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Kuper T, Famure O, Greenfield J, Li Y, Ibrahim S, Narang T, Ashwin M, Joseph Kim S. Time-Varying Proteinuria and the Risk of Cardiovascular Disease and Graft Failure in Kidney Transplant Recipients. Prog Transplant 2021; 31:288-297. [PMID: 34839728 DOI: 10.1177/15269248211046011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction: Proteinuria is recognized as an independent risk factor for cardiovascular disease in kidney transplant recipients, but previous studies have not considered the impact of changes in urine protein over time. Research Question and Design: We used time-dependent, multivariable Cox proportional hazards models in this observational cohort study of adult kidney transplant recipients to evaluate whether proteinuria measured by dipstick on random spot urine samples starting from 1-month post-transplant was associated with the risk of major adverse cardiac events and graft loss. Results: A total of 144 major adverse cardiac events, defined as acute myocardial infarction, cerebrovascular accident, revascularization, or all-cause mortality, were observed in 1106 patients over 5728.7 person-years. Any level of proteinuria greater or equal to trace resulted in a two-fold increase in the risk of major adverse cardiac events (hazard ratio 2.00 [95% confidence interval 1.41, 2.84]). This relationship was not found to be dose-dependent (hazard ratios of 2.98, 1.76, 1.63, and 1.54 for trace, 1+, 2+, and 3+ urine protein, respectively). There was an increased risk of graft failure with greater urine protein concentration (hazard ratios 2.22, 2.85, 6.41, and 19.71 for trace, 1+, 2+, and 3+, respectively). Conclusion: Urine protein is associated with major adverse cardiac events and graft loss in kidney transplant recipients. The role of interventions to reduce proteinuria on decreasing the risk of adverse cardiovascular and graft outcomes in kidney transplant recipients requires further study.
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Affiliation(s)
- Tanya Kuper
- Toronto General Hospital, 7989University Health Network, Toronto, Ontario, Canada
| | - Olusegun Famure
- Toronto General Hospital, 7989University Health Network, Toronto, Ontario, Canada
| | - Jamie Greenfield
- Toronto General Hospital, 7989University Health Network, Toronto, Ontario, Canada
| | - Yanhong Li
- Toronto General Hospital, 7989University Health Network, Toronto, Ontario, Canada
| | - Syed Ibrahim
- Toronto General Hospital, 7989University Health Network, Toronto, Ontario, Canada
| | - Tanya Narang
- Toronto General Hospital, 7989University Health Network, Toronto, Ontario, Canada
| | - Monika Ashwin
- Toronto General Hospital, 7989University Health Network, Toronto, Ontario, Canada
| | - S Joseph Kim
- Toronto General Hospital, 7989University Health Network, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada.,St Michael's Hospital, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
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He Y, Zhang J, Shen G, Liu L, Zhao Q, Lu X, Yang H, Hong D. Aromatase inhibitors and risk of cardiovascular events in breast cancer patients: a systematic review and meta-analysis. BMC Pharmacol Toxicol 2019; 20:62. [PMID: 31665091 PMCID: PMC6820915 DOI: 10.1186/s40360-019-0339-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 09/20/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Cardiovascular events (CVEs) was considered as one of the primary cause to reduce the quality of life in breast cancer patients with aromatase inhibitors (AIs) treatment, which has not been sufficiently addressed. The aim of this study was to assess the correlation between risk of CVEs and AIs in patients with breast cancer. METHODS Included studies were obtained from the databases of Embase, Pubmed, Cochrane Library, Clinical Trials.gov, and reference lists. The main outcome measures were overall incidence, odds ratios (ORs), and 95% confidence intervals (CIs). Furthermore, the association and the risk differences among different tumor types, AIs,ages,or treatment regimens were conducted. Fixed-effect or random-effect models were applied in the statistical analyses according to the heterogeneity. Our analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. RESULTS Seventeen studies, which included 44,411 subjects, were included in our analyses. The overall incidence of CVEs in AIs group was 13.02% (95% CI: 8.15-20.17%) and almost all of the high-grade CVEs occurred in patients treated with AIs. The pooled ORs of CVEs was 0.9940 (95% CI: 0.8545-1.1562). Under sub-group analysis, the incidence of CVEs related to exemestane was higher than that of controls (OR = 1.1564, 95% CI: 1.0656-1.2549), but no statistical differences in risk of CVEs were found in other sub-group analysis. No evidence of publication bias was found for incidence of CVEs in our meta-analysis by a funnel plot. CONCLUSIONS These results suggest that patients with breast cancer treated with AIs do not have a significant risk of developing CVEs in comparison with the controls, and exemestane might not be considered as the alternative AI to the breast cancer patients from the perspective of CVEs. Further studies are recommended to investigate this association and the risk differences among different tumor types, AIs or treatment regimens.
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Affiliation(s)
- Yang He
- Department of Pharmacy, the First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, 310003, People's Republic of China.,College of Medicine, Zhejiang University, 866 Yuhangtang Road, Hangzhou, 310003, People's Republic of China
| | - Jianhua Zhang
- Department of Management, the Logistics Service Center of Municipal Government, Hangzhou, 310019, People's Republic of China
| | - Guofang Shen
- Loma Linda University School of Pharmacy, Loma Linda, CA, 92354, USA
| | - Lin Liu
- Department of Pharmacy, the First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, 310003, People's Republic of China
| | - Qingwei Zhao
- Department of Pharmacy, the First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, 310003, People's Republic of China
| | - Xiaoyang Lu
- Department of Pharmacy, the First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, 310003, People's Republic of China
| | - Hongyu Yang
- Department of Pharmacy, the First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, 310003, People's Republic of China.
| | - Dongsheng Hong
- Department of Pharmacy, the First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, 310003, People's Republic of China.
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Tapak L, Hamidi O, Amini P, Poorolajal J. Prediction of Kidney Graft Rejection Using Artificial Neural Network. Healthc Inform Res 2017; 23:277-284. [PMID: 29181237 PMCID: PMC5688027 DOI: 10.4258/hir.2017.23.4.277] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Revised: 08/17/2017] [Accepted: 09/10/2017] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Kidney transplantation is the best renal replacement therapy for patients with end-stage renal disease. Several studies have attempted to identify predisposing factors of graft rejection; however, the results have been inconsistent. We aimed to identify prognostic factors associated with kidney transplant rejection using the artificial neural network (ANN) approach and to compare the results with those obtained by logistic regression (LR). METHODS The study used information regarding 378 patients who had undergone kidney transplantation from a retrospective study conducted in Hamadan, Western Iran, from 1994 to 2011. ANN was used to identify potential important risk factors for chronic nonreversible graft rejection. RESULTS Recipients' age, creatinine level, cold ischemic time, and hemoglobin level at discharge were identified as the most important prognostic factors by ANN. The ANN model showed higher total accuracy (0.75 vs. 0.55 for LR), and the area under the ROC curve (0.88 vs. 0.75 for LR) was better than that obtained with LR. CONCLUSIONS The results of this study indicate that the ANN model outperformed LR in the prediction of kidney transplantation failure. Therefore, this approach is a promising classifier for predicting graft failure to improve patients' survival and quality of life, and it should be further investigated for the prediction of other clinical outcomes.
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Affiliation(s)
- Leili Tapak
- Modeling of Noncommunicable Diseases Research Center, Department of Biostatistics, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Omid Hamidi
- Department of Science, Hamedan University of Technology, Hamedan, Iran
| | - Payam Amini
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Jalal Poorolajal
- Research Center for Health Sciences & Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
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