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Funes DR, Blanco DG, Lo Menzo E, Szomstein S, Rosenthal RJ. Changes in renal blood flow after surgically induced weight loss: can bariatric surgery halt the progression of chronic kidney disease? Surg Obes Relat Dis 2024; 20:439-444. [PMID: 38158311 DOI: 10.1016/j.soard.2023.11.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 10/19/2023] [Accepted: 11/05/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND We previously demonstrated how kidney injury in patients with morbid obesity can be reversed by bariatric surgery (BaS). OBJECTIVE(S) Based on previous experience, we hypothesize patients' potentially reversible kidney injury might be secondary to reduction in renal blood flow (RBF), which improves following BaS. SETTING Academic Hospital. METHODS We conducted a retrospective analysis of patients who underwent BaS at our institution from 2002 to 2019. We identified patients with chronic kidney disease (CKD) using the estimated glomerular filtration rate (eGFR) from the CKD Epidemiology Collaboration Study (CKD-EPI) classification system. We used the BUN/Creatinine (Cr) ratio pre- and postoperatively to determine a prerenal (decreased RBF) versus intrinsic component as the responsible cause of CKD in this patient population. Decreased RBF was defined as BUN/Cr > 20 preoperatively. RESULTS Our analysis included n = 2924 patients, of which 11% (n = 325) presented decreased RBF. From our original sample, only n = 228 patients had the complete data necessary to assess both eGFR and RBF (BUN/Cr). Patients with baseline CKD stage 2 demonstrated preoperative BUN/Cr 20.85 ± 10.23 decreasing to 14.99 ± 9.10 at 12-month follow-up (P < .01). Patients with baseline CKD stage 3 presented with preoperative BUN/Cr 23.88 ± 8.75; after 12-month follow-up, BUN/Cr ratio decreased to 16.38 ± 9.27 (P < .01). Patients with CKD stage 4 and ESRD (eGFR < 30) did not demonstrate a difference for pre- and postoperative BUN/Cr 21.71 ± 9.28 and 19.21 ± 14.58, respectively. CONCLUSION(S) According to our findings, patients with CKD stages 1-3 present improvement of their kidney function after BaS. This amelioration could be secondary to improvement of the RBF, an unstudied reversible mechanism of kidney injury in the bariatric population.
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Affiliation(s)
- David Romero Funes
- Department of General Surgery and the Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida
| | - David Gutierrez Blanco
- Department of General Surgery and the Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida
| | - Emanuele Lo Menzo
- Department of General Surgery and the Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida
| | - Samuel Szomstein
- Department of General Surgery and the Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida
| | - Raul J Rosenthal
- Department of General Surgery and the Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida.
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Nan Y, Yang J, Yang J, Wei L, Bai Y. Associations Between Individual and Combined Metal Exposures in Whole Blood and Kidney Function in U.S. Adults Aged 40 Years and Older. Biol Trace Elem Res 2024; 202:850-865. [PMID: 37291467 DOI: 10.1007/s12011-023-03722-z] [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: 02/12/2023] [Accepted: 05/29/2023] [Indexed: 06/10/2023]
Abstract
The effects of metal exposure on kidney function have been reported in previous literature. There is limited and inconsistent information on the associations between individual and combined exposures to metals and kidney function among the middle-aged and older population. The aim of this study was to clarify the associations of exposure to individual metals with kidney function while accounting for potential coexposure to metal mixtures and to evaluate the joint and interactive associations of blood metals with kidney function. A total of 1669 adults aged 40 years and older were enrolled in the present cross-sectional study using the 2015-2016 National Health and Nutrition Examination Survey (NHANES). Single-metal and multimetal multivariable logistic regression models, quantile G-computation, and Bayesian kernel machine regression models (BKMR) were fitted to explore the individual and joint associations of whole blood metals [lead (Pb), cadmium (Cd), mercury (Hg), cobalt (Co), manganese (Mn), and selenium (Se)] with the odds of decreased estimated glomerular filtration rate (eGFR) and albuminuria. A decreased eGFR was defined as an eGFR ≤ 60 mL/min per 1.73 m2, and albuminuria was categorized as a urinary albumin-creatinine ratio (UACR) of ≥ 30.0 mg/g. The results from quantile G-computation and BKMR indicated positive associations between exposure to the metal mixture and the prevalence of decreased eGFR and albuminuria (all P values < 0.05). These positive associations were mainly driven by blood Co, Cd, and Pb. Furthermore, blood Mn was identified as an influential element contributing to an inverse correlation with kidney dysfunction within metal mixtures. Increasing blood Se levels were negatively associated with the prevalence of decreased eGFR and positively associated with albuminuria. In addition, a potential pairwise interaction between Mn-Co on decreased eGFR was identified by BKMR analysis. Findings from our study suggested a positive association between exposure to the whole blood metal mixture and decreased kidney function, with blood Co, Pb, and Cd being the main contributors to this association, while Mn demonstrated an inverse relationship with renal dysfunction. However, as our study was cross-sectional in nature, further prospective studies are warranted to better understand the individual and combined effects of metals on kidney function.
