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Claudel SE, Waikar SS, Schmidt IM, Vasan RS, Verma A. The relationship between low levels of albuminuria and mortality among adults without major cardiovascular risk factors. Eur J Prev Cardiol 2024:zwae189. [PMID: 38825979 DOI: 10.1093/eurjpc/zwae189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 05/23/2024] [Accepted: 05/31/2024] [Indexed: 06/04/2024]
Abstract
AIMS The determine if elevated levels of albuminuria within the low range (urinary albumin-to-creatinine ratio, UACR <30 mg/g) are linked to cardiovascular death in adults lacking major cardiovascular risk factors. METHODS The association between UACR and cardiovascular mortality was investigated among 12,835 participants in the 1999-2014 National Health and Nutrition Examination Survey using Cox proportional hazard models and confounder-adjusted survival curves. We excluded participants with baseline cardiovascular disease, hypertension, diabetes, pre-diabetes, estimated glomerular filtration rate (eGFR) <60ml/min/1.73m2, currently pregnant, and those who had received dialysis in the last year. RESULTS Over a median follow-up of 12.3 years, 110 and 621 participants experienced cardiovascular and all-cause mortality. In multivariable-adjusted models, each doubling of UACR was associated with a 36% higher risk of cardiovascular death [HR 1.36 (95% confidence interval (CI) 1.02-1.82)] and a 24% higher risk of all-cause mortality [HR 1.24 (95% CI 1.10-1.39)]. The 15-year adjusted cumulative incidences of cardiovascular mortality were 0.91%, 0.99%, and 2.1% for UACR levels of <4.18 mg/g, 4.18 to <6.91 mg/g, and ≥6.91 mg/g, respectively. The 15-year adjusted cumulative incidences of all-cause mortality were 5.1%, 6.1%, and 7.4% for UACR levels of <4.18 mg/g, 4.18 to <6.91 mg/g, and ≥6.91 mg/g, respectively. CONCLUSIONS Adults with elevated levels of albuminuria within the low range (UACR <30 mg/g) and no major cardiovascular risk factors had elevated risks of cardiovascular and all-cause mortality. The risks increased linearly with higher albuminuria levels. This emphasizes a risk gradient across all albuminuria levels, even within the supposedly normal range, adding to the existing evidence.
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Affiliation(s)
- Sophie E Claudel
- Department of Internal Medicine, Boston Medical Center, Boston, MA, USA
- Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
| | - Sushrut S Waikar
- Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
- Section of Nephrology, Department of Medicine, Boston Medical Center, Boston, MA, USA
| | - Insa M Schmidt
- Section of Nephrology, Department of Medicine, Boston Medical Center, Boston, MA, USA
- Hamburg Center for Kidney Health, University Medical Center Hamburg, Hamburg, Germany
| | - Ramachandran S Vasan
- Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
- University of Texas School of Public Health and University of Texas Health Science Center in San Antonio, TX, USA
| | - Ashish Verma
- Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
- Section of Nephrology, Department of Medicine, Boston Medical Center, Boston, MA, USA
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Ding L, Guo H, Zhang C, Jiang B, Zhang S, Zhang J. Association between dietary inflammation index and albuminuria: results from the National Health and Nutrition Examination Survey. Front Nutr 2024; 11:1361890. [PMID: 38685954 PMCID: PMC11056555 DOI: 10.3389/fnut.2024.1361890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 03/29/2024] [Indexed: 05/02/2024] Open
Abstract
Background The Dietary Inflammation Index (DII) is a tool for evaluating the potential for dietary inflammation, and inflammation is a major cause of exacerbation in chronic kidney disease. Our study aimed to investigate the relationship between DII and albuminuria. Methods Data were obtained from the 2005-2018 National Health and Nutrition Examination Survey (NHANES) after excluding pregnant, minors, and missing data of urinary albumin-creatinine ratio (ACR), estimated glomerular filtration rate (eGFR), and DII were enrolled in our study. Albuminuria was defined as ACR > 30 mg/g. DII was calculated and divided into tertiles. After fully adjusted, multivariate logistic regression analysis and subgroup analysis were performed to investigate the association between DII and albuminuria. Results A total of 22,607 participants including 2,803 (12.40%) with and 19,804 (87.60%) without albuminuria were enrolled in our study. The albuminuria increased with the increasing DII tertiles (Tertile 1: 10.81%; Tertile 2: 12.41%; Tertile 3:13.97%, P < 0.001). After fully adjusting for covariates, multivariate logistic regression showed that the higher the DII, the greater the odds of albuminuria (OR = 1.19; 95% CI, 1.00-1.41, P < 0.001). Subgroup analysis and interaction test of participants found that the positive correlation between DII and albuminuria was not significantly related to gender, age, BMI, hypertension, diabetes, and eGFR (P for interaction >0.05). Conclusion Elevated DII is associated with high odds of albuminuria. Further large-scale prospective studies are still needed to analyze the role of DII in albuminuria.
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Affiliation(s)
- Ling Ding
- Department of Laboratory Medicine, The First Hospital of Qiqihar, Qiqihar, Heilongjiang, China
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Tohl D, Tran Tam Pham A, Li J, Tang Y. Point-of-care image-based quantitative urinalysis with commercial reagent strips: Design and clinical evaluation. Methods 2024; 224:63-70. [PMID: 38367653 DOI: 10.1016/j.ymeth.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 01/24/2024] [Accepted: 02/12/2024] [Indexed: 02/19/2024] Open
Abstract
Urinalysis is a useful test as an indicator of health or disease and as such, is a part of routine health screening. Urinalysis can be undertaken in many ways, one of which is reagent strips used in the general evaluation of health and to aid in the diagnosis and monitoring of kidney disease. To be effective, the test must be performed properly, and the results interpreted correctly. However, different light conditions and colour perception can vary between users leading to ambiguous readings. This has led to camera devices being used to capture and generate the estimated biomarker concentrations, but image colour can be affected by variations in illumination and inbuilt image processing. Therefore, a new portable device with embedded image processing techniques is presented in this study to provide quantitative measurements that are invariant to changes in illumination. The device includes a novel calibration process and uses the ratio of RGB values to compensate for variations in illumination across an image and improve the accuracy of quantitative measurements. Results show that the proposed calibration method gives consistent homogeneous illumination across the whole image. Comparisons against other existing methods and clinical results show good performance with a correlation to the clinical values. The proposed device can be used for point-of-care testing to provide reliable results consistent with clinical values.
