients on maintenance hemodialysis. Sci Rep 2017; 7:4654. [PMID: 28680087 PMCID: PMC5498573 DOI: 10.1038/s41598-017-04063-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 05/08/2017] [Indexed: 12/31/2022] Open
Abstract
Electronegative low-density lipoprotein (LDL) has been shown to increase coronary artery disease risk in hemodialysis patients, but its effect on the risk of peripheral artery disease (PAD) remains unclear. We separated plasma LDL from 90 uremia patients undergoing hemodialysis into 5 subfractions (L1-L5) according to charge by using fast-protein liquid chromatography with an anion-exchange column and examined the distribution of L5-the most electronegative LDL subfraction-in total LDL (i.e. L5%). During a 5-year period, we followed up with these patients until the occurrence of ischemic lower-extremity PAD. During the follow-up period, ischemic lower-extremity PAD developed in 24.4% of hemodialysis patients. L5% was higher in hemodialysis patients in whom ischemic lower-extremity PAD occurred (3.03% [IQR, 2.36-4.54], n = 22) than in hemodialysis patients in whom PAD did not occur (1.13% [IQR, 0.90-1.83], n = 68) (p < 0.001). Furthermore, L5% significantly increased the adjusted hazard ratio of ischemic lower-extremity PAD (1.54 [95% CI, 1.14-2.10]) (p = 0.005). Flow-mediated dilation was negatively associated with L5% (p < 0.001). Additionally, in vivo experiments from mice showed that L5 compromised endothelium-dependent vascular relaxation through a nitric oxide-related mechanism. Our findings indicate that increased L5% may be associated with the occurrence of ischemic lower-extremity PAD in hemodialysis patients.
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Affiliation(s)
- Chiz-Tzung Chang
- Division of Nephrology, China Medical University Hospital (CMUH), Taichung, Taiwan.,Cardiovascular Research Laboratory, CMUH, Taichung, Taiwan.,College of Medicine, China Medical University (CMU), Taichung, Taiwan
| | - Ming-Yi Shen
- Graduate Institute of Clinical Medical Science, CMU, Taichung, Taiwan.,Department of Medical Research, CMUH, Taichung, Taiwan
| | - An-Sean Lee
- Department of Medicine, Mackay Medical College, New Taipei, Taiwan
| | - Chun-Cheng Wang
- Cardiovascular Research Laboratory, CMUH, Taichung, Taiwan.,College of Medicine, China Medical University (CMU), Taichung, Taiwan.,Graduate Institute of Clinical Medical Science, CMU, Taichung, Taiwan
| | - Wei-Yu Chen
- Cardiovascular Research Laboratory, CMUH, Taichung, Taiwan
| | | | - Kuan-Cheng Chang
- Cardiovascular Research Laboratory, CMUH, Taichung, Taiwan.,College of Medicine, China Medical University (CMU), Taichung, Taiwan
| | - Nicole Stancel
- Vascular and Medicinal Research, Texas Heart Institute, Houston, TX, United States
| | - Chu-Huang Chen
- Vascular and Medicinal Research, Texas Heart Institute, Houston, TX, United States. .,Lipid Science and Aging Research Center, Kaohsiung Medical University (KMU), Kaohsiung, Taiwan. .,Center for Lipid Biosciences, KMU Hospital, Kaohsiung, Taiwan.
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30
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Jia XB, Hou XH, Ma QB, Cai XW, Li YR, Mu SH, Na SP, Xie RJ, Bao YS. Assessment of Renal Function and Risk Factors for Chronic Kidney Disease in Patients With Peripheral Arterial Disease. Angiology 2017; 68:776-781. [PMID: 28056516 DOI: 10.1177/0003319716686876] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Chronic kidney disease (CKD) and peripheral arterial disease (PAD) share common risk factors. We assessed renal function and the prevalence of CKD in patients with PAD and investigated the characteristics of the risk factors for CKD in this population. Renal function of 421 patients with PAD was evaluated. Among the participants, 194 (46.1%) patients had decreased estimated glomerular filtration rate (eGFR). The prevalence of CKD was much higher among patients with PAD. Hypertension (odds ratios [ORs] 2.156, 95% confidence interval [CI] 1.413-3.289, P < .001), serum uric acid (OR 3.794, 95% CI 2.220-6.450, P < .001), and dyslipidemia (OR 1.755, 95% CI 1.123-2.745, P = .014) were significantly associated with CKD and the independent risk factors for CKD in patients with PAD. CKD is common and has a high prevalence in a population with PAD. Patients with PAD may be considered as a high-risk population for CKD. Recognition and modification of risk factors for CKD might beneficially decrease CKD incidence and improve prognosis in patients with PAD.
