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Bibi S, Naeem M, Mahmoud Mousa MF, Bahls M, Dörr M, Friedrich N, Nauck M, Bülow R, Völzke H, Markus MR, Ittermann T. Body composition markers are associated with changes in inflammatory markers but not vice versa: A bi-directional longitudinal analysis in a population-based sample. Nutr Metab Cardiovasc Dis 2024; 34:1166-1174. [PMID: 38403482 DOI: 10.1016/j.numecd.2024.01.008] [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: 07/24/2023] [Revised: 12/06/2023] [Accepted: 01/08/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND AND AIM Growing body of evidence consistently link obesity and inflammation, Although the direction of the association is still unclear. We aimed to investigate longitudinal associations of body anthropometric, composition and fat distribution parameters with inflammatory markers and vice versa. METHOD AND RESULTS We used data from 2464 individuals of the SHIP-TREND cohort with a median follow-up of 7 years. Linear regression models adjusted for confounders were used to analyze associations of standardized body composition markers derived from classic anthropometry, bioelectrical impedance analysis (BIA) and magnetic resonance imaging (MRI) at baseline with changes in inflammatory markers (C-reactive protein (CRP), white blood cell (WBC), fibrinogen) and vice versa. Higher level of anthropometric markers at baseline were associated with an increase in the change of inflammatory markers. A 13.5 cm higher waist circumference (WC), 16.0 kg body weight and 7.76 % relative fat mass (FM) at baseline was associated with a change in CRP of 0.52 mg/L (95 % confidence interval [CI]: 0.29 to 0.74), 0.51 mg/L (95 % CI: 0.29; 0.74) and 0.58 mg/L (95 % CI: 0.34; 0.82) respectively. Absolute FM showed the strongest association with changes in serum fibrinogen levels (β for 8.69 kg higher FM: 0.07 g/L; 95 % CI: 0.05; 0.09). Baseline inflammatory markers were only associated with changes in hip circumference. CONCLUSION Our study indicates the importance of anthropometric, body composition and fat distribution markers as a risk factor for the development of inflammation. To prevent inflammatory-related complications, important is to take measures against the development of obesity.
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Affiliation(s)
- Saima Bibi
- Institute for Community Medicine, Department Clinical-Epidemiological Research, University Medicine Greifswald, Greifswald, Germany.
| | - Muhammad Naeem
- Institute for Community Medicine, Department Clinical-Epidemiological Research, University Medicine Greifswald, Greifswald, Germany; Department of Zoology, University of Malakand, Chakdara Dir (L), Pakistan
| | - Mohammed Farah Mahmoud Mousa
- Institute for Community Medicine, Department Clinical-Epidemiological Research, University Medicine Greifswald, Greifswald, Germany
| | - Martin Bahls
- Department of Internal Medicine B - Cardiology, Intensive Care, Pulmonary Medicine and Infectious Diseases, University Medicine Greifswald, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Greifswald, Germany
| | - Marcus Dörr
- Department of Internal Medicine B - Cardiology, Intensive Care, Pulmonary Medicine and Infectious Diseases, University Medicine Greifswald, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Greifswald, Germany
| | - Nele Friedrich
- DZHK (German Center for Cardiovascular Research), Partner Site Greifswald, Germany; Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Germany
| | - Matthias Nauck
- DZHK (German Center for Cardiovascular Research), Partner Site Greifswald, Germany; Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Germany
| | - Robin Bülow
- Institute for Radiology and Neuradiology, University Medicine Greifswald, Germany
| | - Henry Völzke
- Institute for Community Medicine, Department Clinical-Epidemiological Research, University Medicine Greifswald, Greifswald, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Greifswald, Germany
| | - Marcello Rp Markus
- Department of Internal Medicine B - Cardiology, Intensive Care, Pulmonary Medicine and Infectious Diseases, University Medicine Greifswald, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Greifswald, Germany
| | - Till Ittermann
- Institute for Community Medicine, Department Clinical-Epidemiological Research, University Medicine Greifswald, Greifswald, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Greifswald, Germany