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Affiliation(s)
- Damian Tohl
- Australia-China Joint Research Centre for Personal Health Technologies, Medical Device Research Institute, College of Science and Engineering, Flinders University, South Australia 5042, Australia
| | - Anh Tran Tam Pham
- Australia-China Joint Research Centre for Personal Health Technologies, Medical Device Research Institute, College of Science and Engineering, Flinders University, South Australia 5042, Australia
| | - Jordan Li
- Department of Renal Medicine, Flinders Medical Centre, College of Medicine and Public Health, Flinders University, South Australia 5042, Australia
| | - Youhong Tang
- Australia-China Joint Research Centre for Personal Health Technologies, Medical Device Research Institute, College of Science and Engineering, Flinders University, South Australia 5042, Australia.
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Xue X, Li C, Chen D. A cross-sectional study investigating the relationship between urinary albumin creatinine ratio and abdominal aortic calcification in adults. Front Cardiovasc Med 2024; 11:1352921. [PMID: 38500760 PMCID: PMC10944970 DOI: 10.3389/fcvm.2024.1352921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 02/15/2024] [Indexed: 03/20/2024] Open
Abstract
Introduction The presence of abdominal aortic calcification (AAC) is strongly linked to the development of atherosclerosis and the incidence of morbidity and mortality related to cardiovascular diseases (CVD). Urinary albumin creatinine ratio (UACR) was found related with the increased risk of CVD. The aim of this study is to explore the relationship between the UACR and severe AAC (SAAC). Methods and Results This study included a total of 2,379 individuals aged over 40 years, and their information was obtained from the National Health and Nutrition Examination Survey conducted (NHANES) in 2013-2014. The measurement of AAC was conducted through dual-energy x-ray absorptiometry and assessed using the Kauppila scoring system. SAAC was characterized by a Kauppila score of 6 or higher. Multivariate regression models were used to analyze the relationship between UACR level and SAAC, with covariate adjustment. In the completely adapted model, the top third subgroup exhibits increased likelihood of SAAC (odds ratio 1.50; 95%CI: 0.98, 2.29; p = 0.030) in contrast to the bottom third subgroup. The subgroup analyses revealed a more pronounced correlation among the older participants (p-value for interaction = 0.013). Discussion In the United States, SAAC was more likely to occur in adults who had a higher probability of UACR. The use of UACR has the potential to be a valuable method for forecasting the likelihood of SAAC.
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Affiliation(s)
- Xian Xue
- Nanyang City Center Hospital, Nanyang, China
| | - Chen Li
- Nanyang Second General Hospital, Nanyang, China
| | - Dongping Chen
- Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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Palomo-Piñón S, Enciso-Muñoz JM, Meaney E, Díaz-Domínguez E, Cardona-Muller D, Pérez FP, Cantoral-Farfán E, Anda-Garay JC, Mijangos-Chavez J, Antonio-Villa NE. Strategies to prevent, diagnose and treat kidney disease related to systemic arterial hypertension: a narrative review from the Mexican Group of Experts on Arterial Hypertension. BMC Nephrol 2024; 25:24. [PMID: 38238661 PMCID: PMC10797813 DOI: 10.1186/s12882-023-03450-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 12/27/2023] [Indexed: 01/22/2024] Open
Abstract
This narrative review highlights strategies proposed by the Mexican Group of Experts on Arterial Hypertension endorsed to prevent, diagnose, and treat chronic kidney disease (CKD) related to systemic arterial hypertension (SAH). Given the growing prevalence of CKD in Mexico and Latin America caused by SAH, there is a need for context-specific approaches to address the effects of SAH, given the diverse population and unique challenges faced by the region. This narrative review provides clinical strategies for healthcare providers on preventing, diagnosing, and treating kidney disease related to SAH, focusing on primary prevention, early detection, evidence-based diagnostic approaches, and selecting pharmacological treatments. Key-strategies are focused on six fundamental areas: 1) Strategies to mitigate kidney disease in SAH, 2) early detection of CKD in SAH, 3) diagnosis and monitoring of SAH, 4) blood pressure targets in patients living with CKD, 5) hypertensive treatment in patients with CKD and 6) diuretics and Non-Steroidal Mineralocorticoid Receptor Inhibitors in Patients with CKD. This review aims to provide relevant strategies for the Mexican and Latin American clinical context, highlight the importance of a multidisciplinary approach to managing SAH, and the role of community-based programs in improving the quality of life for affected individuals. This position paper seeks to contribute to reducing the burden of SAH-related CKD and its complications in Mexico and Latin America.
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Affiliation(s)
- Silvia Palomo-Piñón
- Grupo de Expertos en Hipertensión Arterial México (GREHTA), Ciudad de México, México.
- Colaborador Externo, Unidad de Investigación Médica en Enfermedades Nefrológicas Siglo XXI (UIMENSXII), UMAE Hospital de Especialidades "Dr. Bernardo Sepúlveda G" Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México.
- Grupo Colaborativo en Hipertensión Arterial (GCHTA), Ciudad de México, México.