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Affiliation(s)
- Xi-Bei Jia
- Department of Nephrology, The First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, China
- Xi-Bei Jia, Xi-Hua Hou and Qiu-Bo Ma are joint first authors
| | - Xi-Hua Hou
- Department of Nephrology, The First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, China
- Xi-Bei Jia, Xi-Hua Hou and Qiu-Bo Ma are joint first authors
| | - Qiu-Bo Ma
- Department of Nephrology, The First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, China
- Xi-Bei Jia, Xi-Hua Hou and Qiu-Bo Ma are joint first authors
| | - Xiao-Wen Cai
- Department of Nephrology, The First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, China
| | - Yi-Ran Li
- Department of Nephrology, The First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, China
| | - Su-Hong Mu
- Department of Nephrology, The First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, China
| | - Shi-Ping Na
- Department of Nephrology, The First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, China
| | - Ru-Juan Xie
- Department of Nephrology, The First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, China
| | - Yu-Shi Bao
- Department of Nephrology, The First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, China
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Munoz Mendoza J, Isakova T, Cai X, Bayes LY, Faul C, Scialla JJ, Lash JP, Chen J, He J, Navaneethan S, Negrea L, Rosas SE, Kretzler M, Nessel L, Xie D, Anderson AH, Raj DS, Wolf M. Inflammation and elevated levels of fibroblast growth factor 23 are independent risk factors for death in chronic kidney disease. Kidney Int 2016; 91:711-719. [PMID: 28017325 DOI: 10.1016/j.kint.2016.10.021] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 09/28/2016] [Accepted: 10/20/2016] [Indexed: 01/07/2023]
Abstract
Inflammation is a consequence of chronic kidney disease (CKD) and is associated with adverse outcomes in many clinical settings. Inflammation stimulates production of fibroblast growth factor 23 (FGF23), high levels of which are independently associated with mortality in CKD. Few large-scale prospective studies have examined inflammation and mortality in patients with CKD, and none tested the interrelationships among inflammation, FGF23, and risk of death. Therefore, we conducted a prospective investigation of 3875 participants in the Chronic Renal Insufficiency Cohort (CRIC) study with CKD stages 2 to 4 to test the associations of baseline plasma interleukin-6, high-sensitivity C-reactive protein, and FGF23 levels with all-cause mortality, censoring at the onset of end-stage renal disease. During a median follow-up of 6.9 years, 550 participants died (20.5/1000 person-years) prior to end-stage renal disease. In separate multivariable-adjusted analyses, higher levels of interleukin-6 (hazard ratio per one standard deviation increase of natural log-transformed levels) 1.35 (95% confidence interval, 1.25-1.46), C-reactive protein 1.28 (1.16-1.40), and FGF23 1.45 (1.32-1.60) were each independently associated with increased risk of death. With further adjustment for FGF23, the risks of death associated with interleukin-6 and C-reactive protein were minimally attenuated. Compared to participants in the lowest quartiles of inflammation and FGF23, the multivariable-adjusted hazard ratio of death among those in the highest quartiles of both biomarkers was 4.38 (2.65-7.23) for interleukin-6 and FGF23, and 5.54 (3.04-10.09) for C-reactive protein and FGF23. Thus, elevated levels of interleukin-6, C-reactive protein, and FGF23 are independent risk factors for mortality in CKD.