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Bibi S, Naeem M, Bahls M, Dörr M, Friedrich N, Nauck M, Bülow R, Völzke H, Paulista Markus MR, Ittermann T. Body composition markers from classic anthropometry, bioelectrical impedance analysis, and magnetic resonance imaging are associated with inflammatory markers in the general population. Nutr Metab Cardiovasc Dis 2023; 33:1899-1906. [PMID: 37500343 DOI: 10.1016/j.numecd.2023.05.026] [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: 01/31/2023] [Revised: 04/28/2023] [Accepted: 05/24/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND AND AIM The associations of body composition markers derived from different modalities with inflammatory markers are unclear. The aim of this study was to determine associations of the body composition markers from different modalities with inflammatory markers in a population-based study. METHODS AND RESULTS We analyzed data from 4048 participants (2081 women, 51.4%) aged 20-84 years. Linear regression models adjusted for confounding were used to analyze the association of classic anthropometry markers, absolute and relative fat mass, absolute fat-free mass (FFM), and body cell mass (BCM) assessed by bioelectrical impedance analysis, subcutaneous, visceral, and liver fat from magnetic resonance imaging (MRI), with markers of inflammation. We found positive associations of classic anthropometry markers, total body fat, subcutaneous, visceral, and liver fat, with all inflammatory markers. Waist circumference (WC) showed the strongest association with high-sensitivity C-reactive protein (hsCRP) (β: 1.39; 95% confidence interval [CI]: 1.22 to 1.56) and white blood cell (WBC) (0.39; 0.29 to 0.48), whereas visceral fat showed the strongest association with ferritin (41.9; 34.7 to 49.0). Relative body fat was strongly associated with hsCRP (1.39; 1.20 to 1.58), fibrinogen (0.29; 0.27 to 0.32), and WBC (0.35; 0.25 to 0.46). Conversely, we found inverse associations of body height, FFM, and BCM with hsCRP, fibrinogen, and WBC. CONCLUSIONS Our study indicates the importance of WC as an easily measured marker for early inflammation. MRI-assessed markers of central obesity seem to be most strongly related to ferritin.
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Affiliation(s)
- Saima Bibi
- Institute for Community Medicine - Department Clinical-Epidemiological Research, University Medicine Greifswald, Greifswald, Germany.
| | - Muhammad Naeem
- Institute for Community Medicine - Department Clinical-Epidemiological Research, University Medicine Greifswald, Greifswald, Germany; Department of Zoology, University of Malakand, 18800, Pakistan
| | - Martin Bahls
- Department of Internal Medicine B - Cardiology, Intensive Care, Pulmonary Medicine and Infectious Diseases, University Medicine Greifswald, Germany; DZHK (German Center for Cardiovascular Research), partner site Greifswald, Germany
| | - Marcus Dörr
- Department of Internal Medicine B - Cardiology, Intensive Care, Pulmonary Medicine and Infectious Diseases, University Medicine Greifswald, Germany; DZHK (German Center for Cardiovascular Research), partner site Greifswald, Germany
| | - Nele Friedrich
- DZHK (German Center for Cardiovascular Research), partner site Greifswald, Germany; Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Germany
| | - Matthias Nauck
- DZHK (German Center for Cardiovascular Research), partner site Greifswald, Germany; Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Germany
| | - Robin Bülow
- Institute for Radiology and Neuroradiology, University Medicine Greifswald, Germany
| | - Henry Völzke
- Institute for Community Medicine - Department Clinical-Epidemiological Research, University Medicine Greifswald, Greifswald, Germany; DZHK (German Center for Cardiovascular Research), partner site Greifswald, Germany
| | - Marcello Ricardo Paulista Markus
- Department of Internal Medicine B - Cardiology, Intensive Care, Pulmonary Medicine and Infectious Diseases, University Medicine Greifswald, Germany; DZHK (German Center for Cardiovascular Research), partner site Greifswald, Germany
| | - Till Ittermann
- Institute for Community Medicine - Department Clinical-Epidemiological Research, University Medicine Greifswald, Greifswald, Germany; DZHK (German Center for Cardiovascular Research), partner site Greifswald, Germany