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Affiliation(s)
- Yaxing Nan
- Gansu University of Chinese Medicine, Lanzhou, 730000, China
- College of Earth and Environmental Sciences, Lanzhou University, Dong Gang Xi Road 199, Lanzhou, Gansu, 730000, China
| | - Jingli Yang
- College of Earth and Environmental Sciences, Lanzhou University, Dong Gang Xi Road 199, Lanzhou, Gansu, 730000, China
| | - Jinyu Yang
- Gansu University of Chinese Medicine, Lanzhou, 730000, China
| | - Lili Wei
- Gansu University of Chinese Medicine, Lanzhou, 730000, China
| | - Yana Bai
- College of Earth and Environmental Sciences, Lanzhou University, Dong Gang Xi Road 199, Lanzhou, Gansu, 730000, China.
- Department of Epidemiology and Statistics, School of Public Health, Lanzhou University, 730000, Lanzhou, China.
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Li K, Zhao J, Yang W, Ye Z. Sleep traits and risk of end-stage renal disease: a mendelian randomization study. BMC Med Genomics 2023; 16:76. [PMID: 37029366 PMCID: PMC10080763 DOI: 10.1186/s12920-023-01497-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 03/23/2023] [Indexed: 04/09/2023] Open
Abstract
BACKGROUND Epidemiological evidence relating sleep disorders to end-stage renal disease (ESRD) has been obscure. The present study is sought to examine the association between sleep traits and ESRD. METHODS For this analysis, we selected genetic instruments for sleep traits from published genome-wide association studies (GWAS). As instrumental variables, independent genetic variations linked with seven sleep-related features (sleep duration, getting up in the morning, daytime napping, chronotype of morning/evening person, sleeplessness/insomnia, non-snoring, and daytime dozing) were chosen. A two-sample Mendelian randomization (TSMR) study was conducted to assess the causal relationship between sleep traits and ESRD (N = 33,061). The reverse MR analysis subsequently determined the causal relationship between ESRD and sleep traits. The causal effects were estimated using inverse variance weighted, MR-Egger, weighted median. To conduct sensitivity studies, Cochran's Q test, MR-Egger intercept test, MR-PRESSO, leave-one-out analysis, and funnel plot were used. To study the potential mediators, multivariable mendelian randomization analyses were undertaken further. RESULTS Genetically predicted sleeplessness/ insomnia (OR = 6.11, 95%CI 1.00-37.3, P = 0.049, FDR = 0.105), getting up in the morning easily(OR = 0.23, 95%CI 0.063-0.85; P = 0.0278, FDR = 0.105), non-snoring (OR = 4.76E-02, 95%CI 2.29E-03-0.985, P = 0.0488, FDR = 0.105) was suggestively associated with the risk of ESRD. However, we found no evidence favoring a causal association between other sleep traits and ESRD through the IVW method. CONCLUSION The present TSMR found no strong evidence of a bidirectional causal association between genetically predicted sleep traits and ESRD.