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Affiliation(s)
- Jair Munoz Mendoza
- Division of Nephrology and Hypertension, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Tamara Isakova
- Division of Nephrology and Hypertension, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA; Center for Translational Metabolism and Health, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Xuan Cai
- Division of Nephrology and Hypertension, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA; Center for Translational Metabolism and Health, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Liz Y Bayes
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Christian Faul
- Division of Nephrology and Hypertension, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Julia J Scialla
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA; Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - James P Lash
- Section of Nephrology, Department of Medicine, University of Illinois, Chicago, IL, USA
| | - Jing Chen
- Section of Nephrology and Hypertension, Department of Medicine, Tulane School of Medicine, New Orleans, LA, USA
| | - Jiang He
- Section of Nephrology and Hypertension, Department of Medicine, Tulane School of Medicine, New Orleans, LA, USA
| | - Sankar Navaneethan
- Selzman Institute for Kidney Health, Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA; Section of Nephrology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Lavinia Negrea
- Division of Nephrology and Hypertension, Department of Medicine, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Sylvia E Rosas
- Joslin Diabetes Center, Beth Israel Deaconess Hospital, Harvard Medical School, Boston, MA, USA
| | - Matthias Kretzler
- Division of Nephrology, Department of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Lisa Nessel
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Dawei Xie
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | | | - Dominic S Raj
- Division of Renal Diseases and Hypertension, George Washington University, Washington, DC, USA
| | - Myles Wolf
- Division of Nephrology and Hypertension, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA; Center for Translational Metabolism and Health, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
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Chen J, Mohler ER, Garimella PS, Hamm LL, Xie D, Kimmel S, Townsend RR, Budoff M, Pan Q, Nessel L, Steigerwalt S, Wright JT, He J. Ankle Brachial Index and Subsequent Cardiovascular Disease Risk in Patients With Chronic Kidney Disease. J Am Heart Assoc 2016; 5:e003339. [PMID: 27247339 PMCID: PMC4937276 DOI: 10.1161/jaha.116.003339] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 05/04/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND The clinical implications of ankle-brachial index (ABI) cutpoints are not well defined in patients with chronic kidney disease (CKD) despite increased prevalence of high ABI attributed to arterial stiffness. We examined the relationship of ABI with cardiovascular disease (CVD) and all-cause mortality among CKD patients. METHODS AND RESULTS Three thousand six hundred twenty-seven participants without clinical peripheral artery disease (PAD) at baseline from the Chronic Renal Insufficiency Cohort Study were included. ABI was obtained per standard protocol and CVD events were confirmed by medical record adjudication. A U-shaped association of ABI with PAD, myocardial infarction (MI), composite CVD, and all-cause mortality was observed. Individuals with an ABI between 1.0 and <1.4 had the lowest risk of outcomes. Compared to participants with an ABI between 1.0 and <1.4, multiple-adjusted hazard ratios (95% confidence intervals) for those with an ABI of <0.9, 0.9 to <1.0, and ≥1.4 were 5.78 (3.57, 9.35), 2.76 (1.56, 4.88), and 4.85 (2.05, 11.50) for PAD; 1.67 (1.23, 2.29), 1.85 (1.33, 2.57), and 2.08 (1.10, 3.93) for MI; 1.51 (1.27, 1.79), 1.39 (1.15, 1.68), and 1.23 (0.82, 1.84) for composite CVD; and 1.55 (1.28, 1.89), 1.36 (1.10, 1.69), and 1.00 (0.62, 1.62) for all-cause mortality, respectively. CONCLUSIONS This study indicates that ABI <1.0 was related to risk of PAD, MI, composite CVD, and all-cause mortality whereas ABI ≥1.4 was related to clinical PAD. These findings suggest that ABI cutpoints of <1.0 or ≥1.4 for diagnosing PAD and ABI <1.0 for CVD risk stratification should be further evaluated among CKD patients.
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Affiliation(s)
- Jing Chen
- Department of Medicine, Tulane University School of Medicine, New Orleans, LA Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA
| | - Emile R Mohler
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | | | - L Lee Hamm
- Department of Medicine, Tulane University School of Medicine, New Orleans, LA
| | - Dawei Xie
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Stephen Kimmel
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Raymond R Townsend
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Matthew Budoff
- Los Angeles BioMed at Harbor-UCLA Medical Center, Los Angeles, CA
| | - Qiang Pan
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Lisa Nessel
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Susan Steigerwalt
- Division of Nephrology, University of Michigan School of Medicine, Ann Arbor, MI
| | - Jackson T Wright
- University Hospitals of Case Western Reserve University, Cleveland, OH