- Grupo de Expertos en Hipertensión Arterial México (GREHTA), Calle Retorno del Escorial #13, Col. El Dorado, Tlanepantla de Baz, Estado de México, 54020, México.
| | - José Manuel Enciso-Muñoz
- Grupo de Expertos en Hipertensión Arterial México (GREHTA), Ciudad de México, México
- Asociación Mexicana para la Prevención de la Aterosclerosis y sus Complicaciones A.C, Ciudad de México, México
| | - Eduardo Meaney
- Grupo de Expertos en Hipertensión Arterial México (GREHTA), Ciudad de México, México
- Escuela Superior de Medicina, Instituto Politecnico Nacional, Ciudad de México, México
| | - Ernesto Díaz-Domínguez
- Grupo de Expertos en Hipertensión Arterial México (GREHTA), Ciudad de México, México
- UMAE Hospital de Cardiología, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - David Cardona-Muller
- Grupo de Expertos en Hipertensión Arterial México (GREHTA), Ciudad de México, México
- Universidad de Guadalajara, Guadalajara, Jalisco, México
| | - Fabiola Pazos Pérez
- Grupo de Expertos en Hipertensión Arterial México (GREHTA), Ciudad de México, México
- UMAE Hospital de Especialidades "Dr. Bernardo Sepúlveda G" Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Emilia Cantoral-Farfán
- Grupo de Expertos en Hipertensión Arterial México (GREHTA), Ciudad de México, México
- Jefatura de Nefrología, Hospital General De Zona Médico Familiar No. 8 Gilberto Flores Izquierdo, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Juan Carlos Anda-Garay
- Grupo de Expertos en Hipertensión Arterial México (GREHTA), Ciudad de México, México
- UMAE Hospital de Especialidades "Dr. Bernardo Sepúlveda G" Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Janet Mijangos-Chavez
- Grupo de Expertos en Hipertensión Arterial México (GREHTA), Ciudad de México, México
- Jefatura de Cardiología, UMAE Dr. Antonio Fraga Mouret, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Neftali Eduardo Antonio-Villa
- Grupo de Expertos en Hipertensión Arterial México (GREHTA), Ciudad de México, México
- Departamento de Endocrinologia, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
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Mahemuti N, Zou J, Liu C, Xiao Z, Liang F, Yang X. Urinary Albumin-to-Creatinine Ratio in Normal Range, Cardiovascular Health, and All-Cause Mortality. JAMA Netw Open 2023; 6:e2348333. [PMID: 38113044 PMCID: PMC10731498 DOI: 10.1001/jamanetworkopen.2023.48333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 11/06/2023] [Indexed: 12/21/2023] Open
Abstract
Importance Although cumulative evidence suggests that elevated urinary albumin-to-creatinine ratio (UACR) in the normal range (<30 mg/g) may be associated with an increased risk of mortality, few studies have investigated whether cardiovascular health (CVH) modifies the harmful outcomes of high-normal UACR. Objective To investigate associations of traditionally normal UACR and CVH with all-cause mortality. Design, Setting, and Participants This cohort study used National Health and Nutrition Examination Survey data from 2005 through 2018 and linked mortality information until 2019. Data were analyzed from March 1 through October 31, 2023. The study included adult participants aged 20 to 79 years with a normal UACR (<30 mg/g) based on Kidney Disease: Improving Global Outcomes criteria. Exposures The UACR was treated as a continuous variable and categorized into tertiles delineated as low (<4.67 mg/g), medium (4.67-7.67 mg/g), and high (7.68 to <30 mg/g). Cardiovascular health was assessed using Life's Essential 8 scores and grouped as poor (0-49 points), moderate (50-79 points), and ideal (80-100 points). Main Outcomes and Measures Multivariable Cox proportional hazards regression was used to estimate hazard ratios (HRs) and 95% CIs for associations of UACR with all-cause mortality in total participants and as stratified by CVH groups. Results The study included 23 697 participants (mean [SD] age, 45.58 [15.44] years; 11 806 women [49.7%] and 11 891 men [50.3%]). During the median 7.8 years (range, 4.5-11.1 years) of follow-up, 1403 deaths were recorded. Near-linear associations were observed for continuous UACR and CVH with all-cause mortality. Compared with the low UACR group, high UACR in the normal range showed an increased mortality risk in the moderate and poor CVH groups (CVH [50-79]: HR, 1.54 [95% CI, 1.26-1.89]; CVH [0-49]: HR, 1.56 [95% CI, 1.10-2.20]), with a significant multiplicative interaction of UACR and CVH (P < .001). Conclusions and Relevance The findings suggest that high UACR within the normal range is associated with a significantly increased risk of all-cause mortality, with the association more pronounced in adults with poor CVH status. These findings highlight the importance of risk management for early kidney dysfunction, particularly among individuals with poor CVH.