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Affiliation(s)
- Kaixin Li
- Department of Nephrology, Shanghai Key Laboratory of Clinical Geriatric Medicine, Huadong Hospital Affiliated to Fudan University, Shanghai, 200040, China
| | - Jiaxi Zhao
- General Practice Ward/International Medical Center Ward, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Wenjing Yang
- Huadong Hospital Affiliated to Fudan University, Shanghai, 200040, China
| | - Zhibin Ye
- Department of Nephrology, Shanghai Key Laboratory of Clinical Geriatric Medicine, Huadong Hospital Affiliated to Fudan University, Shanghai, 200040, China.
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Ardiles LG. Obesity and renal disease: Benefits of bariatric surgery. Front Med (Lausanne) 2023; 10:1134644. [PMID: 36926320 PMCID: PMC10011092 DOI: 10.3389/fmed.2023.1134644] [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: 12/30/2022] [Accepted: 01/25/2023] [Indexed: 03/04/2023] Open
Abstract
The prevalence of obesity, a preventable and reversible condition with a high impact on health, continues to rise, especially after the COVID-19 pandemic. Severe overweight is well recognized as a risk factor for diabetes and hypertension, among other conditions, that may increase cardiovascular risk. Obesity has grown simultaneously with a rise in the prevalence of chronic kidney disease, and a pathophysiological link has been established, which explains its role in generating the conditions to facilitate the emergence and maximize the impact of the risk factors of chronic kidney disease and its progression to more advanced stages. Knowing the mechanisms involved and having different tools to reverse the overweight and its consequences, bariatric surgery has arisen as a useful and efficient method, complementary or alternative to others, such as lifestyle changes and/or pharmacotherapy. In a detailed review, the mechanisms involved in the renal consequences of obesity, the impact on risk factors, and the potential benefit of bariatric surgery at different stages of the disease and its progression are exposed and analyzed. Although the observational evidence supports the value of bariatric surgery as a renoprotective measure in individuals with obesity, diabetic or not, randomized studies are expected to establish evidence-based recommendations that demonstrate its positive risk-benefit balance as a complementary or alternative therapeutic tool.
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Affiliation(s)
- Leopoldo G Ardiles
- Department of Nephrology, Faculty of Medicine, Universidad Austral de Chile, Valdivia, Chile
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Nan Y, Yang J, Ma L, Jin L, Bai Y. Associations of nickel exposure and kidney function in U.S. adults, NHANES 2017-2018. J Trace Elem Med Biol 2022; 74:127065. [PMID: 36108461 DOI: 10.1016/j.jtemb.2022.127065] [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: 05/21/2022] [Revised: 07/26/2022] [Accepted: 09/05/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUNDS Nickel (Ni) is a ubiquitous heavy metal, but epidemiological studies on the association between Ni and kidney function are limited and controversial. AIM We aimed to explore the relationship between urinary Ni concentrations and kidney function in U.S. adults. METHODS This was a cross-sectional study based on the 2017-2018 National Health and Nutrition Examination Survey (NHANES) (n = 1588). Multiple linear regression models, logistic regression models, and restricted cubic spline models (RCS) were fitted to explore the associations between urinary Ni and estimated glomerular filtration rate (eGFR), urinary albumin-creatinine ratio (UACR), and the odds of impaired kidney function, which was defined as an eGFR ≤ 60 mL/min per 1.73 m2, or UACR ≥ 30.0 mg/g. Bayesian kernel machine regression (BKMR) was used to account for joint-metal effects. RESULTS Compared with the lowest quartile, urinary Ni at the third quartile was associated with increased eGFR (β = 2.42, 95 % CI: 0.23-4.19); the highest quartile of urinary Ni was correlated with increased UACR (β = 0.10, 95 % CI: 0.02-0.18), as well as higher odds of impaired kidney function (OR=1.65, 95 % CI:1.08-2.54). Urinary Ni had a nonlinear inverted U-shape relationship with eGFR (Pnonlinear = 0.007), and linear J-shape associations with UACR (Pnonlinear = 0.063) and impaired kidney function (Pnonlinear= 0.215). Metal interaction of urinary Ni with cadmium (Cd) on eGFR was observed. CONCLUSIONS Our findings provided evidence that Ni exposure linked with declined kidney function and might interact with Cd exposure. Considering the cross-sectional design of the NHANES study, further prospective studies are necessary.