| | - Jiang He
- Department of Medicine, Tulane University School of Medicine, New Orleans, LA Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA
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Chen J, Mohler ER, Xie D, Shlipak M, Townsend RR, Appel LJ, Ojo A, Schreiber M, Nessel L, Zhang X, Raj D, Strauss L, Lora CM, Rahman M, Hamm LL, He J. Traditional and non-traditional risk factors for incident peripheral arterial disease among patients with chronic kidney disease. Nephrol Dial Transplant 2015; 31:1145-51. [PMID: 26682964 DOI: 10.1093/ndt/gfv418] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 09/08/2015] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The risk of peripheral arterial disease (PAD) is higher in patients with chronic kidney disease (CKD) compared with those without. However, reasons for this increased risk are not fully understood. METHODS We studied risk factors for incident PAD among 3169 participants in the Chronic Renal Insufficiency Cohort (CRIC) Study. Patients with CKD aged 21-74 years were recruited between 2003 and 2008 and followed for a median of 6.3 years. Incident PAD was defined as a new onset ankle-brachial index (ABI) of <0.9 or confirmed clinical PAD. RESULTS In a multivariate-adjusted model, older age, female sex, non-Hispanic Black, current smoking, diabetes, higher pulse pressure, lower high-density lipoprotein cholesterol, higher low-density lipoprotein cholesterol, and lower estimated glomerular filtration rate were significantly associated with the increased risk of incident PAD. After adjustment for these traditional risk factors as well as use of medications and CRIC Study clinic sites, the following baseline novel risk factors were significantly associated with risk of incident PAD [hazard ratio and 95% confidence interval (CI) for a one standard deviation (SD) higher level]: log[C-reactive protein (CRP)] (1.16, 1.06-1.25, P < 0.001), white blood cell count (1.09, 1.01-1.18, P = 0.03), fibrinogen (1.15, 1.06-1.26, P = 0.002), log(myeloperoxidase) (1.12, 1.03-1.23, P = 0.01), uric acid (0.88, 0.80-0.97, P = 0.01), glycated hemoglobin (1.16, 1.05-1.27, P = 0.003), log(homeostatic model assessment-insulin resistance) (1.21, 1.10-1.32, P < 0.001) and alkaline phosphatase (1.15, 1.07-1.24, P < 0.001). CONCLUSIONS Among patients with CKD, inflammation, prothrombotic state, oxidative stress, glycated hemoglobin, insulin resistance and alkaline phosphatase are associated with an increased risk of PAD, independent of traditional risk factors.
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Affiliation(s)
- Jing Chen
- Department of Medicine, Tulane University School of Medicine, New Orleans, LA, USA Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Emile R Mohler
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Dawei Xie
- Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Michael Shlipak
- Department of Medicine, University of California at San Francisco School of Medicine, San Francisco, CA, USA
| | - Raymond R Townsend
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Lawrence J Appel
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Akinlolu Ojo
- Department of Medicine, University of Michigan School of Medicine, Ann Arbor, MI, USA
| | - Martin Schreiber
- Department of Nephrology and Hypertension, Cleveland Clinic, Cleveland, OH, USA
| | - Lisa Nessel
- Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Xiaoming Zhang
- Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Dominic Raj
- Department of Medicine, George Washington University School of Medicine, Washington, DC, USA
| | - Louise Strauss
- Department of Medicine, Case Western University, Cleveland, OH, USA
| | - Claudia M Lora
- Department of Medicine, University of Illinois College of Medicine, Chicago, IL, USA
| | - Mahboob Rahman
- Department of Medicine, Case Western University, Cleveland, OH, USA
| | - L Lee Hamm
- Department of Medicine, Tulane University School of Medicine, New Orleans, LA, USA
| | - Jiang He
- Department of Medicine, Tulane University School of Medicine, New Orleans, LA, USA Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
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Catena C, Colussi G, Nait F, Pezzutto F, Martinis F, Sechi LA. Early renal failure as a cardiovascular disease: Focus on lipoprotein(a) and prothrombotic state. World J Nephrol 2015; 4:374-378. [PMID: 26167461 PMCID: PMC4491928 DOI: 10.5527/wjn.v4.i3.374] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 02/13/2015] [Accepted: 04/29/2015] [Indexed: 02/06/2023] Open
Abstract
Patients with renal failure are at increased risk of cardiovascular events even at the earliest stages of disease. In addition to many classic cardiovascular risk factors, many conditions that are commonly identified as emerging risk factors might contribute to occurrence of cardiovascular disease. Changes in circulating levels of many of these emerging risk factors have been demonstrated in patients with early stages of renal failure caused by different types of renal disease and have been associated with detection of cardiovascular complications. However, for most of these factors evidence of benefits of correction on cardiovascular outcome is missing. In this article, we comment on the role of lipoprotein(a) and prothrombotic factors as potential contributors to cardiovascular events in patients with early renal failure.