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Sherman SB, Sarsour N, Salehi M, Schroering A, Mell B, Joe B, Hill JW. Prenatal androgen exposure causes hypertension and gut microbiota dysbiosis. Gut Microbes 2018; 9:400-421. [PMID: 29469650 PMCID: PMC6219642 DOI: 10.1080/19490976.2018.1441664] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 11/24/2017] [Accepted: 02/08/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Conditions of excess androgen in women, such as polycystic ovary syndrome (PCOS), often exhibit intergenerational transmission. One way in which the risk for PCOS may be increased in daughters of affected women is through exposure to elevated androgens in utero. Hyperandrogenemic conditions have serious health consequences, including increased risk for hypertension and cardiovascular disease. Recently, gut dysbiosis has been found to induce hypertension in rats, such that blood pressure can be normalized through fecal microbial transplant. Therefore, we hypothesized that the hypertension seen in PCOS has early origins in gut dysbiosis caused by in utero exposure to excess androgen. We investigated this hypothesis with a model of prenatal androgen (PNA) exposure and maternal hyperandrogenemia by single-injection of testosterone cypionate or sesame oil vehicle (VEH) to pregnant dams in late gestation. We then completed a gut microbiota and cardiometabolic profile of the adult female offspring. RESULTS The metabolic assessment revealed that adult PNA rats had increased body weight and increased mRNA expression of adipokines: adipocyte binding protein 2, adiponectin, and leptin in inguinal white adipose tissue. Radiotelemetry analysis revealed hypertension with decreased heart rate in PNA animals. The fecal microbiota profile of PNA animals contained higher relative abundance of bacteria associated with steroid hormone synthesis, Nocardiaceae and Clostridiaceae, and lower abundance of Akkermansia, Bacteroides, Lactobacillus, Clostridium. The PNA animals also had an increased relative abundance of bacteria associated with biosynthesis and elongation of unsaturated short chain fatty acids (SCFAs). CONCLUSIONS We found that prenatal exposure to excess androgen negatively impacted cardiovascular function by increasing systolic and diastolic blood pressure and decreasing heart rate. Prenatal androgen was also associated with gut microbial dysbiosis and altered abundance of bacteria involved in metabolite production of short chain fatty acids. These results suggest that early-life exposure to hyperandrogenemia in daughters of women with PCOS may lead to long-term alterations in gut microbiota and cardiometabolic function.
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Affiliation(s)
- Shermel B. Sherman
- Department of Physiology and Pharmacology, The University of Toledo College of Medicine and Life Sciences, Toledo, OH
| | - Nadeen Sarsour
- Department of Biological Sciences, University of Toledo, Toledo, OH
| | - Marziyeh Salehi
- Department of Physiology and Pharmacology, The University of Toledo College of Medicine and Life Sciences, Toledo, OH
| | - Allen Schroering
- Department of Neurosciences and Neurological Disorders, The University of Toledo College of Medicine and Life Sciences, Toledo, OH
| | - Blair Mell
- Department of Physiology and Pharmacology, The University of Toledo College of Medicine and Life Sciences, Toledo, OH
- Center for Hypertension and Personalized Medicine, The University of Toledo College of Medicine and Life Sciences, Toledo, OH
| | - Bina Joe
- Department of Physiology and Pharmacology, The University of Toledo College of Medicine and Life Sciences, Toledo, OH
- Center for Hypertension and Personalized Medicine, The University of Toledo College of Medicine and Life Sciences, Toledo, OH
| | - Jennifer W. Hill
- Department of Physiology and Pharmacology, The University of Toledo College of Medicine and Life Sciences, Toledo, OH
- Center for Diabetes and Endocrine Research, The University of Toledo College of Medicine and Life Sciences, Toledo, OH