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Affiliation(s)
- Yaxing Nan
- College of Earth and Environmental Sciences, Lanzhou University, Lanzhou 730000, China; Gansu University of Chinese Medicine, Lanzhou 730000, China
| | - Jingli Yang
- College of Earth and Environmental Sciences, Lanzhou University, Lanzhou 730000, China
| | - Li Ma
- Department of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou 730000, China
| | - Limei Jin
- College of Earth and Environmental Sciences, Lanzhou University, Lanzhou 730000, China; Gansu University of Chinese Medicine, Lanzhou 730000, China
| | - Yana Bai
- College of Earth and Environmental Sciences, Lanzhou University, Lanzhou 730000, China; Department of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou 730000, China.
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Nan Y, Bai Y. Sex-Based Differences in the Association between Serum Copper and Kidney Function: Evidence from NHANES 2011-2016. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14086. [PMID: 36360964 PMCID: PMC9655743 DOI: 10.3390/ijerph192114086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 10/22/2022] [Accepted: 10/27/2022] [Indexed: 06/16/2023]
Abstract
Epidemiological evidence on the relationship between copper (Cu) and kidney function is rare, and few studies examine the sex differences in this association. We aimed to explore the overall and sex-based relationship between exposure to Cu and biomarkers of kidney function among 4331 participants of the 2011-2016 National Health and Nutrition Examination Survey. Multiple linear regression models were fitted to examine the overall and sex-specific associations between serum Cu and the kidney function indicator-estimated glomerular filtration rate (eGFR) and urinary albumin-creatinine ratio (UACR). Restricted cubic spline models (RCS) stratified by sex were performed to explore the sex-based dose-response associations. Serum Cu in the highest quartile was associated with higher levels of UACR (β = 0.203, 95% CI: 0.100 to 0.306) among overall participants. In males, there was an association of the highest Cu quartile with decreased eGFR (β = -0.023, 95% CI: -0.042 to -0.003) and increased UACR (β = 0.349, 95% CI: 0.171 to 0.527); serum Cu levels also demonstrated a negative nonlinear dose-response association with eGFR and a positive linear dose-response association with UACR in males, whereas females showed a marginally significant nonlinear positive association of eGFR with serum Cu levels. In conclusion, there were sex-specific and dose-response relationships between serum Cu and kidney function indicators. Further prospective and mechanistic studies are warranted.
