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Al-Momany AM, Almomani EY, Al-Omari L, Qablan AM, Almomani HY. The assessment of public perception towards chronic kidney disease in Jordan: a cross-sectional study. Ann Med 2024; 56:2386044. [PMID: 39101222 DOI: 10.1080/07853890.2024.2386044] [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: 01/15/2024] [Revised: 05/28/2024] [Accepted: 06/04/2024] [Indexed: 08/06/2024] Open
Abstract
OBJECTIVES Kidney diseases are considered silent killers due to the lack of well-defined symptoms. Public knowledge about chronic kidney disease (CKD) management has been shown to decrease the risk of CKD onset and progression to end-stage renal disease and renal failure. The main objective of this study was to assess the knowledge of kidney function, CKD symptoms, etiology, prevention and treatment in the general population. METHODS A cross-sectional study using a validated questionnaire was conducted in Jordan to assess public knowledge of CKD. Public knowledge of CKD was assessed using a questionnaire consisting of 32 knowledge questions, including risk factors, symptoms, treatment, protective measures and kidney function. The knowledge level was classified according to the total score: poor (0-50%), intermediate (51-70%) and good/high (71-100%). Multiple regression analysis was performed to compare knowledge scores (KS) and predict associations with the participants' baseline characteristics. RESULTS The level of knowledge about CKD among the 2181 participants was intermediate. The KS was significantly higher among participants with health issues such as hypertension, diabetes and heart problems, first-degree relatives working in the medical field, majors relevant to health, married, employed, highly educated, high-income and smokers. The main sources of knowledge about CKD were health professionals, TV shows, books and magazines. Multiple regression analysis showed an association between KS and age, sex, functional status, educational level and field, income, smoking status, having a family member/spouse work in the medical field, and knowledge source. CONCLUSIONS The public level of knowledge about CKD management is greatly influenced by participants' health and social factors. Thus, improving public knowledge and perception through education and the media will significantly reduce CKD prevalence and incidence.
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Affiliation(s)
- Abass M Al-Momany
- Department of Clinical Laboratory Sciences, The University of Jordan, Amman, Jordan
| | - Ensaf Y Almomani
- Faculty of Medicine, Al-Balqa Applied University, Al-Salt, Jordan
| | - Laila Al-Omari
- Department of Medical Laboratory Sciences, Al-Ahliyya Amman University, Amman, Jordan
| | - Ahmad M Qablan
- Faculty of Educational Sciences, Hashemite University, Zarqa, Jordan
| | - Huda Y Almomani
- Department of Applied Pharmaceutical Sciences and Clinical Pharmacy, Faculty of Pharmacy, Isra University, Amman, Jordan
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Dong X, Zhang J, Li W, Li Y, Jia L, Liu Z, Fu W, Zhang A. Yi-Shen-Hua-Shi regulates intestinal microbiota dysbiosis and protects against proteinuria in patients with chronic kidney disease: a randomized controlled study. PHARMACEUTICAL BIOLOGY 2024; 62:356-366. [PMID: 38720666 PMCID: PMC11085992 DOI: 10.1080/13880209.2024.2345080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 04/15/2024] [Indexed: 05/12/2024]
Abstract
CONTEXT Yi-Shen-Hua-Shi (YSHS) is a traditional Chinese medicine that treats chronic kidney disease (CKD). However, its efficacy in reducing proteinuria and underlying mechanisms is unknown. OBJECTIVE This single-center randomized controlled trial explored whether YSHS could improve proteinuria and modulate the gut microbiota. MATERIALS AND METHODS 120 CKD patients were enrolled and randomized to receive the renin-angiotensin-aldosterone system (RAAS) inhibitor plus YSHS (n = 56) or RAAS inhibitor (n = 47) alone for 4 months, and 103 patients completed the study. We collected baseline and follow-up fecal samples and clinical outcomes from participants. Total bacterial DNA was extracted, and the fecal microbiome was analyzed using bioinformatics. RESULTS Patients in the intervention group had a significantly higher decrease in 24-h proteinuria. After 4 months of the YSHS intervention, the relative abundance of bacteria that have beneficial effects on the body, such as Faecalibacterium, Lachnospiraceae, Lachnoclostridium, and Sutterella increased significantly, while pathogenic bacteria such as the Eggerthella and Clostridium innocuum group decreased. However, we could not find these changes in the control group. Redundancy analysis showed that the decline in 24-h proteinuria during follow-up was significantly correlated with various taxa of gut bacteria, such as Lachnospiraceae and the Lachnoclostridium genus in the YSHS group. KEGG analysis also showed the potential role of YSHS in regulating glycan, lipid, and vitamin metabolism. DISCUSSION AND CONCLUSION The YSHS granule reduced proteinuria associated with mitigating intestinal microbiota dysbiosis in CKD patients. The definite mechanisms of YSHS to improve proteinuria need to be further explored. TRIAL REGISTRATION ChiCTR2300076136, retrospectively registered.
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Affiliation(s)
- Xingtong Dong
- Department of Nephrology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jialing Zhang
- Department of Nephrology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Wen Li
- Department of Nephrology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yinping Li
- Department of Nephrology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Linpei Jia
- Department of Nephrology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Zhaohui Liu
- Department of Nephrology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Wenjing Fu
- Department of Nephrology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Aihua Zhang
- Department of Nephrology, Xuanwu Hospital, Capital Medical University, Beijing, China
- National Clinical Research Center for Geriatric Disorders, Xuanwu Hospital, Capital Medical University, Beijing, China
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Wang Y, Zhang L, Yuan L, Xie Q, Liu S, Hao CM. Changes in the spectrum of biopsy-proven renal diseases over 11 years: a single-center study in China. Ren Fail 2024; 46:2381614. [PMID: 39039852 PMCID: PMC11268216 DOI: 10.1080/0886022x.2024.2381614] [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: 04/23/2024] [Accepted: 07/14/2024] [Indexed: 07/24/2024] Open
Abstract
BACKGROUND There have been some shifts in the frequency and distribution of biopsy-proven renal diseases in China over recent years. The aim of the study was to investigate the changing spectrum of renal diseases from the view of kidney biopsy data in a single center of China. METHODS AND RESULTS A total of 10,996 cases of native renal biopsies from patients aged ≥15 years old in Huashan Hospital, Fudan University, between 2008 and 2018 were analyzed retrospectively. The results showed that primary glomerular nephropathy (PGN) remained the most common biopsy-proven renal disease (69.42% of total), with IgA nephropathy (IgAN) accounting for 44.40% of PGN, membranous nephropathy (MN) for 28.55%, minimal change disease (MCD) for 13.26% and focal segmental glomerulosclerosis (FSGS) for 8.00%. During the study period, the proportion of MN in PGN appeared an increasing tendency, while that of IgAN and MCD remained stable and that of FSGS showed a decline. Secondary glomerular nephropathy (SGN) constituted 21.54% of total cases, among which the leading two diseases were lupus nephritis (LN) and Henoch-Schonlein purpura nephritis (HSN) which accounted for 41.08% and 19.11% respectively. CONCLUSIONS The 11-year retrospective study revealed that PGN was the predominant histologic diagnosis among patients undergoing renal biopsy and the most frequent type of PGN remained to be IgAN, followed by MN which increased dramatically.
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Affiliation(s)
- Yujia Wang
- Department of Nephrology, Huashan Hospital, and Nephrology Research Institute, Fudan University, Shanghai, China
- Department of Nephrology, Blood Purification Research Center, First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Liyin Zhang
- Department of Nephrology, Huashan Hospital, and Nephrology Research Institute, Fudan University, Shanghai, China
| | - Li Yuan
- Department of Nephrology, Huashan Hospital, and Nephrology Research Institute, Fudan University, Shanghai, China
| | - Qionghong Xie
- Department of Nephrology, Huashan Hospital, and Nephrology Research Institute, Fudan University, Shanghai, China
| | - Shaojun Liu
- Department of Nephrology, Huashan Hospital, and Nephrology Research Institute, Fudan University, Shanghai, China
| | - Chuan-ming Hao
- Department of Nephrology, Huashan Hospital, and Nephrology Research Institute, Fudan University, Shanghai, China
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Ekholm M, Andersson U, Nilsson PM, Kjellgren K, Midlöv P. Evaluation of self-monitoring of blood pressure in the PERHIT study and the impact on glomerular function. Blood Press 2024; 33:2399565. [PMID: 39250514 DOI: 10.1080/08037051.2024.2399565] [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: 07/29/2024] [Accepted: 08/27/2024] [Indexed: 09/11/2024]
Abstract
BACKGROUND Although intensive blood pressure (BP) control has not been shown to slow the progression of chronic kidney disease (CKD), intensive BP control has been shown to reduce the risk for adverse cardiovascular outcomes in the CKD population. The aim of this post-hoc study was to study the interplay between a self-monitoring BP system and glomerular function. METHODS In all, 949 participants with hypertension underwent visits at baseline, after eight weeks and 12 months. Half of the participants received a BP monitor and installed a program on their mobile phone. During eight weeks, they measured daily and reported their BP values. RESULTS Within the intervention group, BP and systolic BP (SBP) decreased from baseline to eight weeks and 12 months (p < .001). Pulse pressure (PP) and mean arterial blood pressure (MAP) decreased from baseline to eight weeks (p = .021 and p = .004) vs 12 months (p = .035 and p = .008). Within the control group, a decrease was observed from baseline to 12 months for SBP, diastolic BP (DBP) and PP (p = .025, p = .023 and p = .036). In the intervention group, we observed an association between a decrease in SBP, DBP, PP and MAP and a decrease in eGFR (estimated glomerular filtration rate), (p < .001, p < .001, p = .013 and p < .001). In the control group, similar results were observed for PP only (p = .027). Within the intervention group, eGFR decreased (p < .001) but within the control group, the decrease was non-significant (p = .051). CONCLUSION We observed an association between a decrease in all BP components and eGFR decline within the normal range in the intervention group but not in the controls. TRIAL REGISTRATION The study was registered with ClinicalTrials.gov [NCT03554382].
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Affiliation(s)
- Mikael Ekholm
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden
- Wetterhälsan Primary Health Care Centre, Jönköping, Sweden
| | - Ulrika Andersson
- Department of Clinical Sciences Malmö, Center for Primary Health Care Research, Lund University, Sweden
| | - Peter M Nilsson
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Karin Kjellgren
- Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Patrik Midlöv
- Department of Clinical Sciences Malmö, Center for Primary Health Care Research, Lund University, Sweden
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Huang J, Li H, Yang X, Qian C, Wei Y, Sun M. The relationship between dietary inflammatory index (DII) and early renal injury in population with/without hypertension: analysis of the National health and nutrition examination survey 2001-2002. Ren Fail 2024; 46:2294155. [PMID: 38178375 PMCID: PMC10773634 DOI: 10.1080/0886022x.2023.2294155] [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: 08/01/2023] [Accepted: 12/07/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Inflammation plays a crucial role in occurrence of kidney injury, and specific dietary patterns can influence systemic inflammation levels. However, the relationship between dietary inflammatory potential and early-stage kidney damage remains unclear. METHOD 2,108 participants was recruited from 2001-2002 National Health and Nutrition Examination Survey (NHANES). Dietary Inflammatory Index (DII) is utilized to assess dietary inflammatory potential, calculated through a 24-h dietary recall questionnaire. Early renal injury was evaluated using urinary albumin to creatinine (UACR), cystatin C (CysC), β-2 microglobulin (β2M), and estimated glomerular filtration rate (eGFR) based on serum creatinine (eGFRs), cystatin C (eGFRc), and both Scr and CysC (eGFRs&c). Participant characteristics were analyzed, and association between DII, hypertension, and early renal injury markers was explored using multiple linear and logistic regression models. RESULTS The average age of participants was 53.9 years. DII exhibited a positive correlation with UACR (β = -0.048[0.017,0.078]), β2M (β = 0.019[0.010,0.027]), CysC (β = 0.012 [0.004,0.021]). Conversely, a negative correlation was observed between DII and eGFRc (β = -1.126[-1.554, -0.699]), eGFRs&c (β=-1.101[-1.653, -0.549]). A significant association was observed between hypertension and abnormality of early kidney damage markers. Subgroup analysis reveals that the positive correlation between DII and the occurrence of abnormal markers of early kidney damage is only observed in individuals with hypertension. Furthermore, an interaction between DII and hypertension was detected in eGFRs&c (OR:1.250[1.042, 1.499], p for interaction = 0.03). CONCLUSION Higher levels of DII may be associated with occurrence of early kidney damage. For individuals with hypertension, avoiding excessive consumption of pro-inflammatory foods may reduce the risk of renal injury.