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Pastormerlo LE, Maffei S, Latta DD, Chubuchny V, Susini C, Berti S, Prontera C, Storti S, Passino C, Pasanisi E, Emdin M, Chiappino D. N-terminal fragment of B-type natriuretic peptide predicts coexisting subclinical heart and vessel disease. J Cardiovasc Med (Hagerstown) 2017; 18:750-757. [DOI: 10.2459/jcm.0000000000000514] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Kim H, Yoo TH, Choi KH, Oh KH, Lee J, Kim SW, Kim TH, Sung S, Han SH. Baseline Cardiovascular Characteristics of Adult Patients with Chronic Kidney Disease from the KoreaN Cohort Study for Outcomes in Patients With Chronic Kidney Disease (KNOW-CKD). J Korean Med Sci 2017; 32:231-239. [PMID: 28049233 PMCID: PMC5219988 DOI: 10.3346/jkms.2017.32.2.231] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 11/11/2016] [Indexed: 01/17/2023] Open
Abstract
Cardiovascular disease (CVD) is the most common cause of death in patients with chronic kidney disease (CKD). We report the baseline cardiovascular characteristics of 2,238 participants by using the data of the KoreaN Cohort Study for Outcomes in Patients With Chronic Kidney Disease (KNOW-CKD) study. The cohort comprises 5 subcohorts according to the cause of CKD: glomerulonephritis (GN), diabetic nephropathy (DN), hypertensive nephropathy (HTN), polycystic kidney disease (PKD), and unclassified. The average estimated glomerular filtration rate (eGFR) was 50.5 ± 30.3 mL/min⁻¹/1.73 m⁻² and lowest in the DN subcohort. The overall prevalence of previous CVD was 14.4% in all patients, and was highest in the DN followed by that in the HTN subcohort. The DN subcohort had more adverse cardiovascular risk profiles (higher systolic blood pressure [SBP], and higher levels of cardiac troponin T, left ventricular mass index [LVMI], coronary calcium score, and brachial-ankle pulse wave velocity [baPWV]) than the other subcohorts. The HTN subcohort exhibited less severe cardiovascular risk profiles than the DN subcohort, but had more severe cardiovascular risk features than the GN and PKD subcohorts. All these cardiovascular risk profiles were inversely correlated with eGFR. In conclusion, this study shows that the KNOW-CKD cohort exhibits high cardiovascular burden, as other CKD cohorts in previous studies. Among the subcohorts, the DN subcohort had the highest risk for CVD. The ongoing long-term follow-up study up to 10 years will further delineate cardiovascular characteristics and outcomes of each subcohort exposed to different risk profiles.
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Affiliation(s)
- Hyoungnae Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Tae Hyun Yoo
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Kyu Hun Choi
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Kook Hwan Oh
- Department of Internal Medicine, Seoul National University, Seoul, Korea
| | - Joongyub Lee
- Medical Research Collaborating Center, Seoul National University Hospital and Seoul National University College of Medicine, Seoul, Korea
| | - Soo Wan Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Tae Hee Kim
- Department of Internal Medicine, Inje University, Pusan Paik Hospital, Busan, Korea
| | - Suah Sung
- Department of Internal Medicine, Eulji Medical Center, Eulji University, Seoul, Korea
| | - Seung Hyeok Han
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
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Brück K, Jager KJ, Dounousi E, Kainz A, Nitsch D, Ärnlöv J, Rothenbacher D, Browne G, Capuano V, Ferraro PM, Ferrieres J, Gambaro G, Guessous I, Hallan S, Kastarinen M, Navis G, Gonzalez AO, Palmieri L, Romundstad S, Spoto B, Stengel B, Tomson C, Tripepi G, Völzke H, Wiȩcek A, Gansevoort R, Schöttker B, Wanner C, Vinhas J, Zoccali C, Van Biesen W, Stel VS. Methodology used in studies reporting chronic kidney disease prevalence: a systematic literature review. Nephrol Dial Transplant 2016. [PMID: 26209739 PMCID: PMC4514069 DOI: 10.1093/ndt/gfv131] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background Many publications report the prevalence of chronic kidney disease (CKD) in the general population. Comparisons across studies are hampered as CKD prevalence estimations are influenced by study population characteristics and laboratory methods. Methods For this systematic review, two researchers independently searched PubMed, MEDLINE and EMBASE to identify all original research articles that were published between 1 January 2003 and 1 November 2014 reporting the prevalence of CKD in the European adult general population. Data on study methodology and reporting of CKD prevalence results were independently extracted by two researchers. Results We identified 82 eligible publications and included 48 publications of individual studies for the data extraction. There