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Affiliation(s)
- Yaxing Nan
- College of Earth and Environmental Sciences, Lanzhou University, Lanzhou 730000, China
- School of Economics and Management, Gansu University of Chinese Medicine, Lanzhou 730000, China
| | - Yana Bai
- College of Earth and Environmental Sciences, Lanzhou University, Lanzhou 730000, China
- Department of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou 730000, China
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Theofilis P, Vordoni A, Kalaitzidis RG. Interplay between metabolic dysfunction-associated fatty liver disease and chronic kidney disease: Epidemiology, pathophysiologic mechanisms, and treatment considerations. World J Gastroenterol 2022; 28:5691-5706. [PMID: 36338895 PMCID: PMC9627426 DOI: 10.3748/wjg.v28.i39.5691] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 09/06/2022] [Accepted: 09/19/2022] [Indexed: 02/06/2023] Open
Abstract
The recently proposed nomenclature change from non-alcoholic fatty liver disease to metabolic dysfunction-associated fatty liver disease (MAFLD) has resulted in the reappraisal of epidemiological trends and associations with other chronic diseases. In this context, MAFLD appears to be tightly linked to incident chronic kidney disease (CKD). This association may be attributed to multiple shared risk factors including type 2 diabetes mellitus, arterial hypertension, obesity, dyslipidemia, and insulin resistance. Moreover, similarities in their molecular pathophysiologic mechanisms can be detected, since inflammation, oxidative stress, fibrosis, and gut dysbiosis are highly prevalent in these pathologic states. At the same time, lines of evidence suggest a genetic predisposition to MAFLD due to gene polymorphisms, such as the PNPLA3 rs738409 G allele polymorphism, which may also propagate renal dysfunction. Concerning their management, available treatment considerations for obesity (bariatric surgery) and novel antidiabetic agents (glucagon-like peptide 1 receptor agonists, sodium-glucose co-transporter 2 inhibitors) appear beneficial in preclinical and clinical studies of MAFLD and CKD modeling. Moreover, alternative approaches such as melatonin supplementation, farnesoid X receptor agonists, and gut microbiota modulation may represent attractive options in the future. With a look to the future, additional adequately sized studies are required, focusing on preventing renal complications in patients with MAFLD and the appropriate management of individuals with concomitant MAFLD and CKD.
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Affiliation(s)
- Panagiotis Theofilis
- Center for Nephrology “G. Papadakis,” General Hospital of Nikaia-Piraeus “Agios Panteleimon,” Nikaia 18454, Greece
| | - Aikaterini Vordoni
- Center for Nephrology “G. Papadakis,” General Hospital of Nikaia-Piraeus “Agios Panteleimon,” Nikaia 18454, Greece
| | - Rigas G Kalaitzidis
- Center for Nephrology “G. Papadakis,” General Hospital of Nikaia-Piraeus “Agios Panteleimon,” Nikaia 18454, Greece
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Cogollo VJ, Valera RJ, Botero-Fonnegra C, Sarmiento-Cobos M, Montorfano L, Bordes SJ, Rivera C, Hong L, Lo Menzo E, Szomstein S, Rosenthal RJ. BARIATRIC SURGERY DECREASES HOSPITALIZATION RATES OF PATIENTS WITH OBSTRUCTIVE LUNG DISEASES: A NATIONWIDE ANALYSIS. Surg Obes Relat Dis 2022; 18:1042-1048. [DOI: 10.1016/j.soard.2022.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 04/06/2022] [Accepted: 04/17/2022] [Indexed: 10/18/2022]
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Peride I, Tiglis M, Neagu TP, Niculae A, Checherita IA. Magnesium—A More Important Role in CKD–MBD than We Thought. Diagnostics (Basel) 2022; 12:diagnostics12040880. [PMID: 35453928 PMCID: PMC9031465 DOI: 10.3390/diagnostics12040880] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 03/13/2022] [Accepted: 03/30/2022] [Indexed: 12/17/2022] Open
Abstract
Chronic kidney disease (CKD) is associated with different complications, including chronic kidney disease–mineral and bone disorder (CKD–MBD), which represents a systemic disorder that involves the presence of different mineral or bone structure abnormalities (i.e., modification of bone turnover, strength, volume, etc.), including even vascular calcification development. Even if, over the years, different pathophysiological theories have been developed to explain the onset and progression of CKD–MBD, the influence and importance of serum magnesium level on the evolution of CKD have only recently been highlighted. So far, data are inconclusive and conflicting; therefore, further studies are necessary to validate these findings, which could be useful in developing a better, more adequate, and personalized management of CKD patients.
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Affiliation(s)
- Ileana Peride
- Clinical Department No. 3, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania;
- Correspondence: (I.P.); (A.N.)
| | - Mirela Tiglis
- Clinical Department No. 14, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania;
| | - Tiberiu Paul Neagu
- Clinical Department No. 11, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania;
| | - Andrei Niculae
- Clinical Department No. 3, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania;
- Correspondence: (I.P.); (A.N.)
| | - Ionel Alexandru Checherita
- Clinical Department No. 3, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania;
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