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Affiliation(s)
- Nayili Mahemuti
- Department of Occupational and Environmental Health, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Jiao Zou
- Department of Occupational and Environmental Health, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Chuanlang Liu
- Department of Occupational and Environmental Health, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Zhiyi Xiao
- School of Public Health and Emergency Management, Southern University of Science and Technology, Shenzhen, China
| | - Fengchao Liang
- School of Public Health and Emergency Management, Southern University of Science and Technology, Shenzhen, China
| | - Xueli Yang
- Department of Occupational and Environmental Health, School of Public Health, Tianjin Medical University, Tianjin, China
- Key Laboratory of Prevention and Control of Major Diseases in the Population, Ministry of Education, Tianjin Medical University, Tianjin, China
- Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin Medical University, Tianjin, China
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Drexler Y, Tremblay J, Mesa RA, Parsons B, Chavez E, Contreras G, Fornoni A, Raij L, Swift S, Elfassy T. Associations Between Albuminuria and Mortality Among US Adults by Demographic and Comorbidity Factors. J Am Heart Assoc 2023; 12:e030773. [PMID: 37850454 PMCID: PMC10727384 DOI: 10.1161/jaha.123.030773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 09/14/2023] [Indexed: 10/19/2023]
Abstract
Background Albuminuria is a known marker of mortality risk. Whether the association between albuminuria and mortality differs by demographic and comorbidity factors remains unclear. Therefore, we sought to determine whether albuminuria is differentially associated with mortality. Methods and Results This study included 49 640 participants from the National Health and Nutrition Examination Survey (1999-2018). All-cause mortality through 2019 was linked from the National Death Index. Multivariable-adjusted Poisson regression models were used to determine whether levels of urine albumin-to-creatinine ratio (ACR) were associated with mortality. Models were adjusted for demographic, socioeconomic, behavioral, and clinical factors. Mean age in the population was 46 years, with 51.3% female, and 30.3% with an ACR ≥10 mg/g. Over a median follow-up of 9.5 years, 6813 deaths occurred. Compared with ACR <10, ACR ≥300 was associated with increased risk of mortality by 132% overall (95% CI, 2.01-2.68), 124% among men (95% CI, 1.84-2.73), 158% among women (95% CI, 2.14-3.11), 130% among non-Hispanic White adults (95% CI: 1.89-2.79), 135% among non-Hispanic Black adults (95% CI, 1.82-3.04), and 114% among Hispanic adults (95% CI, 1.55-2.94). Compared with ACR <10, ACR ≥300 was associated with increased risk of mortality by 148% among individuals with neither hypertension nor hypercholesterolemia (95% CI, 1.69-3.64), 128% among individuals with hypertension alone (95% CI, 1.86-2.79), and 166% among individuals with both hypertension and hypercholesterolemia (95% CI, 2.18-3.26). Conclusions We found strong associations between albuminuria and mortality risk, even at mildly increased levels of albuminuria. Associations persisted across categories of sex, race or ethnicity, and comorbid conditions, with subtle differences.
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Affiliation(s)
- Yelena Drexler
- Katz Family Division of Nephrology and Hypertension, Department of MedicineUniversity of Miami Miller School of MedicineFLMiamiUSA
| | - Julien Tremblay
- Department of MedicineUniversity of Miami Miller School of MedicineMiamiFLUSA
| | - Robert A. Mesa
- Department of Public Health SciencesUniversity of Miami Miller School of MedicineMiamiFLUSA
| | - Bailey Parsons
- University of Central Florida College of MedicineOrlandoFLUSA
| | - Efren Chavez
- Katz Family Division of Nephrology and Hypertension, Department of MedicineUniversity of Miami Miller School of MedicineFLMiamiUSA
| | - Gabriel Contreras
- Katz Family Division of Nephrology and Hypertension, Department of MedicineUniversity of Miami Miller School of MedicineFLMiamiUSA
| | - Alessia Fornoni
- Katz Family Division of Nephrology and Hypertension, Department of MedicineUniversity of Miami Miller School of MedicineFLMiamiUSA
| | - Leopoldo Raij
- Katz Family Division of Nephrology and Hypertension, Department of MedicineUniversity of Miami Miller School of MedicineFLMiamiUSA
| | - Samuel Swift
- Center for Healthcare Equity in Kidney DiseaseUniversity of New Mexico Health Science CenterAlbuquerqueNMUSA
| | - Tali Elfassy
- Katz Family Division of Nephrology and Hypertension, Department of MedicineUniversity of Miami Miller School of MedicineFLMiamiUSA
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Xuereb S, Magri CJ, Xuereb RA, Xuereb RG, Galea J, Fava S. Predictors of subclinical atherosclerosis and microalbuminuria in middle-aged women: a cross-sectional study. Minerva Med 2023; 114:601-607. [PMID: 35671000 DOI: 10.23736/s0026-4806.22.07579-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Cardiovascular disease is of increasing concern in women. The aim was to assess the role of clinical and anthropometric measures in the development of subclinical atherosclerosis. METHODS A cross-sectional study in 203 Europid females to determine the prevalence of abnormal carotid intima-media thickness (CIMT) and associated clinical parameters. RESULTS The study population had a mean age of the 38.3±5.4 years, a median Body Mass Index of 29.25 (IQR 25.06-36.11) kg/m2 and median waist index (WI) of 1.15 (IQR 1.06-1.34). Increased CIMT was present in 169 (83.25%) participants. Linear regression analysis revealed WI to be the sole predictor of increased CIMT (β=24.387, P<0.001). Post-hoc ROC analysis revealed a WI of 1.12 has 62% sensitivity and 53% specificity for predicting increased CIMT (AUC 0.63, 95% CI 0.55-0.72, P=0.016). The median urinary albumin-creatinine ratio (ACR) was 4.4 mg/g, and the prevalence of microalbuminuria was 8.9%; serum triglycerides were the only independent predictor of ACR. CONCLUSIONS Atherosclerosis, as detected by abnormal CIMT, is very prevalent in middle-aged women. Waist index is the major predictor of subclinical atherosclerosis in a contemporary premenopausal female population. A WI of 1.12 exhibits relatively good sensitivity and specificity in predicting the presence of atherosclerosis in this patient population.