was considerable variation in population sample selection. The majority of studies did not report the sampling frame used, and the response ranged from 10 to 87%. With regard to the assessment of kidney function, 67% used a Jaffe assay, whereas 13% used the enzymatic assay for creatinine determination. Isotope dilution mass spectrometry calibration was used in 29%. The CKD-EPI (52%) and MDRD (75%) equations were most often used to estimate glomerular filtration rate (GFR). CKD was defined as estimated GFR (eGFR) <60 mL/min/1.73 m2 in 92% of studies. Urinary markers of CKD were assessed in 60% of the studies. CKD prevalence was reported by sex and age strata in 54 and 50% of the studies, respectively. In publications with a primary objective of reporting CKD prevalence, 39% reported a 95% confidence interval. Conclusions The findings from this systematic review showed considerable variation in methods for sampling the general population and assessment of kidney function across studies reporting CKD prevalence. These results are utilized to provide recommendations to help optimize both the design and the reporting of future CKD prevalence studies, which will enhance comparability of study results.
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Affiliation(s)
- Katharina Brück
- ERA-EDTA Registry, Amsterdam Medical Center, Amsterdam, The Netherlands
| | - Kitty J Jager
- ERA-EDTA Registry, Amsterdam Medical Center, Amsterdam, The Netherlands
| | - Evangelia Dounousi
- Department of Nephrology, Medical School, University of Ioannina, Ioannina, Greece
| | - Alexander Kainz
- Department of Internal Medicine III/Nephrology, Medical University, Vienna, Austria
| | - Dorothea Nitsch
- Epidemiology and Population Health, LSHTM and UCL Centre for Nephrology, London, UK
| | - Johan Ärnlöv
- Department of Medical Sciences/Molecular Epidemiology, Uppsala University, Uppsala, Sweden
| | | | - Gemma Browne
- Department of Epidemiology & Public Health, University College Cork, Ireland
| | - Vincenzo Capuano
- Unità Opaerativa di Cardiologia ed UTIC, Mercato S. Severino Hospital, Mercato S. Severino, Italy
| | - Pietro Manuel Ferraro
- Nephrology and Dialysis, Columbus-Gemelli University Hospital, Catholic University of the Sacred Heart, Rome, Italy
| | - Jean Ferrieres
- Department of Cardiology, Toulouse University School of Medicine, Rangueil Hospital, Toulouse, France
| | - Giovanni Gambaro
- Nephrology and Dialysis, Columbus-Gemelli University Hospital, Catholic University of the Sacred Heart, Rome, Italy
| | - Idris Guessous
- Unit of Population Epidemiology, Division of primary care medicine, Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospital, Geneva, Switzerland
| | - Stein Hallan
- Department of Nephrology, St Olav Hospital, Norway/Faculty of Medicine, The Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Mika Kastarinen
- Finnish Medicines Agency, Kuopio/National Institute for Health and Welfare, Helsinki, Finland
| | - Gerjan Navis
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, Groningen, The Netherlands
| | | | | | - Solfrid Romundstad
- Department of Nephrology, Levanger Hospital, Health Trust Nord-Trøndelag/The Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Belinda Spoto
- Department of Nephrology, Dialysis and Transplantation Unit, CNR-IFC, Clinical Epidemiology and Pathophysiology of Renal Diseases and Hypertension, Reggio Calabria, Italy
| | - Benedicte Stengel
- Research Centre in Epidemiology and Population Health, Inserm Unit 1018, Villejuif, France
| | - Charles Tomson
- Department of Nephrology, Freeman Hospital, Newcastle upon Tyne, UK
| | - Giovanni Tripepi
- Department of Nephrology, Dialysis and Transplantation Unit, CNR-IFC, Clinical Epidemiology and Pathophysiology of Renal Diseases and Hypertension, Reggio Calabria, Italy
| | - Henry Völzke
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Andrzej Wiȩcek
- Departement of Nephrology, Transplantology and Internal Diseases, Faculty of Medicine in Katowice, Medical University of Silesia in Katowice, Poland
| | - Ron Gansevoort
- Department of Nephrology/Graduate School of Medical Sciences, University Medical Center Groningen, Groningen, The Netherlands
| | - Ben Schöttker
- Division of Clinical Epidemiology and Ageing Research, German Cancer Research, Heidelberg, Germany
| | - Christoph Wanner
- Department of Nephrology, University Hospital Würzburg, Würzburg, Germany