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Affiliation(s)
- Jingda Huang
- Department of Nephrology, First Hospital of Jilin University, Changchun, China
| | - Huimin Li
- Department of Nephrology, First Hospital of Jilin University, Changchun, China
| | - Xu Yang
- Department of Neurology, People’s hospital of Jilin province, Changchun, China
| | - Chuyue Qian
- Department of Nephrology, First Hospital of Jilin University, Changchun, China
| | - Yihui Wei
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing, China
| | - Mindan Sun
- Department of Nephrology, First Hospital of Jilin University, Changchun, China
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Herold JM, Wiegrebe S, Nano J, Jung B, Gorski M, Thorand B, Koenig W, Zeller T, Zimmermann ME, Burkhardt R, Banas B, Küchenhoff H, Stark KJ, Peters A, Böger CA, Heid IM. Population-based reference values for kidney function and kidney function decline in 25- to 95-year-old Germans without and with diabetes. Kidney Int 2024; 106:699-711. [PMID: 39084259 DOI: 10.1016/j.kint.2024.06.024] [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: 01/26/2024] [Revised: 06/04/2024] [Accepted: 06/24/2024] [Indexed: 08/02/2024]
Abstract
Understanding normal aging of kidney function is pivotal to help distinguish individuals at particular risk for chronic kidney disease. Glomerular filtration rate (GFR) is typically estimated via serum creatinine (eGFRcrea) or cystatin C (eGFRcys). Since population-based age-group-specific reference values for eGFR and eGFR-decline are scarce, we aimed to provide such reference values from population-based data of a wide age range. In four German population-based cohorts (KORA-3, KORA-4, AugUR, DIACORE), participants underwent medical exams, interview, and blood draw up to five times within up to 25 years. We analyzed eGFRcrea and eGFRcys cross-sectionally and longitudinally (12,000 individuals, age 25-95 years). Cross-sectionally, we found age-group-specific eGFRcrea to decrease approximately linearly across the full age range, for eGFRcys up to the age of 60 years. Within age-groups, there was little difference by sex or diabetes status. Longitudinally, linear mixed models estimated an annual eGFRcrea decline of -0.80 [95% confidence interval -0.82, -0.77], -0.79 [-0.83, -0.76], and -1.20 mL/min/1.73m2 [-1.33, -1.08] for the general population, "healthy" individuals, or individuals with diabetes, respectively. Reference values for eGFR using cross-sectional data were shown as percentile curves for "healthy" individuals and for individuals with diabetes. Reference values for eGFR-decline using longitudinal data were presented as 95% prediction intervals for "healthy" individuals and for individuals with diabetes, obesity, and/or albuminuria. Thus, our results can help clinicians to judge eGFR values in individuals seen in clinical practice according to their age and to understand the expected range of annual eGFR-decline based on their risk profile.
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Affiliation(s)
- Janina M Herold
- Department of Genetic Epidemiology, University of Regensburg, Regensburg, Germany
| | - Simon Wiegrebe
- Department of Genetic Epidemiology, University of Regensburg, Regensburg, Germany; Statistical Consulting Unit StaBLab, Department of Statistics, LMU Munich, Munich, Germany
| | - Jana Nano
- Institute of Epidemiology, Helmholtz Zentrum München-German Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | - Bettina Jung
- Department of Nephrology, University of Regensburg, University Hospital Regensburg, Regensburg, Germany; Department of Nephrology, Diabetology, and Rheumatology, Traunstein Hospital, Southeast Bavarian Clinics, Traunstein, Germany; KfH Kidney Center Traunstein, Traunstein, Germany
| | - Mathias Gorski
- Department of Genetic Epidemiology, University of Regensburg, Regensburg, Germany
| | - Barbara Thorand
- Institute of Epidemiology, Helmholtz Zentrum München-German Research Center for Environmental Health (GmbH), Neuherberg, Germany; German Center for Diabetes Research (DZD), Partner München-Neuherberg, Neuherberg, Germany; Institute for Medical Information Processing, Biometry and Epidemiology, Medical Faculty, Ludwig-Maximilians-Universität (LMU) Munich, Munich, Germany
| | - Wolfgang Koenig
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany; Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany
| | - Tanja Zeller
- University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Hamburg, Hamburg, Germany
| | - Martina E Zimmermann
- Department of Genetic Epidemiology, University of Regensburg, Regensburg, Germany
| | - Ralph Burkhardt
- Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Regensburg, Regensburg, Germany
| | - Bernhard Banas
- Department of Nephrology, University of Regensburg, University Hospital Regensburg, Regensburg, Germany
| | - Helmut Küchenhoff
- Statistical Consulting Unit StaBLab, Department of Statistics, LMU Munich, Munich, Germany
| | - Klaus J Stark
- Department of Genetic Epidemiology, University of Regensburg, Regensburg, Germany
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum München-German Research Center for Environmental Health (GmbH), Neuherberg, Germany; German Center for Diabetes Research (DZD), Partner München-Neuherberg, Neuherberg, Germany; Institute for Medical Information Processing, Biometry and Epidemiology, Medical Faculty, Ludwig-Maximilians-Universität (LMU) Munich, Munich, Germany
| | - Carsten A Böger
- Department of Nephrology, University of Regensburg, University Hospital Regensburg, Regensburg, Germany; Department of Nephrology, Diabetology, and Rheumatology, Traunstein Hospital, Southeast Bavarian Clinics, Traunstein, Germany; KfH Kidney Center Traunstein, Traunstein, Germany
| | - Iris M Heid
- Department of Genetic Epidemiology, University of Regensburg, Regensburg, Germany.
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Walker RC, Palmer SC, Abel S, Jones M, Walker C, Tipene-Leach D. Health care delivery of kidney transplantation to indigenous Māori in Aotearoa New Zealand: A qualitative interview study with clinician stakeholders. J Health Serv Res Policy 2024; 29:257-265. [PMID: 38662788 DOI: 10.1177/13558196241248525] [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] [Indexed: 08/27/2024]
Abstract
OBJECTIVES Indigenous people experience higher rates of kidney failure than do non-Indigenous Peoples. However, compared to Indigenous patients, health care systems deliver kidney transplantation to non-Indigenous patients at a substantially higher rate and more frequently as the first treatment of kidney failure. Indigenous Māori patients in Aotearoa New Zealand report numerous barriers to kidney transplantation. We explore the perspectives of clinicians as stakeholders in the delivery of kidney transplantation. METHODS In 2021/2022 we conducted in-depth qualitative interviews with key stakeholder clinicians within kidney transplantation services in Aotearoa New Zealand, asking them about the issues for Māori patients. We used thematic analysis informed by critical theory to identify key findings and used structural coding to categorize the themes at the level of society, health system, and health services. RESULTS We interviewed 18 clinicians (nine nephrologists, including two transplant nephrologists, and nine nurses, including six transplant coordinators). We identified nine themes from stakeholders related to delivery of kidney transplantation services to Māori patients and whānau (family), categorized according to three main levels: Firstly, at the level of society (the impact of colonization and distrust). Secondly, the health care system (failure to prevent and manage kidney disease, health care model delivers inequitable outcomes, and inadequate Māori health professional workforce). Thirdly, health care services (transplantation reliant on patient and family resources, complex assessment causes untimely delays, clinical criteria for transplantation, and lack of clinician ability to effect change). CONCLUSIONS Delivery of kidney transplantation to Indigenous Peoples is impacted at the level of society, health care system, and health care service. To address inequities, a broad approach that addresses each of these levels is required.
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Affiliation(s)
- Rachael C Walker
- School of Nursing, University of Auckland, Auckland, New Zealand
| | - Suetonia C Palmer
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Sally Abel
- Independent Health Researcher, Napier, New Zealand
| | - Merryn Jones
- Transplant Nurse, Renal Services, Te Whatu Ora - Te Matau a Māui, Christchurch, New Zealand
| | - Curtis Walker
- Department of Medicine, Te Whatu Ora - Te Pae Hauora o Ruahine o Tararua, Palmerston North, New Zealand
| | - David Tipene-Leach
- Te Kura i Awarua Rangahau Māori Research Centre, Te Pukenga - Eastern Institute of Technology, Napier, New Zealand
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Tungsanga S, Fung W, Okpechi IG, Ye F, Ghimire A, Li PKT, Shlipak MG, Tummalapalli SL, Arruebo S, Caskey FJ, Damster S, Donner JA, Jha V, Levin A, Saad S, Tonelli M, Bello AK, Johnson DW. Organization and Structures for Detection and Monitoring of CKD Across World Countries and Regions: Observational Data From a Global Survey. Am J Kidney Dis 2024; 84:457-468.e1. [PMID: 38788792 DOI: 10.1053/j.ajkd.2024.03.024] [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: 12/18/2023] [Revised: 03/20/2024] [Accepted: 03/24/2024] [Indexed: 05/26/2024]
Abstract
RATIONALE & OBJECTIVE Established therapeutic interventions effectively mitigate the risk and progression of chronic kidney disease (CKD). Countries and regions have a compelling need for organizational structures that enable early identification of people with CKD who can benefit from these proven interventions. We report the current global status of CKD detection programs. STUDY DESIGN A multinational cross-sectional survey. SETTING & PARTICIPANTS Stakeholders, including nephrologist leaders, policymakers, and patient advocates from 167 countries, participating in the International Society of Nephrology (ISN) survey from June to September 2022. OUTCOME Structures for the detection and monitoring of CKD, including CKD surveillance systems in the form of registries, community-based detection programs, case-finding practices, and availability of measurement tools for risk identification. ANALYTICAL APPROACH Descriptive statistics. RESULTS Of all participating countries, 19% (n=31) reported CKD registries, and 25% (n=40) reported implementing CKD detection programs as part of their national policies. There were variations in CKD detection program, with 50% (n=20) using a reactive approach (managing cases as identified) and 50% (n=20) actively pursuing case-finding in at-risk populations. Routine case-finding for CKD in high-risk populations was widespread, particularly for diabetes (n=152; 91%) and hypertension (n=148; 89%). Access to diagnostic tools, estimated glomerular filtration rate (eGFR), and urine albumin-creatinine ratio (UACR) was limited, especially in low-income (LICs) and lower-middle-income (LMICs) countries, at primary (eGFR: LICs 22%, LMICs 39%, UACR: LICs 28%, LMICs 39%) and secondary/tertiary health care levels (eGFR: LICs 39%, LMICs 73%, UACR: LICs 44%, LMICs 70%), potentially hindering CKD detection. LIMITATIONS A lack of detailed data prevented an in-depth analysis. CONCLUSIONS This comprehensive survey highlights a global heterogeneity in the organization and structures (surveillance systems and detection programs and tools) for early identification of CKD. Ongoing efforts should be geared toward bridging such disparities to optimally prevent the onset and progression of CKD and its complications. PLAIN-LANGUAGE SUMMARY Early detection and management of chronic kidney disease (CKD) is crucial to prevent progression to kidney failure. A multinational survey across 167 countries revealed disparities in CKD detection programs. Only 19% reported CKD registries, and 25% implemented detection programs as part of their national policy. Half used a reactive approach while others actively pursued case-finding in at-risk populations. Routine case-finding was common for individuals with diabetes and hypertension. However, limited access to gold standard tools such as estimated glomerular filtration rate (eGFR) and urine albumin-creatinine ratio (UACR), especially in low-income and lower-middle income countries, may hinder CKD detection. A global effort to bridge these disparities is needed to optimally prevent the onset and progression of CKD and its complications.