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Shen CH, Lin TY, Huang WY, Chen HJ, Kao CH. Pneumoconiosis increases the risk of peripheral arterial disease: a nationwide population-based study. Medicine (Baltimore) 2015; 94:e911. [PMID: 26020403 PMCID: PMC4616412 DOI: 10.1097/md.0000000000000911] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
This nationwide population-based retrospective cohort study was used to evaluate the association between pneumoconiosis and peripheral arterial disease (PAD). We identified 3374 patients with pneumoconiosis from the catastrophic illness registry who were newly diagnosed from 2000 to 2005; 13,496 patients without pneumoconiosis from Longitudinal Health Insurance Database 2000 (LHID2000) were randomly frequency matched according to sex, age, and index year and used as a nonpneumoconiosis group. Multivariate Cox proportional hazards regression was used to calculate adjusted hazard ratios (HRs) of PAD in the pneumoconiosis group compared with the nonpneumoconiosis group. The mean follow-up years were 7.44 years in the pneumoconiosis group and 8.17 years in the nonpneumoconiosis group. The incidence density rate of PAD was 1.25 times greater in the pneumoconiosis group than in the nonpneumoconiosis group (8.37 vs 6.70 per 1000 person-years). After adjusting for sex, age, and comorbidities, the adjusted HRs of PAD for the pneumoconiosis group were 1.30 (95% CI = 1.08-1.57), compared with the nonpneumoconiosis group. The combined impacts of patients with pneumoconiosis and diabetes, hyperlipidemia, hypertension, ischemic heart disease, chronic obstructive pulmonary disease, and asthma showed a significant by joint association with PAD risk compared with patients with no pneumoconiosis and no counterpart comorbidity. Patients with pneumoconiosis have an independently higher risk of developing PAD. Physicians should include pneumoconiosis in evaluating PAD risk.
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Affiliation(s)
- Chih-Hao Shen
- From the Division of Pulmonary and Critical Care Medicine (C-HS), Department of Internal Medicine; Division of Infectious Diseases and Tropical Medicine (T-YL), Department of Internal Medicine; Department of Radiation Oncology (W-YH), Tri-Service General Hospital, National Defense Medical Center, Taipei; Management Office for Health Data (H-JC), China Medical University Hospital; College of Medicine (H-JC), China Medical University, Taichung; Graduate Institute of Clinical Medical Science (C-HK), College of Medicine, China Medical University; and Department of Nuclear Medicine and PET Center (C-HK), China Medical University Hospital, Taichung, Taiwan
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Garimella PS, Hirsch AT. Peripheral artery disease and chronic kidney disease: clinical synergy to improve outcomes. Adv Chronic Kidney Dis 2014; 21:460-71. [PMID: 25443571 DOI: 10.1053/j.ackd.2014.07.005] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 07/16/2014] [Accepted: 07/18/2014] [Indexed: 01/07/2023]
Abstract
Persons with CKD are at a higher risk of developing peripheral artery disease (PAD) and its adverse health outcomes than individuals in the general population who have normal renal function. Classic atherosclerosis risk factors (eg, age, smoking, diabetes, hypertension, and hyperlipidemia) are common in patients with CKD, but CKD also imposes additional unique risk factors that promote arterial disease (eg, chronic inflammation, hypoalbuminemia, and a procalcific state). Current nephrology clinical practice is adversely affected by PAD diagnostic challenges, the complexities of managing 2 serious comorbid diseases, delayed vascular specialist referral, and slow PAD treatment initiation in patients with CKD. Persons with CKD are less likely to be provided recommended "optimal" PAD care. The knowledge that both limb and mortality outcomes are significantly worse in patients with CKD, especially those on dialysis, is not just a biologic fact but can serve as a care delivery call to action. Nephrologists can facilitate positive change. This article proposes that patients with PAD and CKD be strategically comanaged by care teams that encompass the skills to create and use evidence-based care pathways. This proposed collaborative multidisciplinary approach will include vascular medicine specialists, nephrologists, wound specialists, and mid-level providers. Just as clinical care quality metrics have served as the base for ESRD and acute MI quality improvement, it is time that such quality outcomes metrics be initiated for the large PAD-CKD population. This new system will identify and resolve key gaps in the current care model so that clinical outcomes improve within a cost-effective care frame for this vulnerable population.