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Affiliation(s)
| | - Caroline J Magri
- Mater Dei Hospital, Msida, Malta
- Medical School, Mater Dei Hospital, University of Malta, Msida, Malta
| | - Rachel A Xuereb
- Medical School, Mater Dei Hospital, University of Malta, Msida, Malta
| | - Robert G Xuereb
- Mater Dei Hospital, Msida, Malta
- Medical School, Mater Dei Hospital, University of Malta, Msida, Malta
| | - Joseph Galea
- Mater Dei Hospital, Msida, Malta
- Medical School, Mater Dei Hospital, University of Malta, Msida, Malta
| | - Stephen Fava
- Mater Dei Hospital, Msida, Malta -
- Medical School, Mater Dei Hospital, University of Malta, Msida, Malta
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Zhou Y, Wei C, Gao X, Sun Y, Han X. Positive associations between different circulating trans fatty acids (TFAs) and urinary albumin excretion among adults in the U.S.: a population-based study. Lipids Health Dis 2023; 22:152. [PMID: 37710270 PMCID: PMC10500873 DOI: 10.1186/s12944-023-01917-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 09/03/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND It is well established that the consumption of trans-fatty acids (TFAs) can increase the incidence of total mortality, cardiovascular disease, cancer, and diabetes. However, there are still no demographic studies on the effects of circulating TFA isoforms on the albumin-creatinine ratio (ACR), an early marker of chronic kidney disease. Our goal was to explore the possible relationships between TFAs and ACR. METHODS In this study, complete TFAs and urinary ACR data were collected from the National Health and Nutrition Examination Survey (NHANES) (2009-2010 and 1999-2000 cycles). The independent linear relationships between different circulating TFA isoforms and the ACR were examined by performing multivariable linear regression models. Machine learning was used to analyze the contribution of the different TFA isoforms to the ACR. To assess the nonlinearity of the relationship, smooth curve fitting and an analysis of threshold effect were performed, and a stratified analysis was conducted to identify possible susceptible populations. RESULTS Our analysis included a total of 3785 individuals. Elaidic acid, linolelaidic acid, and sum TFAs were shown to be positively associated with the ACR after full adjustment by weighted multivariable regression analysis. In the subgroup analysis, the positive associations were maintained in participants with hypertension and without diabetes. In the XGBoost model of the ACR, Sum TFAs were found to be the most crucial factor. In addition, smooth curve fitting showed that there was a nonlinear relationship between the different TFAs and the ACR, and there was a saturation point. CONCLUSIONS Our study demonstrated that TFA isoforms were positively and independently correlated with urinary albumin excretion, especially in participants with hypertension and without diabetes. This suggested that reducing trans fatty acid intake may reduce the risk of renal events.
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Affiliation(s)
- Yuancheng Zhou
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Road, Wuhan, 430022, Hubei Province, China
| | - Chengcheng Wei
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Road, Wuhan, 430022, Hubei Province, China
| | - Xincheng Gao
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Road, Wuhan, 430022, Hubei Province, China
| | - Yi Sun
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Road, Wuhan, 430022, Hubei Province, China
| | - Xiaomin Han
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Road, Wuhan, 430022, Hubei Province, China.
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Chen L, Zhang J, Zhou N, Weng JY, Bao ZY, Wu LD. Association of different obesity patterns with hypertension in US male adults: a cross-sectional study. Sci Rep 2023; 13:10551. [PMID: 37386040 PMCID: PMC10310720 DOI: 10.1038/s41598-023-37302-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 06/20/2023] [Indexed: 07/01/2023] Open
Abstract
Obesity is an important risk factor for hypertension. We aimed to investigate the association between different obesity patterns and hypertension risk in a large male population in the US. Male participants from the National Health and Nutrition Examination Survey (NHANES) (2007-2018) were enrolled in this cross-sectional study. Social demographic information, lifestyle factors, anthropometric measurements and biochemical measurements were collected. Three obesity patterns were classified according to the body mass index (BMI) and waist circumference (WC), including overweight and general obesity, abdominal obesity, and compound obesity. We adopted multivariate logistic regression to investigate the associations between hypertension and different obesity patterns after adjusting for cofounding factors. Subgroup analysis, stratified by age, smoking, drinking and estimated glomerular filtration rate (eGFR), was also conducted to explore the associations between obesity patterns and hypertension risk among different populations. Moreover, the association between WC and hypertension among male individuals was also explored using restricted cubic spline (RCS) analysis. Receiver operating characteristic (ROC) was used to evaluate the discriminatory power of WC for screening hypertension risk. 13,859 male participants from NHANES survey (2007-2018) were enrolled. Comparing with the normal-weight group, the odds ratios (ORs) [95% confidence interval (CI)] for hypertension in individuals with overweight and general obesity, abdominal obesity and compound obesity were 1.41 [1.17-1.70], 1.97 [1.53-2.54] and 3.28 [2.70-3.99], respectively. Subgroup analysis showed that the effect of different obesity patterns on hypertension risk was highly stable among individuals with different clinical conditions. In addition, WC had a positive correlation with the risk of hypertension (OR: 1.43; 95% CI 1.37-1.52; P < 0.001) in fully adjusted multivariate logistic regression model. RCS analysis showed that the association between WC and hypertension risk was in a nonlinear pattern, and WC had a good discriminatory power for hypertension in ROC analysis. Different patterns of obesity have a great impact on the risk of hypertension among male individuals. Increment of WC significantly increased the hypertension risk. More attention should be paid to the prevention of obesity, especially abdominal obesity and compound obesity in male individuals.
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Affiliation(s)
- Lu Chen
- Department of Cardiology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, 215000, China
| | - Jun Zhang
- Department of Cardiology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, 215000, China
| | - Nan Zhou
- Health Examination Center, Huadong Sanatorium, Wuxi, 214065, China.
| | - Jia-Yi Weng
- Department of Cardiology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, 215000, China.
| | - Zheng-Yang Bao
- Department of Internal Medicine, Wuxi Maternity and Child Health Care Hospital, Women's Hospital of Jiangnan University, Jiangnan University, Wuxi, 214002, China.
| | - Li-Da Wu
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210029, China.