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Affiliation(s)
- Somkanya Tungsanga
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada; Division of General Internal Medicine-Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
| | - Winston Fung
- Department of Medicine & Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Ikechi G Okpechi
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada; Division of Nephrology and Hypertension and Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa
| | - Feng Ye
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Anukul Ghimire
- Division of Nephrology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Philip Kam-Tao Li
- Department of Medicine & Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Michael G Shlipak
- Kidney Health Research Collaborative, Department of Medicine, University of California at San Francisco, San Francisco, California; General Internal Medicine Division, Medical Service, San Francisco Veterans Affairs Health Care System, San Francisco, California
| | - Sri Lekha Tummalapalli
- Division of Healthcare Delivery Science and Innovation, Department of Population Health Sciences, Weill Cornell Medicine, New York, New York; Division of Nephrology and Hypertension, Department of Medicine, Weill Cornell Medicine, New York, New York
| | | | - Fergus J Caskey
- Population Health Sciences, Bristol Medical School, University of Bristol, United Kingdom
| | | | - Jo-Ann Donner
- International Society of Nephrology, Brussels, Belgium
| | - Vivekanand Jha
- School of Public Health, Imperial College, London, United Kingdom; George Institute for Global Health, University of New South Wales, New Delhi, India; Manipal Academy of Higher Education, Manipal, India
| | - Adeera Levin
- Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Syed Saad
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Marcello Tonelli
- Canada and Pan-American Health Organization/World Health Organization's Collaborating Centre in Prevention and Control of Chronic Kidney Disease, University of Calgary, Calgary, Alberta, Canada; Division of Nephrology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Aminu K Bello
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - David W Johnson
- Department of Kidney and Transplant Services and Centre for Kidney Disease Research, University of Queensland at Princess Alexandra Hospital, Translational Research Institute, Brisbane, Australia; Australasian Kidney Trials Network at the University of Queensland, Brisbane, Australia
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Mohammadi S, Khorasani M. Implications of the cGAS-STING pathway in diabetes: Risk factors and therapeutic strategies. Int J Biol Macromol 2024; 278:134210. [PMID: 39069057 DOI: 10.1016/j.ijbiomac.2024.134210] [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: 05/12/2024] [Revised: 07/20/2024] [Accepted: 07/25/2024] [Indexed: 07/30/2024]
Abstract
Diabetes mellitus is an increasingly prevalent metabolic disorder characterized by chronic hyperglycemia and impaired insulin action. Although the pathogenesis of diabetes is multifactorial, emerging evidence suggests that chronic low-grade inflammation plays a significant role in the development and progression of the disease. The cyclic GMP-AMP synthase (cGAS) and its downstream signaling pathway, the stimulator of interferon genes (STING), have recently gained attention in the field of diabetes research. This article aims to provide an overview of the role of cGAS-STING in diabetes, focusing on its involvement in the regulation of immune responses, inflammation, insulin resistance, and β-cell dysfunction. Understanding the contribution of cGAS-STING signaling in diabetes may lead to the development of targeted therapeutic strategies for this prevalent metabolic disorder. The results section presents key findings from multiple studies on the impact of STING in diabetes. It discusses the influence of STING on inflammation levels within a diabetic environment, its effect on insulin resistance, and its implications for the development and progression of diabetes. The cGAS-STING signaling pathway plays a crucial role in the development and progression of diabetes.
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Affiliation(s)
- Saeed Mohammadi
- Natural and Medical Sciences Research Center, University of Nizwa, 611, Oman
| | - Milad Khorasani
- Healthy Ageing Research Centre, Neyshabur University of Medical Sciences, Neyshabur, Iran; Department of Biochemistry and Nutrition, Neyshabur University of Medical Sciences, Neyshabur, Iran.
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10
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Lyons OD. Sleep disorders in chronic kidney disease. Nat Rev Nephrol 2024; 20:690-700. [PMID: 38789686 DOI: 10.1038/s41581-024-00848-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2024] [Indexed: 05/26/2024]
Abstract
Sleep disorders are highly prevalent in chronic kidney disease (CKD) but are often under-recognized. Restless legs syndrome, which is common in CKD owing to issues with dopamine metabolism and is exacerbated by iron deficiency and uraemia, can lead to poor sleep quality and increased daytime fatigue. Insomnia is also prevalent in CKD, particularly in patients requiring dialysis, with increased sleep latency and sleep fragmentation being reported. The cause of insomnia in CKD is multifactorial - poor sleep habits and frequent napping during dialysis, uraemia, medications and mood disorders have all been suggested as potential contributing factors. Sleep apnoea and CKD are also now recognized as having a bi-directional relationship. Sleep apnoea is a risk factor for accelerated progression of CKD, and fluid overload, which is associated with kidney failure, can lead to both obstructive and central sleep apnoea. The presence of obstructive sleep apnoea in CKD can exacerbate the already heightened cardiovascular morbidity and mortality in these patients, as well as leading to daytime fatigue and reduced quality of life. Increased awareness, timely diagnosis and appropriate therapeutic interventions are essential to reduce the negative impact of sleep disorders in patients with kidney disease.
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Affiliation(s)
- Owen D Lyons
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
- Department of Medicine, Women's College Hospital, Toronto, Canada.
- Women's College Research Institute, Toronto, Ontario, Canada.
- Sleep Research Laboratory, Toronto Rehabilitation Institute, KITE-UHN, Toronto, Ontario, Canada.
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11
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Wang Y, Huang Y, Al Jawish MM, Bakheet NG, Acosta A, Ordog T, Clift K, Chase K, Kumbhari V, Badurdeen DS. Rising Obesity-Associated Mortality in Men: Exploration of Gender Disparity from the Global Burden of Disease Study, 1990-2019. J Gen Intern Med 2024:10.1007/s11606-024-09033-w. [PMID: 39302563 DOI: 10.1007/s11606-024-09033-w] [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: 04/01/2024] [Accepted: 09/10/2024] [Indexed: 09/22/2024]
Abstract
OBJECTIVES The global rise in overweight, obesity, and related diseases is undeniable; however, the pathogenesis of obesity and obesity-associated diseases is heterogeneous, with varied complications and a discordant response to treatment. Intriguingly, men have a shorter lifespan than women, despite being half as likely to be obese. This paradox suggests a potential gender disparity in the impact of obesity on mortality, with men potentially being more vulnerable to obesity-associated health risks. METHODS This retrospective study utilized Global Burden of Diseases data from 204 countries/territories to bridge the knowledge gap in understanding gender disparities in obesity-related mortality. Outcomes were obesity-associated mortality, years of life lost, years lived with disability, and disability-adjusted life years (DALYs). RESULTS In 2019, the global overweight/obesity-related disease burden reached 160.2 million DALYs, with 5.02 million associated deaths. From 1990 to 2019, the age-standardized death rates increased in males (from 58.19 to 66.55 per 100,000 person-years, APC = 0.36%, 95% CI: 0.30 to 0.42%, P < 0.001), while females experienced a decrease in age-standardized death rates (from 59.31 to 58.14 per 100,000 person-years, APC = -0.22%, 95% CI: -0.29% to -0.14%, P < 0.001). Age-standardized DALYs increased more in males (1632.5 to 2070.34 per 100,000 years, APC = 0.74%, 95% CI: 0.70% to 0.78%, P < .001) compared to females (1618.26 to 1789.67 per 100,000 years, APC = 0.24%, 95% CI: 0.19% to 0.29%, P < 0.001). Disparities were more pronounced in countries with a higher socioeconomic status and predominantly affected younger populations. CONCLUSIONS Overweight/obesity-related morbidity and mortality are higher among male sex. Identifying differences in pathogenesis, complications and treatment response is crucial to develop targeted interventions and equitable public health policies to combat this global burden.
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Affiliation(s)
- Yichen Wang
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Yuting Huang
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL, USA
| | - Mhd Manar Al Jawish
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL, USA
| | - Nader G Bakheet
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL, USA
| | - Andres Acosta
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Tamas Ordog
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
- Department of Physiology & Biomedical Engineering, Mayo Clinic, Rochester, MN, USA
| | - Kristin Clift
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL, USA
| | - Katherine Chase
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL, USA
| | - Vivek Kumbhari
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL, USA
| | - Dilhana S Badurdeen
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL, USA.
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Kang J, Park SH, Park KW, Koo BK, Lee H, Han M, Hwang D, Yang HM, Chae IH, Shin WY, Oh JH, Kim YH, Park TH, Kim BS, Han JK, Shin ES, Kim HS. Clopidogrel Versus Aspirin as Chronic Maintenance Antiplatelet Monotherapy in Patients After Percutaneous Coronary Intervention With Chronic Kidney Disease: A Post Hoc Analysis of the HOST-EXAM Trial. J Am Heart Assoc 2024; 13:e035269. [PMID: 39248265 DOI: 10.1161/jaha.124.035269] [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: 02/29/2024] [Accepted: 08/08/2024] [Indexed: 09/10/2024]
Abstract
BACKGROUND Clopidogrel monotherapy improved clinical outcomes compared with aspirin monotherapy during a chronic maintenance period in patients who underwent coronary stenting in the HOST-EXAM (Harmonizing Optimal Strategy for Treatment of Coronary Artery Stenosis-Extended Antiplatelet Monotherapy) trial. However, it is uncertain whether the beneficial effect of clopidogrel over aspirin is different according to the renal function. METHODS AND RESULTS We conducted a post hoc analysis of the HOST-EXAM trial. Chronic kidney disease (CKD) was defined as baseline estimated glomerular filtration rate <60 mL/min per 1.73 m2. The primary end point was a composite of all-cause death, nonfatal myocardial infarction, stroke, readmission due to acute coronary syndrome, and Bleeding Academic Research Consortium bleeding type ≥3, during the 2-year follow up. Among the 5438 patients enrolled in the HOST-EXAM trial, 4844 patients (mean age, 63.3±10.6 years; 74.9% men) with a baseline creatinine value were analyzed in this study. A total of 508 (10.5%) patients had CKD, who were at higher risk of the primary end point compared with those without CKD (hazard ratio [HR], 2.01 [95% CI, 1.51-2.67]). Clopidogrel monotherapy was associated with a lower rate of the primary end point in both patients with CKD (HR, 0.74 [95% CI, 0.44-1.25]) and patients without CKD (HR, 0.71 [95% CI, 0.56-0.91]). No significant interaction was observed between the treatment effect and CKD status (P for interaction=0.889). CONCLUSIONS During the chronic maintenance period after coronary stenting, the risk of thrombotic and bleeding events was significantly higher in patients with CKD compared with those without CKD. There was no statistical difference in the treatment effect of clopidogrel monotherapy in those with versus without CKD.