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Yoshitomi R, Nakayama M, Ura Y, Kuma K, Nishimoto H, Fukui A, Ikeda H, Tsuchihashi T, Tsuruya K, Kitazono T. Ankle-brachial blood pressure index predicts cardiovascular events and mortality in Japanese patients with chronic kidney disease not on dialysis. Hypertens Res 2014; 37:1050-5. [PMID: 25056682 DOI: 10.1038/hr.2014.120] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Revised: 05/24/2014] [Accepted: 06/20/2014] [Indexed: 12/24/2022]
Abstract
The ankle-brachial blood pressure index (ABPI) has been recognized to have a predictive value for cardiovascular (CV) events and mortality in general or dialysis populations. However, the associations between ABPI and those outcomes have not been fully investigated in predialysis patients. The present study aimed to clarify the relationships between ABPI and both CV events and mortality in Japanese chronic kidney disease (CKD) patients not on dialysis. In this prospective observational study, we enrolled 320 patients with CKD stages 3-5 who were not on dialysis. At baseline, ABPI was examined and a low ABPI was defined as <0.9. CV events and all-cause deaths were examined in each patient. A Cox proportional hazards model was applied to determine the risk factors for CV events, as well as for mortality from CV and all causes. The median follow-up period was 30 months. CV events occurred in 56 patients and all-cause deaths occurred in 48, including 20 CV deaths. Multivariate analysis showed that age and low ABPI were risk factors for CV events. It was demonstrated that age, a history of cerebrovascular disease and low ABPI were determined as independent risk factors for CV mortality. In addition, age, body mass index and low ABPI were independently associated with all-cause mortality. In patients with CKD, low ABPI during the predialysis period is independently associated with poor survival and CV events, suggesting the usefulness of measuring ABPI for predicting CV events and patient survival in CKD.
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Affiliation(s)
- Ryota Yoshitomi
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masaru Nakayama
- Division of Nephrology and Clinical Research Institute, Department of Internal Medicine, National Kyushu Medical Center Hospital, Fukuoka, Japan
| | - Yoriko Ura
- Division of Nephrology and Clinical Research Institute, Department of Internal Medicine, National Kyushu Medical Center Hospital, Fukuoka, Japan
| | - Kazuyoshi Kuma
- Division of Nephrology and Clinical Research Institute, Department of Internal Medicine, National Kyushu Medical Center Hospital, Fukuoka, Japan
| | - Hitomi Nishimoto
- Division of Nephrology and Clinical Research Institute, Department of Internal Medicine, National Kyushu Medical Center Hospital, Fukuoka, Japan
| | - Akiko Fukui
- Division of Nephrology and Clinical Research Institute, Department of Internal Medicine, National Kyushu Medical Center Hospital, Fukuoka, Japan
| | - Hirofumi Ikeda
- Division of Nephrology and Clinical Research Institute, Department of Internal Medicine, National Kyushu Medical Center Hospital, Fukuoka, Japan
| | - Takuya Tsuchihashi
- Division of Hypertension and Clinical Research Institute, Department of Internal Medicine, National Kyushu Medical Center Hospital, Fukuoka, Japan
| | - Kazuhiko Tsuruya
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takanari Kitazono
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Dong J, Han QF, Zhu TY, Ren YP, Chen JH, Zhao HP, Chen MH, Xu R, Wang Y, Hao CM, Zhang R, Zhang XH, Wang M, Tian N, Wang HY. The associations of uric acid, cardiovascular and all-cause mortality in peritoneal dialysis patients. PLoS One 2014; 9:e82342. [PMID: 24416142 PMCID: PMC3885378 DOI: 10.1371/journal.pone.0082342] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Accepted: 10/31/2013] [Indexed: 12/22/2022] Open
Abstract
AIMS To investigate whether uric acid (UA) is an independent predictor of cardiovascular (CV) and all-cause mortality in peritoneal dialysis (PD) patients after controlling for recognized CV risk factors. METHODS A total of 2264 patients on chronic PD were collected from seven centers affiliated with the Socioeconomic Status on the Outcome of Peritoneal Dialysis (SSOP) Study. All demographic and laboratory data were recorded at baseline. Multivariate Cox regression was used to calculate the hazard ratio (HR) of CV and all-cause mortality with adjustments for recognized traditional and uremia-related CV factors. RESULTS There were no significant differences in baseline characteristics between patients with (n = 2193) and without (n = 71) UA measured. Each 1 mg/dL of increase in UA was associated with higher all-cause mortality with 1.05(1.00∼1.10) of HR and higher CV mortality with 1.12 (1.05∼1.20) of HR after adjusting for age, gender and center size. The highest gender-specific tertile of UA predicted higher all-cause mortality with 1.23(1.00∼1.52) of HR and higher CV mortality with 1.69 (1.21∼2.38) of HR after adjusting for age, gender and center size. The predictive value of UA was stronger in patients younger than 65 years without CV disease or diabetes at baseline. The prognostic value of UA as both continuous and categorical variable weakened or disappeared after further adjusted for uremia-related and traditional CV risk factors. CONCLUSIONS The prognostic value of UA in CV and all-cause mortality was weak in PD patients generally, which was confounded by uremia-related and traditional CV risk factors.