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11
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Indah Wardani N, Kanatharana P, Thavarungkul P, Limbut W. Molecularly imprinted polymer dual electrochemical sensor for the one-step determination of albuminuria to creatinine ratio (ACR). Talanta 2023; 265:124769. [PMID: 37329752 DOI: 10.1016/j.talanta.2023.124769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 06/02/2023] [Accepted: 06/04/2023] [Indexed: 06/19/2023]
Abstract
The urinary albumin to creatinine ratio (ACR) is a convenient and accurate biomarker of chronic kidney disease (CKD). An electrochemical sensor for the quantification of ACR was developed based on a dual screen-printed carbon electrode (SPdCE). The SPdCE was modified with carboxylated multiwalled carbon nanotubes (f-MWCNTs) and redox probes of polymethylene blue (PMB) for creatinine and ferrocene (Fc) for albumin. The modified working electrodes were then molecularly imprinted with coated with polymerized poly-o-phenylenediamine (PoPD) to form surfaces that could be separately imprinted with creatinine and albumin template molecules. The seeded polymer layers were polymerized with a second coating of PoPD and the templates were removed to form two different molecularly imprinted polymer (MIP) layers. The dual sensor presented recognition sites for creatinine and albumin on different working electrodes, enabling the measurement of each analyte in one potential scan of square wave voltammetry (SWV). The proposed sensor produced linear ranges of 5.0-100 ng mL-1 and 100-2500 ng mL-1 for creatinine, and 5.0-100 ng mL-1 for albumin. LODs were 1.5 ± 0.2 ng mL-1 and 1.5 ± 0.3 ng mL-1, respectively. The dual MIP sensor was highly selective and stable for seven weeks at room temperature. The ACRs obtained using the proposed sensor compared well (P > 0.05) with the results from immunoturbidimetric and enzymatic methods.
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Affiliation(s)
- Nur Indah Wardani
- Center of Excellence for Trace Analysis and Biosensor, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand; Division of Physical Science, Faculty of Science, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand; Center of Excellence for Innovation in Chemistry, Faculty of Science, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand
| | - Proespichaya Kanatharana
- Center of Excellence for Trace Analysis and Biosensor, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand; Division of Physical Science, Faculty of Science, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand; Center of Excellence for Innovation in Chemistry, Faculty of Science, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand
| | - Panote Thavarungkul
- Center of Excellence for Trace Analysis and Biosensor, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand; Division of Physical Science, Faculty of Science, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand; Center of Excellence for Innovation in Chemistry, Faculty of Science, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand
| | - Warakorn Limbut
- Center of Excellence for Trace Analysis and Biosensor, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand; Center of Excellence for Innovation in Chemistry, Faculty of Science, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand; Division of Health and Applied Sciences, Faculty of Science, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand.
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12
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Yang ZW, Fu YB, Wei XB, Fu BQ, Huang JL, Zhang GR, Yu DQ. Optimal threshold of urinary albumin-to-creatinine ratio (UACR) for predicting long-term cardiovascular and noncardiovascular mortality. Int Urol Nephrol 2023:10.1007/s11255-023-03499-z. [PMID: 36757657 DOI: 10.1007/s11255-023-03499-z] [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: 04/07/2022] [Accepted: 01/27/2023] [Indexed: 02/10/2023]
Abstract
PURPOSE Traditional cutoff values of urinary albumin-to-creatinine ratio (UACR) for predicting mortality have recently been challenged. In this study, we investigated the optimal threshold of UACR for predicting long-term cardiovascular and non-cardiovascular mortality in the general population. METHODS Data for 25,302 adults were extracted from the National Health and Nutrition Examination Survey (2005-2014). Receiver operating characteristic (ROC) curve analysis was performed to assess the predictive value of UACR for cardiovascular and non-cardiovascular mortality. A Cox regression model was established to examine the association between UACR and cardiovascular and non-cardiovascular mortality. X-tile was used to estimate the optimal cutoff of UACR. RESULTS The UACR had acceptable predictive value for both cardiovascular (AUC (95% CI) for 1-year, 3-year and 5-year mortality, respectively: 0.769 (0.711-0.828), 0.764 (0.722-0.805) and 0.763 (0.730-0.795)) and non-cardiovascular (AUC (95% CI) for 1-year, 3-year and 5-year mortality, respectively: 0.772 (0.681-0.764), 0.708 (0.686-0.731) and 0.708 (0.690-0.725)) mortality. The optimal cutoff values were 16 and 30 mg/g for predicting long-term cardiovascular and non-cardiovascular mortality, respectively. Both cutoffs of UACR had acceptable specificity (0.785-0.891) in predicting long-term mortality, while the new proposed cutoff (16 mg/g) had higher sensitivity. The adjusted hazard ratios of cardiovascular and non-cardiovascular mortality for the high-risk group were 2.50 (95% CI 1.96-3.18, P < 0.001) and 1.92 (95% CI 1.70-2.17, P < 0.001), respectively. CONCLUSIONS Compared to the traditional cutoff value (30 mg/g), a UACR cutoff of 16 mg/g may be more sensitive for identifying patients at high risk for cardiovascular mortality in the general population.
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Affiliation(s)
- Zhi-Wen Yang
- Division of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510080, Guangdong, China
- Shantou University Medical College, Shantou, Guangdong, China
| | - Yan-Bin Fu
- Division of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510080, Guangdong, China
| | - Xue-Biao Wei
- Division of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510080, Guangdong, China
- Division of Geriatric Intensive Medicine, Guangdong Provincial Geriatrics Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
| | - Bing-Qi Fu
- Division of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510080, Guangdong, China
- Shantou University Medical College, Shantou, Guangdong, China
| | - Jie-Leng Huang
- Division of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510080, Guangdong, China
| | - Guan-Rong Zhang
- Information and Statistics Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
| | - Dan-Qing Yu
- Division of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510080, Guangdong, China.