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Affiliation(s)
- Jeehoon Kang
- Department of Internal Medicine, Cardiovascular Center Seoul National University Hospital Seoul South Korea
| | - Sang-Hyeon Park
- Department of Internal Medicine, Cardiovascular Center Seoul National University Hospital Seoul South Korea
| | - Kyung Woo Park
- Department of Internal Medicine, Cardiovascular Center Seoul National University Hospital Seoul South Korea
| | - Bon-Kwon Koo
- Department of Internal Medicine, Cardiovascular Center Seoul National University Hospital Seoul South Korea
| | - Huijin Lee
- Department of Internal Medicine, Cardiovascular Center Seoul National University Hospital Seoul South Korea
| | - Minju Han
- Department of Internal Medicine, Cardiovascular Center Seoul National University Hospital Seoul South Korea
| | - Doyeon Hwang
- Department of Internal Medicine, Cardiovascular Center Seoul National University Hospital Seoul South Korea
| | - Han-Mo Yang
- Department of Internal Medicine, Cardiovascular Center Seoul National University Hospital Seoul South Korea
| | - In-Ho Chae
- Department of Internal Medicine Seoul National University Bundang Hospital Seongnam South Korea
| | - Won-Yong Shin
- Department of Internal Medicine Soonchunhyang University Cheonan Hospital Cheonan South Korea
| | - Ju Hyeon Oh
- Department of Cardiology, Samsung Changwon Hospital Sungkyunkwan University School of Medicine Changwon South Korea
| | - Yong Hoon Kim
- Department of Internal Medicine Kangwon National University School of Medicine Chuncheon South Korea
| | - Tae-Ho Park
- Department of Internal Medicine Dong-A University Hospital Busan South Korea
| | - Bum Soo Kim
- Department of Internal Medicine, Kangbuk Samsung Hospital Sungkyunkwan University Seoul South Korea
| | - Jung-Kyu Han
- Department of Internal Medicine, Cardiovascular Center Seoul National University Hospital Seoul South Korea
| | - Eun-Seok Shin
- Department of Internal Medicine Ulsan University Hospital Ulsan South Korea
| | - Hyo-Soo Kim
- Department of Internal Medicine, Cardiovascular Center Seoul National University Hospital Seoul South Korea
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13
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Zamarrón E, Diab L, Pavón J, Carpio C, Álvarez-Sala R, Prados MC. [Renal involvement in adults with cystic fibrosis: study of 89 patients]. Med Clin (Barc) 2024; 163:238-241. [PMID: 38918113 DOI: 10.1016/j.medcli.2024.03.010] [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: 12/31/2023] [Revised: 03/05/2024] [Accepted: 03/06/2024] [Indexed: 06/27/2024]
Abstract
INTRODUCTION We are assisting to an increase in survival rates among individuals with cystic fibrosis (CF). Until now, renal involvement was a minority issue, but with the rise in life expectancy, we will likely see an increase in its prevalence. Our main objective was to assess renal function in CF and study risk factors associated with its deterioration. METHODS A cross-sectional, retrospective study was conducted, including adults with CF. Clinical, respiratory function, microbiological, blood and urine analysis, and major chronic treatments received were collected. RESULTS Eighty nine patients with a mean age of 35±12 years were analyzed. Mean serum creatinine levels were 0.8±0.2mg/dL. 10.6% had a glomerular filtration rate less than 90mL/min/1.73m2. No patient showed albuminuria. In multivariate model, only age was an independent risk factor for reduced glomerular filtration (OR: 0.344; 95%CI: 0.004-0.017; P=.002). CONCLUSIONS 11% of CF adults show decreased glomerular filtration, with age being the sole independent risk factor. Vigilance for this uncommon condition is crucial.
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Affiliation(s)
- Ester Zamarrón
- Servicio de Neumología, Hospital Universitario La Paz, Universidad Autónoma de Madrid, IdiPAZ, Madrid, España.
| | - Layla Diab
- Servicio de Neumología, Hospital Universitario 12 de Octubre, Madrid, España
| | - Jaime Pavón
- Servicio de Neumología, Hospital Universitario La Paz, Universidad Autónoma de Madrid, IdiPAZ, Madrid, España
| | - Carlos Carpio
- Servicio de Neumología, Hospital Universitario La Paz, Universidad Autónoma de Madrid, IdiPAZ, Madrid, España
| | - Rodolfo Álvarez-Sala
- Servicio de Neumología, Hospital Universitario La Paz, Universidad Autónoma de Madrid, IdiPAZ, Madrid, España
| | - María Concepción Prados
- Servicio de Neumología, Hospital Universitario La Paz, Universidad Autónoma de Madrid, IdiPAZ, Madrid, España
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Liu J, Chen S, Gao W. Gender differences in cardiovascular outcomes of kidney transplant recipients: A retrospective cohort study. Medicine (Baltimore) 2024; 103:e39568. [PMID: 39287307 PMCID: PMC11404969 DOI: 10.1097/md.0000000000039568] [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] [Indexed: 09/19/2024] Open
Abstract
The purpose of this study was to investigate gender differences in cardiovascular outcomes of kidney transplant recipients (KTRs). Here, a retrospective cohort study was conducted, and data from the National Health Insurance Research Database in Taiwan were used. In total, 2904 patients who had end-stage renal disease (ERSD) and received kidney transplantation (KT) were identified by propensity score matching (PSM) and were enrolled from 1997 to 2012, with follow-up ending in 2013. Besides, major adverse cardiovascular events (MACEs) were defined as a composite of all-cause mortality, nonfatal myocardial infarction, and nonfatal strokes. Apart from that, hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated by Cox regression, while the Bayesian network model was constructed to assess the importance of risk factors for MACEs. Furthermore, the original cohort was a sensitivity analysis. Women had a lower risk of MACEs compared with men (hazard ratio [HR]: 0.84; 95% CI: 0.72-0.98; P = .024). Beyond that, stratified analysis of age and waiting time for KT showed that the risk of MACEs was significantly lower in women than in men among KTRs aged > 50 years (HR: 0.79; 95% CI: 0.62-1.0; P = .05) or waiting time for KT ≤ 6 years (HR: 0.85; 95% CI: 0.72-0.99; P = .04). Bayesian network indicated that age is an important determinant of cardiovascular outcomes in KTRs, regardless of gender. In Taiwan, women had a lower risk of adverse cardiovascular outcomes than men in KTRs aged > 50 years or with a waiting time for KT ≤ 6 years. Furthermore, age is an important independent determinant for the prognosis of KTRs.
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Affiliation(s)
- Jiang Liu
- Department of Cardiovascular Medicine, Yingtan People's Hospital, Jiangxi, P.R. China
| | - Siwei Chen
- Department of Cardiovascular Medicine, The Third Hospital of Nanchang, Jiangxi, P.R. China
| | - Wenqiang Gao
- Department of Urology, Zaozhuang Municipal Hospital, Zaozhuang, P.R. China
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15
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Lee YJ, Kim KM, Ko NG, Jin M, Na JH, Park IH. Effects of MAFLD defined by fatty liver index or ultrasonography on kidney function decline in the general population. Sci Rep 2024; 14:21189. [PMID: 39261554 PMCID: PMC11390887 DOI: 10.1038/s41598-024-72482-0] [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: 05/31/2024] [Accepted: 09/09/2024] [Indexed: 09/13/2024] Open
Abstract
This study aimed to investigate whether metabolic dysfunction-associated fatty liver disease (MAFLD) defined by the fatty liver index (FLI) affects the decline in kidney function and whether this relationship is still observed in MAFLD defined by ultrasonography (USG). A retrospective cohort study was conducted using de-identified data from participants who received health checkups at Samsung Changwon Hospital between 2002 and 2018. The primary and secondary exposures were the presence of FLI- and USG-defined MAFLD, respectively. The primary outcome was 5-years slope of eGFR. The secondary outcome was a rapid decline in kidney function, defined as a 5-years slope of estimated glomerular filtration rate (eGFR) of less than - 3 mL/min/1.73 m2 per year. A total of 37,500 participants were included in the analysis. Participants with FLI-defined MAFLD had a larger decline in 5-year eGFR slope than those without FLI-defined MAFLD (beta coefficients - 0.11; 95% CI - 0.14 to - 0.08). Participants with FLI-defined MAFLD had a higher risk of rapid kidney function decline than those without FLI-defined MAFLD (odds ratio 1.33; 95% confidence intervals (CIs) 1.05-1.69). However, USG-defined MAFLD was less related to kidney function decline. In conclusion, the presence of FLI-defined MAFLD was associated with larger and faster kidney function decline.
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Affiliation(s)
- Yu-Ji Lee
- Division of Nephrology, Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, 158, Paryong-ro, Masanhoewon-gu, Changwon, 51353, Republic of Korea.
| | - Kwang Min Kim
- Division of Gastroenterology, Department of Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Nak Gyeong Ko
- Department of Research and Support, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Mihyeon Jin
- Department of Research and Support, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Jin Hee Na
- Division of Nephrology, Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, 158, Paryong-ro, Masanhoewon-gu, Changwon, 51353, Republic of Korea
| | - In Ho Park
- Division of Nephrology, Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, 158, Paryong-ro, Masanhoewon-gu, Changwon, 51353, Republic of Korea
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16
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Hu JQ, Zheng DC, Huang L, Yang X, Ning CQ, Zhou J, Yu LL, Zhou H, Xie Y. Suppression of ZEB1 by Ethyl caffeate attenuates renal fibrosis via switching glycolytic reprogramming. Pharmacol Res 2024; 209:107407. [PMID: 39270946 DOI: 10.1016/j.phrs.2024.107407] [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: 07/05/2024] [Revised: 08/23/2024] [Accepted: 09/10/2024] [Indexed: 09/15/2024]
Abstract
Renal fibrosis (RF) is a common endpoint of various chronic kidney diseases, leading to functional impairment and ultimately progressing to end-stage renal failure. Glycolytic reprogramming plays a critical role in the pathogenesis of fibrosis, which maybe a potential therapeutic target for treating renal fibrosis. Here, we revealed the novel role of ZEB1 in renal fibrosis, and whether targeting ZEB1 is the underlying mechanism for the anti-fibrotic effects of ethyl caffeate (EC) to regulate the glycolytic process. Treatment of EC attenuated the renal fibrosis and inhibited ZEB1 expression in vivo and in vitro, reducing the upregulated expression of glycolytic enzymes (HK2, PKM2, PFKP) and key metabolites (lactic acid, pyruvate). ZEB1 overexpression promoted the renal fibrosis and glycolysis, whereas knockout of ZEB1 apparently attenuated renal fibrosis in vivo and in vitro. EC interacted with ZEB1 to modulate the glycolytic enzymes for suppressing the elevated glycolytic reprogramming during renal fibrosis. In summary, our study reveals that ZEB1 plays an important role in regulating glycolytic reprogramming during the renal tubular epithelial cell fibrosis, suggesting inhibition of ZEB1 may be a potential strategy for treating renal fibrosis. Additionally, EC is a potential new drug candidate for the treatment of renal fibrosis and CKD.
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Affiliation(s)
- Jia-Qin Hu
- State Key Laboratory of Traditional Chinese Medicine Syndrome, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China; State Key Laboratory of Quality Research in Chinese Medicines, Macau University of Science and Technology, China
| | - De-Chong Zheng
- State Key Laboratory of Quality Research in Chinese Medicines, Macau University of Science and Technology, China
| | - Li Huang
- State Key Laboratory of Quality Research in Chinese Medicines, Macau University of Science and Technology, China
| | - Xi Yang
- State Key Laboratory of Quality Research in Chinese Medicines, Macau University of Science and Technology, China
| | - Cang-Qiong Ning
- State Key Laboratory of Traditional Chinese Medicine Syndrome, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Jian Zhou
- State Key Laboratory of Traditional Chinese Medicine Syndrome, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Li-Li Yu
- State Key Laboratory of Quality Research in Chinese Medicines, Macau University of Science and Technology, China.
| | - Hua Zhou
- State Key Laboratory of Traditional Chinese Medicine Syndrome, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China; Chinese Medicine Guangdong Laboratory (Hengqin Laboratory), Hengqin, Guangdong, China.
| | - Ying Xie
- State Key Laboratory of Traditional Chinese Medicine Syndrome, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China; Chinese Medicine Guangdong Laboratory (Hengqin Laboratory), Hengqin, Guangdong, China.