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Affiliation(s)
- Jie Dong
- Renal Division, Department of Medicine, Peking University First Hospital; Institute of Nephrology, Peking University; Key Laboratory of Renal Disease, Ministry of Health; Key Laboratory of Renal Disease, Ministry of Education; Beijing, China
| | - Qing-Feng Han
- Department of Nephrology, Peking University Third Hospital, Beijing, China
| | - Tong-Ying Zhu
- Department of Nephrology, Huashan Hospital of Fudan University, Shanghai, China
| | - Ye-Ping Ren
- Department of Nephrology, Second Affiliated Hospital of Harbin Medical University, Heilongjiang, China
| | - Jiang-Hua Chen
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Hui-Ping Zhao
- Department of Nephrology, Peking University People's Hospital, Beijing, China
| | - Meng-Hua Chen
- Department of Nephrology, General Hospital of Ningxia Medical University, Ningxia, China
| | - Rong Xu
- Renal Division, Department of Medicine, Peking University First Hospital; Institute of Nephrology, Peking University; Key Laboratory of Renal Disease, Ministry of Health; Key Laboratory of Renal Disease, Ministry of Education; Beijing, China
| | - Yue Wang
- Department of Nephrology, Peking University Third Hospital, Beijing, China
| | - Chuan-Ming Hao
- Department of Nephrology, Huashan Hospital of Fudan University, Shanghai, China
| | - Rui Zhang
- Department of Nephrology, Second Affiliated Hospital of Harbin Medical University, Heilongjiang, China
| | - Xiao-Hui Zhang
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Mei Wang
- Department of Nephrology, Peking University People's Hospital, Beijing, China
| | - Na Tian
- Department of Nephrology, General Hospital of Ningxia Medical University, Ningxia, China
| | - Hai-Yan Wang
- Renal Division, Department of Medicine, Peking University First Hospital; Institute of Nephrology, Peking University; Key Laboratory of Renal Disease, Ministry of Health; Key Laboratory of Renal Disease, Ministry of Education; Beijing, China
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Liu F, Shen J, Zhao J, Zeng H, Li L, Zhao J, Lu F, Bao Y, Jia W. Cystatin C: a strong marker for lower limb ischemia in Chinese type 2 diabetic patients? PLoS One 2013; 8:e66907. [PMID: 23843968 PMCID: PMC3699611 DOI: 10.1371/journal.pone.0066907] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Accepted: 05/11/2013] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Cystatin C is growing to be an ideal indicator for renal function and cardiovascular events. The aim of this study was to investigate the relationship between serum cystatin C levels and peripheral arterial disease and to explore its diagnostic value for lower limb ischemia (LLI) in type 2 diabetic population. METHODS A total of 1609 T2DM patients were included in this cross-sectional study. Their clinical and biochemical characteristics, ankle-brachial index (ABI), carotid and lower extremity arterial ultrasound were detected. LLI was defined by ABI <0.9 and lower extremity arterial stenosis >50% by ultrasound examination. Patients were divided to two groups: with LLI and without. The risk factors of LLI were explored by binary logistic regression analysis. RESULTS The serum concentrations of cystatin C were 1.53±0.60 and 1.08±0.30 mg/L in patients with and without LLI, respectively. Binary logistic regression analysis showed that the significant risk factors were cystatin C (P = 0.007, OR = 5.081), the presence of hypertension (P = 0.011, OR = 3.527), age (P<0.001, OR = 1.181), GA (P = 0.002, OR = 1.089) and diabetes duration (P = 0.008, OR = 1.074). The prevalence of coronary artery disease, cerebral infarction and LLI increased with cystatin C (P<0.01), and the prevalence of LLI in patients with cystatin C >1.2 mg/L was much higher than other three quartile groups. Receiver operating characteristic curve analysis revealed the cut point of cystatin C for LLI was 1.2 mg/L. The risk of LLI dramatically increased in patients with cystatin C >1.2 mg/L (OR = 21.793, 95% confidence interval 10.046-47.280, P<0.001). After adjusting for sex, age, duration, HbA1c, GA and hypertension, its OR still remained 3.395 (95% confidence interval 1.335-8.634). CONCLUSIONS There was a strong and independent association between cystatin C and limb arterial disease in diabetic population, and cystatin C >1.2 mg/L indicated a great increased risk of LLI.