| | - Jose Vinhas
- Department of Nephrology, Setubal Hospital Centre, Setubal, Portugal
| | - Carmine Zoccali
- Department of Nephrology, Dialysis and Transplantation Unit, CNR-IFC, Clinical Epidemiology and Pathophysiology of Renal Diseases and Hypertension, Reggio Calabria, Italy
| | - Wim Van Biesen
- Department of Nephrology, Ghent University Hospital, Ghent, Belgium
| | - Vianda S Stel
- ERA-EDTA Registry, Amsterdam Medical Center, Amsterdam, The Netherlands
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Matsushita K, Ballew SH, Coresh J. Influence of chronic kidney disease on cardiac structure and function. Curr Hypertens Rep 2015; 17:581. [PMID: 26194332 DOI: 10.1007/s11906-015-0581-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Chronic kidney disease (CKD), the presence of kidney dysfunction and/or damage, is a worldwide public health issue. Although CKD is independently associated with various subtypes of cardiovascular diseases, a recent international collaborative meta-analysis demonstrates that CKD is particularly strongly associated with heart failure, suggesting its critical impact on cardiac structure and function. Although numerous studies have investigated the association of CKD and cardiac structure and function, these studies substantially vary regarding source populations and methodology (e.g., measures of CKD and/or parameters of cardiac structure and function), making it difficult to reach universal conclusions. Nevertheless, in this review, we comprehensively examine relevant studies, discuss potential mechanisms linking CKD to alteration of cardiac structure and function, and demonstrate clinical implications as well as potential future research directions. We exclusively focus on studies investigating both CKD measures, kidney function (i.e., glomerular filtration rate [GFR], creatinine clearance, or levels of filtration markers), and kidney damage represented by albuminuria, since current international clinical guidelines of CKD recommend staging CKD and assessing its clinical risk based on both GFR and albuminuria.
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Affiliation(s)
- Kunihiro Matsushita
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 2024 E. Monument Street, Suite 2-600, Baltimore, MD, USA,
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Titze S, Schmid M, Köttgen A, Busch M, Floege J, Wanner C, Kronenberg F, Eckardt KU. Disease burden and risk profile in referred patients with moderate chronic kidney disease: composition of the German Chronic Kidney Disease (GCKD) cohort. Nephrol Dial Transplant 2014; 30:441-51. [PMID: 25271006 DOI: 10.1093/ndt/gfu294] [Citation(s) in RCA: 114] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND A main challenge for targeting chronic kidney disease (CKD) is the heterogeneity of its causes, co-morbidities and outcomes. Patients under nephrological care represent an important reference population, but knowledge about their characteristics is limited. METHODS We enrolled 5217 carefully phenotyped patients with moderate CKD [estimated glomerular filtration rate (eGFR) 30-60 mL/min per 1.73 m(2) or overt proteinuria at higher eGFR] under routine care of nephrologists into the German Chronic Kidney Disease (GCKD) study, thereby establishing the currently worldwide largest CKD cohort. RESULTS The cohort has 60% men, a mean age (±SD) of 60 ± 12 years, a mean eGFR of 47 ± 17 mL/min per 1.73 m(2) and a median (IQR) urinary albumin/creatinine ratio of 51 (9-392) mg/g. Assessment of causes of CKD revealed a high degree of uncertainty, with the leading cause unknown in 20% and frequent suspicion of multifactorial pathogenesis. Thirty-five per cent of patients had diabetes, but only 15% were considered to have diabetic nephropathy. Cardiovascular disease prevalence was high (32%, excluding hypertension); prevalent risk factors included smoking (59% current or former smokers) and obesity (43% with BMI >30). Despite widespread use of anti-hypertensive medication, only 52% of the cohort had an office blood pressure <140/90 mmHg. Family histories for cardiovascular events (39%) and renal disease (28%) suggest familial aggregation. CONCLUSIONS Patients with moderate CKD under specialist care have a high disease burden. Improved diagnostic accuracy, rigorous management of risk factors and unravelling of the genetic predisposition may represent strategies for improving prognosis.