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13
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Shi Y, Hu H, Wu Z, Wu J, Chen Z, Li P. Sex modifies the association between urinary albumin-to-creatinine ratio and diabetes among adults in the United States (NHANES 2011-2018). Biol Sex Differ 2022; 13:53. [PMID: 36175972 PMCID: PMC9524085 DOI: 10.1186/s13293-022-00462-y] [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] [Received: 05/23/2022] [Accepted: 09/20/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Studies on the association between urinary albumin-to-creatinine ratio (uACR) and diabetes are limited. We aimed to examine the association between uACR and diabetes among adults in the United States, with particular interest in sex differences. METHODS Overall, 5307 participants were included in this study. The exposure variable was uACR, where uACR = urine albumin/urine creatinine. The primary outcome of this study was diabetes, defined as self-reported physician diagnosis of diabetes, fasting plasma glucose concentration ≥ 7.0 mmol/L, or use of glucose-lowering drugs. RESULTS The average age of the participants in this study was 46.37 ± 17.38 years, 818 (15.41%) had diabetes and the median uACR was 7 mg/g (interquartile range, 4-12 mg/g). There was a significant positive association between uACR and diabetes (per natural log [uACR] increment: OR, 1.81; 95% CI 1.39-2.34). A multivariate logistic regression model demonstrated that per unit increment in LguACR, the diabetes prevalence increased 2.26-fold among male participants (OR 2.26, 95% CI 1.59-3.21). However, in female participants, we observed that uACR was not related to the prevalence of diabetes (odds ratio [OR], 1.28; 95% CI 0.82-2.01). Our findings showed that there was an interaction between sex and uACR (P for interaction = 0.049). CONCLUSIONS A higher uACR is significantly associated with an increased prevalence of diabetes, and sex can modify the relationship between them.
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Affiliation(s)
- Yumeng Shi
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, No. 1 Minde Road, Nanchang, 330006, Jiangxi, China
| | - Huan Hu
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, No. 1 Minde Road, Nanchang, 330006, Jiangxi, China
| | - Zuxiang Wu
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, No. 1 Minde Road, Nanchang, 330006, Jiangxi, China
| | - Ji Wu
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, No. 1 Minde Road, Nanchang, 330006, Jiangxi, China
| | - Zhiqiang Chen
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, No. 1 Minde Road, Nanchang, 330006, Jiangxi, China
| | - Ping Li
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, No. 1 Minde Road, Nanchang, 330006, Jiangxi, China.
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14
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Li N, Zhou G, Zheng Y, Zhou E, He W, Sun W, Zhang L. Development and validation of a novel nomogram to predict overall survival of patients with moderate to severe chronic kidney disease. Ren Fail 2022; 44:241-249. [PMID: 35166166 PMCID: PMC8856074 DOI: 10.1080/0886022x.2022.2032744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction The risk of death significantly increased from stage 3 chronic kidney disease (CKD) onward. We aimed to construct a novel nomogram to predict the overall survival (OS) of patients afflicted with CKD from stage 3–5. Methods A total of 882 patients with stage 3–5 CKD were enrolled from the NHANES 2001–2004 survey. Data sets from the 2003–2004 survey population were used to develop a nomogram that would predict the risk of OS. The 2001–2002 survey population was used to validate the nomogram. Least absolute shrinkage and selection operator (Lasso) regression was conducted to screen the significant predictors relative to all-cause death. The multivariate Cox regression based on the screened factors was applied to effectively construct the nomogram. The performance of the nomogram was evaluated according to the C-index, the area under the receiver operating characteristic curve (AUC), and the calibration curve with 1000 bootstraps resample. Kaplan–Meier’s curves were used for testing the discrimination of the prediction model. Results Five variables (age, urinary albumin-to-creatinine ratio (UACR), potassium, cystatin C (Cys C), and homocysteine) were screened by the Lasso regression. The nomogram was constructed using these factors, as well as the CKD stage. The included factors (age, CKD stage, UACR, potassium, Cys C, and homocysteine) were all significantly related to the death of CKD patients, according to the multivariate Cox regression analysis. The internal validation showed that this nomogram demonstrates good discrimination and calibration (adjusted C-index: 0.70; AUC of 3-, 5-, and 10-year OS were 0.75, 0.78, and 0.77, respectively). External validation also demonstrated exceedingly similar results (C-index: 0.72, 95% CI: 0.69–0.76; AUC of 3-, 5-, and 10-year OS were 0.76, 0.79, and 0.80, respectively). Conclusions This study effectively constructed a novel nomogram that incorporates CKD stage, age, UACR, potassium, Cys C, and homocysteine, which can be conveniently used to facilitate the individualized prediction of survival probability in patients with stage 3–5 CKD. It displays valuable potential for clinical application.