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17
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Duke C, Parker SL, Zam BB, Chiong F, Sajiv C, Pawar B, Ashok A, Cooper BP, Tong SYC, Janson S, Wallis SC, Roberts JA, Tsai D. Population pharmacokinetics of unbound cefazolin in infected hospitalized patients requiring intermittent high-flux haemodialysis: can a three-times-weekly post-dialysis dosing regimen provide optimal treatment? J Antimicrob Chemother 2024:dkae318. [PMID: 39255245 DOI: 10.1093/jac/dkae318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 08/22/2024] [Indexed: 09/12/2024] Open
Abstract
OBJECTIVES To describe the population pharmacokinetics of cefazolin in infected hospitalized patients requiring intermittent haemodialysis (IHD). METHODS This prospective population pharmacokinetic study was conducted in IHD patients prescribed cefazolin 2 g three times weekly. Plasma samples were collected at prespecified timepoints and assayed for total and unbound concentrations using validated LC. Pharmacokinetic modelling and dosing simulations were performed using Pmetrics®. PTA in plasma suitable for MSSA (unbound trough concentrations of ≥2 mg/L for the final 24 h of a 72 h interval) were simulated for different dosing regimens. A PTA of ≥95% was deemed acceptable. RESULTS A total of 260 cefazolin concentrations (130 total, 130 unbound) were collected from 16 patients (14 female) with a median age of 51 years. The median (IQR) pre-dialysis unbound cefazolin concentration for a 3 day dose interval trough was 17.7 (13.5-31.4) mg/L. The median (IQR) unbound fraction was 0.38 (0.32-0.46). The lowest pre-dialysis unbound concentration was 9.1 mg/L. A two-compartment model with a complex protein-binding component adequately described the data. The mean unbound cefazolin CL during IHD was 16.4 ± 4.26 L/h, compared with 0.40 ± 0.19 L/h when dialysis was off. Duration of time on haemodialysis (TOH) was the only covariate supported in the final model. The 2 g three-times-weekly regimen was associated with a PTA of 99.7% on dosing simulations to maintain unbound concentrations of ≥2 mg/L with TOH of 6 months. The 1 g three-times-weekly post-dialysis was associated with a PTA of 95.4%. CONCLUSIONS A 2 g three-times-weekly post-dialysis cefazolin regimen is supported for MSSA infections.
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Affiliation(s)
- Carleigh Duke
- College of Medicine and Public Health, Flinders University, Corner Skinner and Simpson Streets, Darwin 0870, Northern Territory, Australia
| | - Suzanne L Parker
- University of Queensland Centre for Clinical Research, University of Queensland, Brisbane, Queensland, Australia
| | - Betty B Zam
- Pharmacy Department, Alice Springs Hospital, Alice Springs, Northern Territory, Australia
| | - Fabian Chiong
- Department of Medicine, Alice Springs Hospital, Alice Springs, Northern Territory, Australia
| | - Cherian Sajiv
- Department of Nephrology, Alice Springs Hospital, Alice Springs, Northern Territory, Australia
| | - Basant Pawar
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Aadith Ashok
- Department of Medicine, Alice Springs Hospital, Alice Springs, Northern Territory, Australia
| | - Brynley P Cooper
- Pharmacy Department, Alice Springs Hospital, Alice Springs, Northern Territory, Australia
| | - Steven Y C Tong
- Department of Nephrology, Alice Springs Hospital, Alice Springs, Northern Territory, Australia
- Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Sonja Janson
- Department of Infectious Diseases, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Steven C Wallis
- University of Queensland Centre for Clinical Research, University of Queensland, Brisbane, Queensland, Australia
| | - Jason A Roberts
- University of Queensland Centre for Clinical Research, University of Queensland, Brisbane, Queensland, Australia
- Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
- Herston Infectious Diseases Institute (HeIDI), Metro North Health, Brisbane, QLD, Australia
- Division of Anaesthesiology Critical Care Emergency and Pain Medicine, Nîmes University Hospital, University of Montpellier, Nîmes, France
| | - Danny Tsai
- College of Medicine and Public Health, Flinders University, Corner Skinner and Simpson Streets, Darwin 0870, Northern Territory, Australia
- University of Queensland Centre for Clinical Research, University of Queensland, Brisbane, Queensland, Australia
- Pharmacy Department, Alice Springs Hospital, Alice Springs, Northern Territory, Australia
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18
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Li Z, Yang L, Xi Z, Yi W, Zeng X, Ma D, Lei Y. Prediction models for intradialytic hypotension in hemodialysis patients: A protocol for systematic review and critical appraisal. PLoS One 2024; 19:e0310191. [PMID: 39250467 PMCID: PMC11383225 DOI: 10.1371/journal.pone.0310191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 08/27/2024] [Indexed: 09/11/2024] Open
Abstract
Intradialytic hypotension (IDH) is common in hemodialysis patients and can lead to several complications. Risk factors for IDH include demographic characteristics, comorbidities, dialysis procedure factors, and so on. Clinical studies on predictive models for dialysis-induced hypotension have shown inconsistent results. This systematic review aims to evaluate published prediction models for IDH, analyzing their characteristics, predictors, efficacy, and the methodological quality and applicability. The protocol has been prepared using the Preferred Items for Systematic Review and Meta-analysis Protocols (PRISMA-P) guidelines. The systematic review protocol for IDH prediction in hemodialysis patients has been registered with the International Platform of Registered Systematic Review and Meta-analysis Protocols (INPLASY2023110081, DOI: 10.37766/inplasy2023.11.0081). A comprehensive search across five major databases (PubMed, Web of Science, Cochrane Library, CNKI, and Wanfang) will be conducted for studies on prediction models of IDH among hemodialysis patients. Two researchers will independently screen literature, extract data, and evaluate the bias risk and applicability of included studies using prediction modelling study tools. This systematic review will provide critical insights into the efficacy and quality of reporting of the IDH model in hemodialysis patients. This will guide clinical staff in selecting the most appropriate IDH prediction model and inform future research endeavors in IDH prediction.
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Affiliation(s)
- Zifeng Li
- Department of Traditional Chinese Medicine, The First College of Clinical Medical Science, Yichang Central People’s Hospital, Three Gorges University, Yichang City, Hubei Province, China
| | - Luhuan Yang
- Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
- Yichang Hubo Medical Research Institute, Yichang City, Hubei Province, China
| | - Zuyang Xi
- Department of Nursing, the First College of Clinical Medical Science, Yichang Central People’s Hospital, Three Gorges University, Yichang City, Hubei Province, China
| | - Wen Yi
- Department of Traditional Chinese Medicine, The First College of Clinical Medical Science, Yichang Central People’s Hospital, Three Gorges University, Yichang City, Hubei Province, China
| | - Xiaoqian Zeng
- Department of Traditional Chinese Medicine, The First College of Clinical Medical Science, Yichang Central People’s Hospital, Three Gorges University, Yichang City, Hubei Province, China
| | - Dongling Ma
- Department of Traditional Chinese Medicine, The First College of Clinical Medical Science, Yichang Central People’s Hospital, Three Gorges University, Yichang City, Hubei Province, China
| | - Yunhong Lei
- Yichang Hubo Medical Research Institute, Yichang City, Hubei Province, China
- Philippine Women’s University School of Nursing, Manila, Philippines
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19
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Secombe P, Lankin E, Beadle R, McAnulty G, Brown A, Bailey M, Schultz R, Pilcher D. Aboriginal and Torres Strait Islander Attitudes to Organ Donation in Central Australia: A Qualitative Pilot Study. Transplant Direct 2024; 10:e1692. [PMID: 39220219 PMCID: PMC11365648 DOI: 10.1097/txd.0000000000001692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 06/05/2024] [Accepted: 06/26/2024] [Indexed: 09/04/2024] Open
Abstract
Background Organ transplantation is a well-established intervention but is reliant on the donation of organs and tissues, mostly from deceased donors. The proportion of Australians proceeding to organ donation (OD) has increased, but the proportion of Indigenous Australians proceeding remains two-thirds that of non-Indigenous Australians. We sought to explore perceived barriers and enablers for the involvement of Indigenous peoples in the OD process. Methods Qualitative methodology centered around focus groups was used to capture the experiences and perspectives of Indigenous people regarding OD. A purposively sampled group of Aboriginal Liaison Officers working within the Alice Springs Hospital Intensive Care Unit (ASH ICU) participated in up to 6 focus groups during 2021 with subsequent thematic analysis of the enablers and barriers to Indigenous participation in the OD process. The ASH ICU is the only ICU servicing Central Australia, and 70% of admissions are Indigenous patients. Results Four primary themes emerged: OD is a new and culturally taboo topic; conversations related to OD are confronting; education is needed (both about OD and cultural education for clinicians); and lack of trust in the healthcare system. Conclusions There are cultural barriers to engaging in the OD process and clinicians need more training on the delivery of culturally safe communication is needed. Despite this, there was a recognition that OD is important. Education about OD needs to be place based, culturally and linguistically appropriate, informed by local knowledge, delivered in community, and occur before a family member is admitted to ICU.
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Affiliation(s)
- Paul Secombe
- Intensive Care Unit, Alice Springs Hospital, Alice Springs (Mparntwe), NT, Australia
- School of Medicine, Flinders University, Bedford Park, SA, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia
- Australian and New Zealand Intensive Care Society Centre for Outcome and Resource Evaluation, Prahran, Vic, Australia
| | - Emslie Lankin
- Intensive Care Unit, Alice Springs Hospital, Alice Springs (Mparntwe), NT, Australia
| | - Rosalind Beadle
- Centre for Remote Health, Flinders University, Alice Springs (Mparntwe), NT, Australia
| | - Greg McAnulty
- Intensive Care Unit, Alice Springs Hospital, Alice Springs (Mparntwe), NT, Australia
- School of Medicine, Flinders University, Bedford Park, SA, Australia
| | - Alex Brown
- National Centre For Indigenous Genomics, College of Health and Medicine, Australian National University, Canberra, ACT, Australia
- Aboriginal Health Equity, South Australian Health and Medical Research Institute (SAHMRI), SA, Australia
| | - Michael Bailey
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia
| | - Rebecca Schultz
- Public and Primary Health Care, Alice Springs (Mparntwe), NT, Australia
| | - David Pilcher
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia
- Australian and New Zealand Intensive Care Society Centre for Outcome and Resource Evaluation, Prahran, Vic, Australia
- Department of Intensive Care, The Alfred Hospital, Prahran, Melbourne, Vic, Australia
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20
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Pai CH, Chen CL, Wang CH, Chi NH, Huang SC, Tseng LJ, Lai CH, Yu HY, Chou NK, Hsu RB, Chen YS. End-stage renal disease should not Be considered a contraindication for veno-arterial extracorporeal membrane oxygenation. J Formos Med Assoc 2024; 123:985-991. [PMID: 38527921 DOI: 10.1016/j.jfma.2024.03.012] [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: 11/19/2023] [Revised: 02/18/2024] [Accepted: 03/14/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND This study aims to determine whether end-stage renal disease (ESRD) is a true contraindication for extracorporeal membrane oxygenation in adult patients. MATERIALS AND METHODS Adult patients who received VA-ECMO at National Taiwan University Hospital between January 2010 and December 2021 were included. Patients who received regular dialysis before the index admission were included in the ESRD group. The primary outcome was in-hospital mortality. RESULTS 1341 patients were included in the analysis, 121 of whom had ESRD before index admission. The ESRD group was older (62.3 versus 56.8 years; P < 0.01) and had more comorbidities. Extracorporeal cardiopulmonary resuscitation (ECPR) was used more frequently in the ESRD group (66.1% versus 51.6%; P < 0.001). The ESRD group had higher in-hospital mortality rates (72.7% versus 63.3%; P = 0.03). In the ECPR subgroup, there was no difference of survival between ESRD and others(P = 0.56). In the multivariate Cox regression, ESRD was not an independent predictor for mortality (P = 0.20). CONCLUSION ESRD was not an independent predictor of in-hospital mortality after VA-ECMO. The survival of ESRD patients was not inferior to those without ESRD when receiving ECPR. Therefore, ESRD should not be considered a contraindication to VA-ECMO in adults.