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Affiliation(s)
- Stephanie Titze
- Department of Nephrology and Hypertension, Friedrich-Alexander University Erlangen-Nürnberg, FAU, Erlangen, Germany
| | - Matthias Schmid
- Department of Medical Informatics, Biometry and Epidemiology, University of Erlangen-Nürnberg, Erlangen, Germany Department of Medical Biometry, Informatics, and Epidemiology, (IMBIE), University of Bonn, Bonn, Germany
| | - Anna Köttgen
- Division of Nephrology, University of Freiburg, Freiburg, Germany
| | - Martin Busch
- Department of Internal Medicine III, University Hospital Jena, Jena, Germany
| | - Jürgen Floege
- Department of Nephrology and Clinical Immunology, RWTH Aachen University, Aachen, Germany
| | - Christoph Wanner
- Division of Nephrology, Department of Medicine, University Hospital of Würzburg, Würzburg, Germany
| | - Florian Kronenberg
- Division of Genetic Epidemiology, Department of Medical Genetics, Molecular and Clinical Pharmacology, Innsbruck Medical University, Innsbruck, Austria
| | - Kai-Uwe Eckardt
- Department of Nephrology and Hypertension, Friedrich-Alexander University Erlangen-Nürnberg, FAU, Erlangen, Germany
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Li X, Zhu H, Li P, Xin Q, Liu J, Zhang W, Xing YH, Xue H. Serum cystatin C concentration as an independent marker for hypertensive left ventricular hypertrophy. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2013; 10:286-90. [PMID: 24133518 PMCID: PMC3796704 DOI: 10.3969/j.issn.1671-5411.2013.03.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Revised: 06/13/2013] [Accepted: 06/27/2013] [Indexed: 01/15/2023]
Abstract
Background Serum cystatin C levels can be used to predict morbidity and mortality in patients with cardiovascular disease. However, the clinical relevance of serum cystatin C levels in patients with hypertensive left ventricular hypertrophy (LVH) has rarely been investigated. We designed the present study to investigate whether serum cystatin C levels are associated with cardiac structural and functional alterations in hypertensive patients. Methods We enrolled 823 hypertensive patients and classified them into two groups: those with LVH (n = 287) and those without LVH (n = 536). All patients underwent echocardiography and serum cystatin C testing. We analyzed the relationship between serum cystatin C levels and LVH. Results Serum cystatin C levels were higher in hypertensive patients with LVH than in those without LVH (P < 0.05). Using linear correlation analysis, we found a positive correlation between serum cystatin C levels and interventricular septal thickness (r = 0.247, P < 0.01), posterior wall thickness (r = 0.216, P < 0.01), and left ventricular weight index (r = 0.347, P < 0.01). When analyzed by multiple linear regression, the positive correlations remained between serum cystatin C and interventricular septal thickness (β = 0.167, P < 0.05), posterior wall thickness (β = 0.187, P < 0.05), and left ventricular weight index (β = 0.245, P < 0.01). Conclusion Serum cystatin C concentration is an independent marker for hypertensive LVH.
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Affiliation(s)
- Xin Li
- Clinical Department of Medicine, Chinese PLA General Hospital, Beijing 100853, China
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