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Affiliation(s)
- Fang Liu
- Department of Endocrinology & Metabolism, Shanghai Jiaotong University Affiliated Sixth People’s Hospital, Shanghai Clinical Center for Diabetes, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Key Clinical Center for Metabolic Diseases, Shanghai, China
- * E-mail: (FL); (WPJ)
| | - Jing Shen
- Department of Endocrinology & Metabolism, Shanghai Jiaotong University Affiliated Sixth People’s Hospital, Shanghai Clinical Center for Diabetes, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Key Clinical Center for Metabolic Diseases, Shanghai, China
| | - Jun Zhao
- Department of Endocrinology & Metabolism, Shanghai Jiaotong University Affiliated Sixth People’s Hospital, Shanghai Clinical Center for Diabetes, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Key Clinical Center for Metabolic Diseases, Shanghai, China
| | - Hui Zeng
- Department of Endocrinology & Metabolism, Shanghai Jiaotong University Affiliated Sixth People’s Hospital, Shanghai Clinical Center for Diabetes, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Key Clinical Center for Metabolic Diseases, Shanghai, China
| | - Lianxi Li
- Department of Endocrinology & Metabolism, Shanghai Jiaotong University Affiliated Sixth People’s Hospital, Shanghai Clinical Center for Diabetes, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Key Clinical Center for Metabolic Diseases, Shanghai, China
| | - Jungong Zhao
- Department of Endocrinology & Metabolism, Shanghai Jiaotong University Affiliated Sixth People’s Hospital, Shanghai Clinical Center for Diabetes, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Key Clinical Center for Metabolic Diseases, Shanghai, China
| | - Fengdi Lu
- Department of Endocrinology & Metabolism, Shanghai Jiaotong University Affiliated Sixth People’s Hospital, Shanghai Clinical Center for Diabetes, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Key Clinical Center for Metabolic Diseases, Shanghai, China
| | - Yuqian Bao
- Department of Endocrinology & Metabolism, Shanghai Jiaotong University Affiliated Sixth People’s Hospital, Shanghai Clinical Center for Diabetes, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Key Clinical Center for Metabolic Diseases, Shanghai, China
| | - Weiping Jia
- Department of Endocrinology & Metabolism, Shanghai Jiaotong University Affiliated Sixth People’s Hospital, Shanghai Clinical Center for Diabetes, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Key Clinical Center for Metabolic Diseases, Shanghai, China
- * E-mail: (FL); (WPJ)
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Ariëns RAS. Fibrin(ogen) and thrombotic disease. J Thromb Haemost 2013; 11 Suppl 1:294-305. [PMID: 23809133 DOI: 10.1111/jth.12229] [Citation(s) in RCA: 122] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Accepted: 03/08/2013] [Indexed: 01/21/2023]
Abstract
Fibrinogen is an abundant plasma protein that, when converted to fibrin by thrombin, provides the main building blocks for the clot. Dys-, a-, and hypo-fibrinogenemias have been variably linked to a normal phenotype, bleeding or even thrombosis. Meanwhile, increased fibrinogen concentrations in the blood have been associated with risk for thrombosis. More recently, studies have focussed on abnormal fibrin structure as a cause for thrombosis. Fibrin clots that have high fiber density and increased resistance to fibrinolysis have been consistently associated with risk for thrombosis. Fibrin structure measurements can (i) provide an overall assessment of hemostatic capacity of a sample, (ii) include effects of thrombin generation and fibrinogen concentrations, (iii) include effects of fibrinogen mutations, polymorphisms, and modifications, and (iv) give an indication of clot mechanical strength and resistance to fibrinolysis. A fibrinogen splice variation of the γ-chain (γ') is discussed as a model for changes in fibrin structure in relation to thrombosis. Results from prospective studies on fibrin structure are awaited. Studies of fibrin formation under flow, interactions of fibrin with blood cells, the mechanical properties of the fibrin clot, and nanoscale/molecular characterization of fibrin formation are likely to expose new causal mechanisms for the role of fibrin in thrombotic disease. Future studies into the causality and mechanisms may lead to new opportunities using fibrin structure in the diagnosis or treatment of thrombosis.
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Affiliation(s)
- R A S Ariëns
- Division of Cardiovascular and Diabetes Research, Leeds Institute for Genetics, Health and Therapeutics, Multidisciplinary Cardiovascular Research Centre, University of Leeds, Leeds, UK.
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