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Affiliation(s)
- Chen-Hsu Pai
- Division of Cardiovascular Surgery, Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chi-Ling Chen
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chih-Hsien Wang
- Division of Cardiovascular Surgery, Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
| | - Nai-Hsin Chi
- Division of Cardiovascular Surgery, Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Shu-Chien Huang
- Division of Cardiovascular Surgery, Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Li-Jung Tseng
- Division of Cardiovascular Surgery, Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chien-Heng Lai
- Division of Cardiovascular Surgery, Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Hsi-Yu Yu
- Division of Cardiovascular Surgery, Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Nai-Kuan Chou
- Division of Cardiovascular Surgery, Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ron-Bin Hsu
- Division of Cardiovascular Surgery, Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yih-Sharng Chen
- Division of Cardiovascular Surgery, Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
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21
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Coppes T, Philbert D, van Gelder T, Bouvy ML, Koster ES. Medication management during sick days: No differences between patients with and without impaired renal function. Eur J Clin Invest 2024; 54:e14231. [PMID: 38641996 DOI: 10.1111/eci.14231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 04/05/2024] [Accepted: 04/11/2024] [Indexed: 04/22/2024]
Affiliation(s)
- Tristan Coppes
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Faculty of Science, Utrecht University, Utrecht, The Netherlands
| | - Daphne Philbert
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Faculty of Science, Utrecht University, Utrecht, The Netherlands
| | - Teun van Gelder
- Department of Clinical Pharmacy & Toxicology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Marcel L Bouvy
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Faculty of Science, Utrecht University, Utrecht, The Netherlands
| | - Ellen S Koster
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Faculty of Science, Utrecht University, Utrecht, The Netherlands
- Clinical Health Sciences, Education Center, University Medical Center Utrecht, Utrecht, The Netherlands
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22
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Tesfaye AH, Birhanu A, Kolola T, Hamza L, Etana D. Time to death and its predictors among patients with chronic kidney disease on hemodialysis at dialysis unit in Addis Ababa, Ethiopia: a retrospective cohort study. BMC Nephrol 2024; 25:279. [PMID: 39198767 PMCID: PMC11360759 DOI: 10.1186/s12882-024-03719-3] [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: 12/26/2023] [Accepted: 08/19/2024] [Indexed: 09/01/2024] Open
Abstract
BACKGROUND Chronic kidney disease is a progressive disease that affects more than 10% of the world's population and is also the leading cause of death in the twenty-first century. Furthermore, it imposes a significant financial burden on people undergoing hemodialysis. However, there is little research, particularly in the study area, on time to death and its predicators among hemodialysis patients in Ethiopia; therefore, knowing time to death and identifying predicators that affect survival time is crucial in order to improve survival time and enhance the prognosis of hemodialysis patients. The aim of this study was to assess time to death and its predictors among patients with chronic kidney disease on hemodialysis at a dialysis unit in Addis Ababa, Ethiopia, in 2023. METHODS An institution-based retrospective cohort study was carried out among 370 chronic kidney disease patients on hemodialysis from January 1st, 2017 to December 30th, 2022. Data were extracted from April 1st-May 20th, 2023, and each variable was coded and entered into Epi Data version 3.1 and then exported into STATA version 15 software for analysis. Kaplan-Meier and the log-rank test were done. Bivariable Cox-proportional regression was done, and a variable whose p-value was < 0.25 and fulfilled the proportional hazard assumption by using graphical and Shenfield residuals was entered into multivariable Cox-proportional regression. Finally, a variable whose p-value < 0.05 and adjusted hazard ratio with its CI were declared statistically significant predictors. RESULT In this study, the overall median survival time was 47 months (95% CI: 36.7, 56), with an incidence rate of death of 16.8 per 1000 people per month of observation (95% CI: 13.8-20.3). Age 64 and above (Adjusted Hazard Ration: 2.8; 95% CI: 1.67-4.98), catheter vascular access (Adjusted Hazard Ration: 3.47; 95% CI: 2.03-5.93), cardiovascular disease (Adjusted Hazard Ration: 1.88; 95% CI: 1.15-3.07), and blood group B (Adjusted Hazard Ration: 2.07; 95% CI: 1.17-3.69) were significant predictors of time to death among hemodialysis patients. CONCLUSION AND RECOMMENDATION: The median survival time was 47 months, with an interquartile range of 40. Cardiovascular disease, older adults, central venous catheters, and blood type B were significant predictors of time to death for hemodialysis patients. Therefore, in order to improve the survival of hemodialysis patients, health professionals and concerned bodies should give concern to and work on those predictors.
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Affiliation(s)
- Azeb Haile Tesfaye
- Department of Nursing, College of Health Sciences, Assosa University, Assosa, Ethiopia.
| | - Adamu Birhanu
- Department of Psychiatry Nursing, College of Health Sciences and Referral Hospital, Ambo University, Ambo, Ethiopia
| | - Tufa Kolola
- Departments of Public Health, College of Health Sciences and Referral Hospital , Ambo University, Ambo, Ethiopia
| | - Leja Hamza
- Department of Internal Medicine, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Diriba Etana
- Department of Midwifery, College of Health Sciences Assosa University, Assosa, Ethiopia
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23
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Xu X, Yu B, Lv Y, Cai Q, Li M, Li G, Chen S, Li Q. Epidural block with lidocaine ameliorates kidney function deterioration and fibrosis of chronic kidney disease in rats. Am J Med Sci 2024:S0002-9629(24)01413-7. [PMID: 39159750 DOI: 10.1016/j.amjms.2024.08.020] [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: 05/29/2023] [Revised: 07/11/2024] [Accepted: 08/15/2024] [Indexed: 08/21/2024]
Abstract
BACKGROUND According to evidences from clinical practices and experiments, renal denervation achieved by removing both the afferent and sympathetic nerves has therapeutic impacts on poor renal function and hypertension in chronic kidney disease (CKD). Epidural anesthesia is presumed to function on the target spine segments with a complete sympathetic block. Based on this perspective, we hypothesized that epidural block with lidocaine could ameliorate renal injury in CKD rats. METHOD AND RESULTS Male Sprague-Dawley rats weighing 250-300 g were randomized into four groups: control, CKD, CKD + sham, and CKD + epidural block with lidocaine groups. CKD was induced by resection of the lower and upper thirds of the left kidney followed by right nephrectomy one week later. Significant differences in renal function, sympathetic activation as well as renal fibrosis parameters were observed between CKD and control rats. These parameters corresponded with typical phenotypes of CKD rats. Epidural block with lidocaine improved renal function as well as renal fibrosis, and reversed the abnormalities of the renal function and cardiovascular parameters either fully or partially. CONCLUSION Epidural block with lidocaine confers renal protection, which is presumably mediated by decreasing sympathetic nerve activities in the renal region and other target organs in CKD.
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Affiliation(s)
- Xin Xu
- Department of Anesthesiology and Perioperative Medicine, Translational Research Institute of Brain and Brain-like Intelligence, Clinical Research Center for Anesthesiology and Perioperative Medicine, Shanghai Fourth People's Hospital, School of Medicine, Tongji University, Shanghai 200434, PR China; Shanghai Key Laboratory of Anesthesiology and Brain Functional Modulation, Shanghai 200434, PR China
| | - Buwei Yu
- Department of Anesthesiology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine, PR China
| | - Youwen Lv
- Department of Anesthesiology, Beijing University of Chinese Medicine Shenzhen Hospital, Shenzhen 518172, PR China
| | - Qing Cai
- Department of Anesthesiology and Perioperative Medicine, Translational Research Institute of Brain and Brain-like Intelligence, Clinical Research Center for Anesthesiology and Perioperative Medicine, Shanghai Fourth People's Hospital, School of Medicine, Tongji University, Shanghai 200434, PR China; Shanghai Key Laboratory of Anesthesiology and Brain Functional Modulation, Shanghai 200434, PR China
| | - Mengya Li
- Department of Anesthesiology and Perioperative Medicine, Translational Research Institute of Brain and Brain-like Intelligence, Clinical Research Center for Anesthesiology and Perioperative Medicine, Shanghai Fourth People's Hospital, School of Medicine, Tongji University, Shanghai 200434, PR China; Shanghai Key Laboratory of Anesthesiology and Brain Functional Modulation, Shanghai 200434, PR China
| | - Guifeng Li
- Department of Anesthesiology and Perioperative Medicine, Translational Research Institute of Brain and Brain-like Intelligence, Clinical Research Center for Anesthesiology and Perioperative Medicine, Shanghai Fourth People's Hospital, School of Medicine, Tongji University, Shanghai 200434, PR China; Shanghai Key Laboratory of Anesthesiology and Brain Functional Modulation, Shanghai 200434, PR China
| | - Shunjie Chen
- Department of Nephrology, Shanghai Fourth People's Hospital, School of Medicine, Tongji University, Shanghai 200434, PR China.
| | - Qifang Li
- Department of Anesthesiology and Perioperative Medicine, Translational Research Institute of Brain and Brain-like Intelligence, Clinical Research Center for Anesthesiology and Perioperative Medicine, Shanghai Fourth People's Hospital, School of Medicine, Tongji University, Shanghai 200434, PR China; Shanghai Key Laboratory of Anesthesiology and Brain Functional Modulation, Shanghai 200434, PR China.
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Muhamad N, Youngvises N, Plengsuriyakarn T, Meesiri W, Chaijaroenkul W, Na-Bangchang K. MyACR: A Point-of-Care Medical Device for Determination of Albumin-Creatinine Ratio (uACR) in Random Urine Samples as a Marker of Nephropathy. Diagnostics (Basel) 2024; 14:1702. [PMID: 39202190 PMCID: PMC11354193 DOI: 10.3390/diagnostics14161702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 08/01/2024] [Accepted: 08/02/2024] [Indexed: 09/03/2024] Open
Abstract
Chronic kidney disease (CKD) is a progressive condition that affects more than 10% of the world's population. Monitoring urine albumin-to-creatinine ratio (uACR) has become the gold standard for nephropathy diagnosis and control. The objective of the present study was to develop a simple, accurate, sensitive, and rapid point-of-care test (PoCT) device, MyACR, for uACR measurement, intended for use in community healthcare to screen for the risk and monitor the progress of CKD. Albumin and creatinine concentrations in urine samples were determined using spectrophotometric dye (tetrabromophenol blue)-binding and colorimetric Jaffe assay, respectively. Urine samples were diluted with distilled water (1:80) and mixed separately with albumin and creatinine reaction mixture. The creatinine reaction was incubated at room temperature (25 °C) for 30 min before analysis. Optical density (OD) was measured at the wavelengths of 625 nm (albumin) and 515 nm (creatinine). All calibration curves (0-60 mg/L and 0-2 mg/dL for albumin and creatinine) yielded linear relationships with correlation coefficients (R2) of >0.997. Good accuracy (% deviation of mean value (DMV) ≤ 5.42%) and precision (% coefficients of variation (CV) ≤ 12.69%) were observed from both the intra- and inter-day assays for the determination of albumin and creatinine using MyACR. The limit of quantification (LOQ) of albumin and creatinine in urine samples determined using MyACR and a laboratory spectrophotometer were 5 mg/L and 0.25 mg/dL, respectively, using 37.5 μL urine spiked samples (n = 5). The device was well-applied with clinical samples from 20 CKD patients. The median (range) of %DMV of the central (hospital) laboratory method (immune-based assay) was 3.48 (-17.05 to 21.64)%, with a high correlation coefficient (R2 > 0.98). In conclusion, MyACR showed satisfactory test performance in terms of accuracy, reproducibility, and sensitivity. Cost-effectiveness and improvement in clinical decision making need to be proven in future multisite community and home studies.
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Affiliation(s)
- Nadda Muhamad
- Department of Biomedicine and Health Informatics, Faculty of Pharmacy, Silpakorn University, Nakhon Pathom 73000, Thailand;
| | - Napaporn Youngvises
- Bangkok High Lab Co., Ltd., Bang Khen District, Bangkok 10220, Thailand; (N.Y.); (W.M.)
| | - Tullayakorn Plengsuriyakarn
- Graduate Program in Bioclinical Sciences, Chulabhorn International College of Medicine, Thammasat University, Pathum Thani 12120, Thailand; (T.P.); (W.C.)
| | - Wanchai Meesiri
- Bangkok High Lab Co., Ltd., Bang Khen District, Bangkok 10220, Thailand; (N.Y.); (W.M.)
| | - Wanna Chaijaroenkul
- Graduate Program in Bioclinical Sciences, Chulabhorn International College of Medicine, Thammasat University, Pathum Thani 12120, Thailand; (T.P.); (W.C.)
| | - Kesara Na-Bangchang
- Graduate Program in Bioclinical Sciences, Chulabhorn International College of Medicine, Thammasat University, Pathum Thani 12120, Thailand; (T.P.); (W.C.)