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Affiliation(s)
- Ning Li
- Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing, PR China
| | - Guowei Zhou
- Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing, PR China
| | - Yawei Zheng
- Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing, PR China
| | - Enchao Zhou
- Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing, PR China
| | - Weiming He
- Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing, PR China
| | - Wei Sun
- Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing, PR China
| | - Lu Zhang
- Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing, PR China
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15
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Gao W, Wang J, Chen Y, Qiao H, Qian X, Xin Z, Zhao Z, Wang T, Xu Y, Xu M, Bi Y, Li M, Gao J. Discordance between the triglyceride glucose index and HOMA-IR in incident albuminuria: a cohort study from China. Lipids Health Dis 2021; 20:176. [PMID: 34865646 PMCID: PMC8647334 DOI: 10.1186/s12944-021-01602-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 11/19/2021] [Indexed: 12/15/2022] Open
Abstract
Background To date, there have no study comparing the associations between TyG index and HOMA-IR on the risk of incident albuminuria. Accordingly, the objective of the present study is to use discordance analysis to evaluate the diverse associations between TyG index and HOMA-IR on the risk of incident albuminuria. Methods A community-based prospective cohort study was performed with 2446 Chinese adults. We categorized participants into 4 concordance or discordance groups. Discordance was defined as a TyG index equal to or greater than the upper quartile and HOMA-IR less than the upper quartile, or vice versa. Results During a median follow-up period of 3.9 years, 203 of 2446 participants developed incident albuminuria (8.3%). In the multivariable logistic analyses, the high TyG index tertile group was associated with a 1.71-fold (95% confidence interval (CI) 1.07–2.72) higher risk of incident albuminuria, comparing with the low tertile group. Participants in TyG (+) & HOMA-IR (−) group had a greater risk of incident albuminuria compared with those in TyG (−) & HOMA-IR (−) group after multivariate adjustment. Subgroup analyses showed that low HOMA-IR and discordantly high TyG index was closely related to a highest risk of incident albuminuria in cardiovascular metabolic disorder subjects. Conclusions Participants with a discordantly high TyG index had a significantly greater risk of incident albuminuria, especially in metabolic dysfunction subjects. The TyG index might be a better predictor of early stage of chronic kidney disease than HOMA-IR for subjects with metabolic abnormality. Supplementary Information The online version contains supplementary material available at 10.1186/s12944-021-01602-w.
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Affiliation(s)
- Wei Gao
- Songnan Town Community health Service Center, Baoshan District, Shanghai, China
| | - Jialu Wang
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Rui-Jin 2nd Road, Shanghai, 200025, China.,Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Rui-Jin 2nd Road, Shanghai, 200025, China
| | - Yan Chen
- Songnan Town Community health Service Center, Baoshan District, Shanghai, China
| | - Hongmei Qiao
- Songnan Town Community health Service Center, Baoshan District, Shanghai, China
| | - Xiaozhong Qian
- Songnan Town Community health Service Center, Baoshan District, Shanghai, China
| | - Zhuojun Xin
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Rui-Jin 2nd Road, Shanghai, 200025, China.,Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Rui-Jin 2nd Road, Shanghai, 200025, China
| | - Zhiyun Zhao
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Rui-Jin 2nd Road, Shanghai, 200025, China.,Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Rui-Jin 2nd Road, Shanghai, 200025, China
| | - Tiange Wang
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Rui-Jin 2nd Road, Shanghai, 200025, China.,Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Rui-Jin 2nd Road, Shanghai, 200025, China
| | - Yu Xu
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Rui-Jin 2nd Road, Shanghai, 200025, China.,Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Rui-Jin 2nd Road, Shanghai, 200025, China
| | - Min Xu
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Rui-Jin 2nd Road, Shanghai, 200025, China.,Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Rui-Jin 2nd Road, Shanghai, 200025, China
| | - Yufang Bi
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Rui-Jin 2nd Road, Shanghai, 200025, China.,Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Rui-Jin 2nd Road, Shanghai, 200025, China
| | - Mian Li
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Rui-Jin 2nd Road, Shanghai, 200025, China. .,Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Rui-Jin 2nd Road, Shanghai, 200025, China.
| | - Jinli Gao
- Songnan Town Community health Service Center, Baoshan District, Shanghai, China.
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Atkin SL, Butler AE, Hunt SC, Kilpatrick ES. The retinopathy-derived HbA1c threshold of 6.5% for type 2 diabetes also captures the risk of diabetic nephropathy in NHANES. Diabetes Obes Metab 2021; 23:2109-2115. [PMID: 34033191 DOI: 10.1111/dom.14449] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/06/2021] [Accepted: 05/23/2021] [Indexed: 01/06/2023]
Abstract
AIM To determine if an HbA1c diagnostic threshold of less than 6.5% (<48 mmol/mol) could be identified based on a urinary albumin-creatinine ratio (UACR) of 30 mg/g or higher in subjects not known to have diabetes. METHODS A UACR was measured for 20 158 participants in the 2011-2018 nationally representative cross-sectional National Health and Nutrition Examination Surveys (NHANES; cycles 7-10 inclusive). RESULTS There was a significant trend for an increasing risk with a UACR of 30 mg/g or higher across increasing HbA1c categories (P < .0001). This trend was mainly attributable to the high prevalence of raised UACR in the 7.0% or higher HbA1c subgroup of subjects not previously diagnosed with diabetes. None of the odds ratios in the lower HbA1c subgroups versus the HbA1c subgroup of less than 5.0% reached significance. There were racial/ethnic differences in UACR risk (P < .0001), with White and Black subjects exhibiting little increased risk (vs. HbA1c <5.0%) until they reached an HbA1c of 7.0%, while Asian and Hispanic subjects showed some increased, but non-significant, risks at lower HbA1c levels. Maximizing the area under receiver operating characteristic curves from logistic regressions predicted an ideal HbA1c threshold of 5.8%, but there was little variation in area from 5.5% to 7.0%. CONCLUSION A clinically useful diagnostic threshold below 6.5% for HbA1c for elevated UACR risk was not identified, with an increased risk only obvious at an HbA1c of 7.0% or higher. Thus, the retinopathy-derived HbA1c threshold of 6.5% also captures the risk of diabetic nephropathy in NHANES.
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Affiliation(s)
- Stephen L Atkin
- Royal College of Surgeons Ireland-Bahrain, Busaiteen, Bahrain
| | - Alexandra E Butler
- Diabetes Research Center (DRC), Qatar Biomedical Research Institute (QBRI), Hamad bin Khalifa University (HBKU), Qatar Foundation (QF), Doha, Qatar
| | - Steven C Hunt
- Weill Cornell Medicine-Qatar, Qatar Foundation - Education City, Doha, Qatar
- University of Utah School of Medicine, Salt Lake City, Utah, USA
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