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Zhang Z, Lv L, Guan S, Jiang F, He D, Song H, Sun W, Jiang S, Tian F. Association between serum methylmalonic acid and chronic kidney disease in adults: a cross-sectional study from NHANES 2013-2014. Front Endocrinol (Lausanne) 2024; 15:1434299. [PMID: 39149121 PMCID: PMC11324440 DOI: 10.3389/fendo.2024.1434299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Accepted: 07/22/2024] [Indexed: 08/17/2024] Open
Abstract
Introduction Chronic kidney disease(CKD) is a global medical problem. Serum methylmalonic acid(MMA) is a serum marker associated with many diseases. This study aimed to investigate the association between MMA and CKD. Methods Data from the National Health and Nutrition Examination Survey (NHANES) 2013-2014 were downloaded and analyzed. The association between MMA and CKD was confirmed by using multiple logistic regression modeling. The smooth curve fitting method was used to investigate the nonlinear relationship between them. Subgroup analyses and interaction tests were used to verify the stability of the association between different subgroups. Threshold effect analysis was used to determine the optimal control point for MMA. Results There was a unique W-shaped nonlinear relationship between MMA and the risk of CKD, with a positive correlation between them (OR=1.66,95% CI:1.27, 2.17; P=0.0002). As the stage of CKD progressed, MMA levels increased. Age, hypertension, and serum vitamin B12 had significant influences on the association between MMA and the risk of CKD. Conclusion Our findings revealed that serum MMA accumulation was positively associated with the risk of CKD. Serum MMA level may be a novel index to predict the development and course of CKD. This study may help in the early identification of people at risk for chronic kidney disease and provide new ideas and approaches for prevention and treatment.
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Affiliation(s)
- Zufa Zhang
- Department of Urology, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning, China
- Zhongshan Clinical Collage of Dalian University, Dalian, Liaoning, China
| | - Long Lv
- Department of Urology, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning, China
- Key Laboratory of Microenvironment Regulation and Immunotherapy of Urinary Tumors of Liaoning Province, Dalian, Liaoning, China
| | - Sheng Guan
- Department of Urology, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning, China
- Key Laboratory of Microenvironment Regulation and Immunotherapy of Urinary Tumors of Liaoning Province, Dalian, Liaoning, China
| | - Fengze Jiang
- Department of Urology, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning, China
- Key Laboratory of Microenvironment Regulation and Immunotherapy of Urinary Tumors of Liaoning Province, Dalian, Liaoning, China
| | - Danni He
- Department of Urology, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning, China
- Key Laboratory of Microenvironment Regulation and Immunotherapy of Urinary Tumors of Liaoning Province, Dalian, Liaoning, China
| | - Hongxuan Song
- Department of Urology, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning, China
- Key Laboratory of Microenvironment Regulation and Immunotherapy of Urinary Tumors of Liaoning Province, Dalian, Liaoning, China
| | - Weibing Sun
- Department of Urology, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning, China
- Key Laboratory of Microenvironment Regulation and Immunotherapy of Urinary Tumors of Liaoning Province, Dalian, Liaoning, China
| | - Sixiong Jiang
- Department of Urology, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning, China
- Key Laboratory of Microenvironment Regulation and Immunotherapy of Urinary Tumors of Liaoning Province, Dalian, Liaoning, China
| | - Feng Tian
- Department of Urology, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning, China
- Key Laboratory of Microenvironment Regulation and Immunotherapy of Urinary Tumors of Liaoning Province, Dalian, Liaoning, China
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Liu L, Zhou H, Wang X, Wen F, Zhang G, Yu J, Shen H, Huang R. Effects of environmental phenols on eGFR: machine learning modeling methods applied to cross-sectional studies. Front Public Health 2024; 12:1405533. [PMID: 39148651 PMCID: PMC11324456 DOI: 10.3389/fpubh.2024.1405533] [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: 03/23/2024] [Accepted: 07/26/2024] [Indexed: 08/17/2024] Open
Abstract
Purpose Limited investigation is available on the correlation between environmental phenols' exposure and estimated glomerular filtration rate (eGFR). Our target is established a robust and explainable machine learning (ML) model that associates environmental phenols' exposure with eGFR. Methods Our datasets for constructing the associations between environmental phenols' and eGFR were collected from the National Health and Nutrition Examination Survey (NHANES, 2013-2016). Five ML models were contained and fine-tuned to eGFR regression by phenols' exposure. Regression evaluation metrics were used to extract the limitation of the models. The most effective model was then utilized for regression, with interpretation of its features carried out using shapley additive explanations (SHAP) and the game theory python package to represent the model's regression capacity. Results The study identified the top-performing random forest (RF) regressor with a mean absolute error of 0.621 and a coefficient of determination of 0.998 among 3,371 participants. Six environmental phenols with eGFR in linear regression models revealed that the concentrations of triclosan (TCS) and bisphenol S (BPS) in urine were positively correlated with eGFR, and the correlation coefficients were β = 0.010 (p = 0.026) and β = 0.007 (p = 0.004) respectively. SHAP values indicate that BPS (1.38), bisphenol F (BPF) (0.97), 2,5-dichlorophenol (0.87), TCS (0.78), BP3 (0.60), bisphenol A (BPA) (0.59) and 2,4-dichlorophenol (0.47) in urinary contributed to the model. Conclusion The RF model was efficient in identifying a correlation between phenols' exposure and eGFR among United States NHANES 2013-2016 participants. The findings indicate that BPA, BPF, and BPS are inversely associated with eGFR.
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Affiliation(s)
- Lei Liu
- Department of Pathology, Affiliated Hospital of Nantong University, Nantong, China
| | - Hao Zhou
- Department of Thoracic Surgery, Affiliated Hospital of Nantong University, Nantong, China
| | - Xueli Wang
- Department of Pathology, Qingdao Eighth People's Hospital, Qingdao, China
| | - Fukang Wen
- Institute of Computer Science and Engineering, Sun Yat-Sen University, Guangzhou, China
| | - Guibin Zhang
- College of Electronic and Information Engineering, Tongji University, Shanghai, China
| | - Jinao Yu
- Institute of Computer Science and Engineering, University of Wisconsin-Madison, Madison, WI, United States
| | - Hui Shen
- Department of Computer Science and Engineering, The Ohio State University, Columbus, OH, United States
| | - Rongrong Huang
- Department of Pharmacy, Affiliated Hospital of Nantong University, Nantong, China
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Li K, Hou Q, Li X, Tian L, Wang L, Wu S, Han Q. Triglyceride-glucose index predicts major adverse cardiovascular events in patients with chronic kidney disease. Int Urol Nephrol 2024; 56:2793-2802. [PMID: 38536621 DOI: 10.1007/s11255-024-04005-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 02/05/2024] [Indexed: 07/25/2024]
Abstract
BACKGROUND AND PURPOSE Triglyceride-glucose (TyG) index has been regarded as a reliable surrogate marker of insulin resistance for predicting cardiovascular outcomes. The current study aimed to explore the associations between TyG index with major adverse cardiovascular events (MACE) in patients with chronic kidney disease (CKD). METHODS/PATIENTS 13,517 patients with chronic kidney disease (CKD) from the Kailuan study were included. Patients were divided into quartiles according to the TyG index. The outcomes were MACE, including acute myocardial infarction (AMI) and ischemic stroke (IS). The association between TyG index and the risk of MACE was analyzed by Cox regression models. RESULTS During 13.87-year follow-up, a total 1356 MACEs occurred. Multivariable Cox proportional-hazards analyses showed that a higher TyG index quartile was associated with an elevated risk of MACE. CONCLUSIONS TyG index is significantly related to MACE in patients with CKD. TyG index can be regarded as a novel predictor of MACE for patients with CKD.
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Affiliation(s)
- Kangbo Li
- Department of Internal Medicine, Wenfeng District Xiguan Subdistrict Office Community Health Center, Anyang, China
| | - Qiqi Hou
- Hebei Medical University, Shijiazhuang, China
| | - Xinyi Li
- School of Clinical Medicine, Xiangnan University, Chenzhou, China
| | - Liying Tian
- Catheterization Unit, Tangshan Gongren Hospital, Tangshan, China
| | - Liyan Wang
- Department of Cardiology, Tangshan Gongren Hospital, Tangshan, China
| | - Shouling Wu
- Department of Cardiology, Kailuan General Hospital, Tangshan, China
| | - Quanle Han
- Department of Cardiology, Tangshan Gongren Hospital, Tangshan, China.
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Wang H, Gao L, Zhao C, Fang F, Liu J, Wang Z, Zhong Y, Wang X. The role of PI3K/Akt signaling pathway in chronic kidney disease. Int Urol Nephrol 2024; 56:2623-2633. [PMID: 38498274 DOI: 10.1007/s11255-024-03989-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 02/12/2024] [Indexed: 03/20/2024]
Abstract
Chronic kidney disease (CKD), including chronic glomerulonephritis, IgA nephropathy and diabetic nephropathy, are common chronic diseases characterized by structural damage and functional decline of the kidneys. The current treatment of CKD is symptom relief. Several studies have reported that the phosphatidylinositol 3 kinases (PI3K)/protein kinase B (Akt) signaling pathway is a pathway closely related to the pathological process of CKD. It can ameliorate kidney damage by inhibiting this signal pathway which is involved with inflammation, oxidative stress, cell apoptosis, epithelial mesenchymal transformation (EMT) and autophagy. This review highlights the role of activating or inhibiting the PI3K/Akt signaling pathway in CKD-induced inflammatory response, apoptosis, autophagy and EMT. We also summarize the latest evidence on treating CKD by targeting the PI3K/Akt pathway, discuss the shortcomings and deficiencies of PI3K/Akt research in the field of CKD, and identify potential challenges in developing these clinical therapeutic CKD strategies, and provide appropriate solutions.
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Affiliation(s)
- Hongshuang Wang
- Graduate School, Hebei University of Chinese Medicine, Shijiazhuang, 050091, China
| | - Lanjun Gao
- Graduate School, Hebei University of Chinese Medicine, Shijiazhuang, 050091, China
| | - Chenchen Zhao
- Graduate School, Hebei University of Chinese Medicine, Shijiazhuang, 050091, China
| | - Fang Fang
- Graduate School, Hebei University of Chinese Medicine, Shijiazhuang, 050091, China
| | - Jiazhi Liu
- Graduate School, Hebei University of Chinese Medicine, Shijiazhuang, 050091, China
| | - Zheng Wang
- Hebei Key Laboratory of Integrative Medicine on Liver-Kidney Patterns Research, Shijiazhuang, 050091, China
- Institute of Integrative Medicine, College of Integrative Medicine, Hebei University of Chinese Medicine, Shijiazhuang, 050200, China
| | - Yan Zhong
- Hebei Key Laboratory of Integrative Medicine on Liver-Kidney Patterns Research, Shijiazhuang, 050091, China.
- Institute of Integrative Medicine, College of Integrative Medicine, Hebei University of Chinese Medicine, Shijiazhuang, 050200, China.
| | - Xiangting Wang
- Hebei Key Laboratory of Integrative Medicine on Liver-Kidney Patterns Research, Shijiazhuang, 050091, China.
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Liu F, Chen X, Wang Q, Lin W, Li Y, Zhang R, Huang H, Jiang S, Niu Y, Liu W, Wang L, Zhang W, Zheng Y, Cao X, Wang Y, Wu J, Zhang L, Tang L, Zhou J, Chen P, Cai G, Dong Z. Correlation between retinal vascular geometric parameters and pathologically diagnosed type 2 diabetic nephropathy. Clin Kidney J 2024; 17:sfae204. [PMID: 39099565 PMCID: PMC11292218 DOI: 10.1093/ckj/sfae204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Indexed: 08/06/2024] Open
Abstract
Background Diabetic nephropathy (DN) and diabetic retinopathy (DR) are common microvascular complications of diabetes. The purpose of this study was to investigate the correlation between retinal vascular geometric parameters and pathologically diagnosed type 2 DN and to determine the capacity of retinal vascular geometric parameters in differentiating DN from non-diabetic renal disease (NDRD). Methods The study participants were adult patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease who underwent a renal biopsy. Univariate and multivariable regression analyses were performed to evaluate associations between retinal vessel geometry parameters and pathologically diagnosed DN. Multivariate binary logistic regression analyses were performed to establish a differential diagnostic model for DN. Results In total, 403 patients were examined in this cross-sectional study, including 152 (37.7%) with DN, 157 (39.0%) with NDRD and 94 (23.3%) with DN combined with NDRD. After univariate logistic regression, total vessel fractal dimension, arteriolar fractal dimension and venular fractal dimension were all found to be associated with DN. In multivariate analyses adjusting for age, sex, blood pressure, diabetes, DR and other factors, smaller retinal vascular fractal dimensions were significantly associated with DN (P < .05). We developed a differential diagnostic model for DN combining traditional clinical indicators and retinal vascular geometric parameters. The area under the curve of the model established by multivariate logistic regression was 0.930. Conclusions Retinal vessel fractal dimension is of great significance for the rapid and non-invasive differentiation of DN. Incorporating retinal vessel fractal dimension into the diagnostic model for DN and NDRD can improve the diagnostic efficiency.
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Affiliation(s)
- Fang Liu
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Diseases Research, Beijing, China
- First Clinical Medical College, Guangdong Pharmaceutical University, Guangzhou, China
| | - Xiaoniao Chen
- Senior Department of Ophthalmology, Third Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Qian Wang
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Diseases Research, Beijing, China
| | - Wenwen Lin
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Diseases Research, Beijing, China
- First Clinical Medical College, Guangdong Pharmaceutical University, Guangzhou, China
| | - Ying Li
- Senior Department of Ophthalmology, Third Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Ruimin Zhang
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Diseases Research, Beijing, China
- College of Basic Medical Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Hui Huang
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Diseases Research, Beijing, China
- First Clinical Medical College, Guangdong Pharmaceutical University, Guangzhou, China
| | - Shuangshuang Jiang
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Diseases Research, Beijing, China
| | - Yue Niu
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Diseases Research, Beijing, China
| | - Weicen Liu
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Diseases Research, Beijing, China
| | - Liqiang Wang
- Senior Department of Ophthalmology, Third Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Weiguang Zhang
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Diseases Research, Beijing, China
| | - Ying Zheng
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Diseases Research, Beijing, China
| | - Xueying Cao
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Diseases Research, Beijing, China
| | - Yong Wang
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Diseases Research, Beijing, China
| | - Jie Wu
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Diseases Research, Beijing, China
| | - Li Zhang
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Diseases Research, Beijing, China
| | - Li Tang
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Diseases Research, Beijing, China
| | - Jianhui Zhou
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Diseases Research, Beijing, China
| | - Pu Chen
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Diseases Research, Beijing, China
| | - Guangyan Cai
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Diseases Research, Beijing, China
| | - Zheyi Dong
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Diseases Research, Beijing, China
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Tan SS, Tan WY, Zheng LS, Adinugraha P, Wang HY, Kumar S, Gulati A, Khurana S, Lam W, Aye T. Multi-year population-based analysis of Asian patients with acute decompensated heart failure and advanced chronic kidney disease. Curr Probl Cardiol 2024; 49:102618. [PMID: 38735349 DOI: 10.1016/j.cpcardiol.2024.102618] [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: 04/29/2024] [Accepted: 05/05/2024] [Indexed: 05/14/2024]
Abstract
BACKGROUND Data on disparities in outcomes and risk factors in Asian patients with advanced chronic kidney disease admitted for heart failure are scare. METHODS This was a retrospective cohort study that utilized data from the National Inpatient Sample between January 2016 and December 2019. Patients who had a primary diagnosis of acute decompensated heart failure and a concomitant diagnosis of advanced CKD were included. The primary outcome of interest was in-hospital mortality. Secondary outcomes include hospital cost, length of stay, and other clinical outcomes. Weighted multivariable logistic regression was used to adjust for comorbidities. RESULTS There were 251,578 cases of ADHF with advanced CKD, out of which 2.6 % were from individuals of Asian ethnicity. Asian patients exhibited a higher burden of comorbidities in comparison to other UREM patients, but a lower burden than White patients. Regardless of differences in comorbidity burden, Asian patients exhibited a higher likelihood of experiencing severe consequences. After adjusting for comorbidies, White (OR:1.11; 95 % CI 1.03-1.20;0.009) patients had higher odds of mortality than Asian patients. However, Blacks (OR: 0.58; 95 % CI 0.53 to 0.63; p < 0.001) and Hispanics (OR: 0.69; 95 % CI 0.62 to 0.78; p < 0.001) had lower odds of mortality. CONCLUSION This first population-based studies shows that Asian patients with advanced CKD admitted for ADHF have greater comorbidity burden and poorer outcomes Black and Hispanic patients. This data underscores the importance of comprehensive approaches in phenotyping, and ethnic specific interventions.
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Affiliation(s)
- Samuel S Tan
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Beth Israel, New York, New York, USA.
| | - Wenchy Yy Tan
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Beth Israel, New York, New York, USA; Department of Population Health Sciences, Weill Cornell, New York, New York, USA
| | - Lucy S Zheng
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Beth Israel, New York, New York, USA
| | - Paulus Adinugraha
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel/West, New York, New York, USA
| | - Hong Yu Wang
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Beth Israel, New York, New York, USA
| | - Shasawat Kumar
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Beth Israel, New York, New York, USA
| | - Amit Gulati
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel/West, New York, New York, USA
| | - Sakshi Khurana
- Department of Radiology, Columbia University, New York, New York, USA
| | - Wan Lam
- Department of Medicine, Lenox Hill Hospital, New York, New York, USA
| | - Thida Aye
- Department of Medicine, Lenox Hill Hospital, New York, New York, USA
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McCarthy FA, Bonilla-Felix M. Advancing equitable access to care and optimal medication practice. World Kidney Day 2024. Pediatr Nephrol 2024; 39:2279-2282. [PMID: 38532035 DOI: 10.1007/s00467-024-06353-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 02/27/2024] [Accepted: 02/28/2024] [Indexed: 03/28/2024]
Affiliation(s)
- Florencio A McCarthy
- Department of Medicine, Pediatric Nephrology Service, Hospital del Niño "Dr. José Renán Esquivel", Panama City, Panama.
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32
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Rose M, Fischer FH, Liegl G, Strippoli GFM, Hockham C, Vernooij RWM, Barth C, Canaud B, Covic A, Cromm K, Cucui AM, Davenport A, Fischer KI, Hegbrant J, Jaha H, Schappert A, Török M, Woodward M, Bots ML, Blankestijn PJ. The CONVINCE randomized trial found positive effects on quality of life for patients with chronic kidney disease treated with hemodiafiltration. Kidney Int 2024:S0085-2538(24)00534-9. [PMID: 39089577 DOI: 10.1016/j.kint.2024.07.014] [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: 01/25/2024] [Revised: 06/18/2024] [Accepted: 07/02/2024] [Indexed: 08/04/2024]
Abstract
In the CONVINCE trial, the primary analysis demonstrated a survival benefit for patients receiving high-dose hemodiafiltration (HDF) as compared with high-flux hemodialysis (HD). A secondary objective was to evaluate effects on health-related quality of life (HRQoL); assessed in eight domains (physical function, cognitive function, fatigue, sleep disturbance, anxiety, depression, pain interference, social participation) applying instruments from the Patient-Reported Outcome Measurement Information System (PROMIS) before randomization and every three months thereafter. In total 1360 adults with dialysis-dependent chronic kidney disease, eligible to receive high-flux HDF (23 liters or more), were randomized (1:1); 84% response rate to all questionnaires. Both groups reported a continuous deterioration in all HRQoL domains. Overall, raw score changes from baseline were more favorable in the HDF group, resulting in a significant omnibus test after a median observation period of 30 months. Most relevant single raw score differences were reported for cognitive function. Patients receiving HDF reported a decline of -0.95 units (95% confidence interval - 2.23 to +0.34) whereas HD treated patients declined by -3.90 units (-5.28 to - 2.52). A joint model, adjusted for mortality differences, utilizing all quarterly assessments, identified a significantly slower HRQoL decline in physical function, cognitive function, pain interference, and social participation for the HDF group. Their physical health summary score declined -0.46 units/year slower compared to the HD group. Thus, the CONVINCE trial showed a beneficial effect of high-dose hemodiafiltration for survival as well as a moderate positive effect on patients' quality of life, most pronounced with respect to their cognitive function. REGISTRATION: NTR7138 on the International Clinical Trials Registry Platform.
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Affiliation(s)
- Matthias Rose
- Department of Psychosomatic Medicine, Center of Internal Medicine and Dermatology, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Center for Patient Centered Outcomes Research, Charité Universitätsmedizin Berlin (CPCOR), Berlin, Germany; German Center for Mental Health (DZPG, Germany
| | - Felix H Fischer
- Department of Psychosomatic Medicine, Center of Internal Medicine and Dermatology, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Center for Patient Centered Outcomes Research, Charité Universitätsmedizin Berlin (CPCOR), Berlin, Germany; German Center for Mental Health (DZPG, Germany.
| | - Gregor Liegl
- Department of Psychosomatic Medicine, Center of Internal Medicine and Dermatology, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Center for Patient Centered Outcomes Research, Charité Universitätsmedizin Berlin (CPCOR), Berlin, Germany
| | - Giovanni F M Strippoli
- Department of Precision and Regenerative Medicine and Ionian Area (DIMEPRE-J), University of Bari, Bari, Italy; School of Public Health, University of Sydney, Sydney, Australia
| | - Carina Hockham
- The George Institute for Global Health, School of Public Health, Imperial College London, London, UK
| | - Robin W M Vernooij
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Claudia Barth
- B. Braun Avitum AG, Medical Scientific Affairs, Melsungen, Germany
| | - Bernard Canaud
- Montpellier University, School of Medicine, Montpellier, France
| | - Adrian Covic
- Department of Nephrology, University of Medicine "Grigore T. Popa" Iasi and Fresenius Nephrocare, Romania
| | - Krister Cromm
- Department of Psychosomatic Medicine, Center of Internal Medicine and Dermatology, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Center for Patient Centered Outcomes Research, Charité Universitätsmedizin Berlin (CPCOR), Berlin, Germany; Fresenius Medical Care Deutschland GmbH, Global Medical Office, Bad Homburg, Germany
| | - Andrea M Cucui
- Fresenius Nephrocare Dialysis Center, Bucharest, Romania
| | - Andrew Davenport
- UCL Department of Renal Medicine, Royal Free Hospital, Division of Medicine, University College London, London, UK
| | - Kathrin I Fischer
- Department of Psychosomatic Medicine, Center of Internal Medicine and Dermatology, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Center for Patient Centered Outcomes Research, Charité Universitätsmedizin Berlin (CPCOR), Berlin, Germany
| | - Jörgen Hegbrant
- Division of Nephrology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Hanna Jaha
- Department of Psychosomatic Medicine, Center of Internal Medicine and Dermatology, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Center for Patient Centered Outcomes Research, Charité Universitätsmedizin Berlin (CPCOR), Berlin, Germany
| | - Anna Schappert
- Department of Psychosomatic Medicine, Center of Internal Medicine and Dermatology, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Center for Patient Centered Outcomes Research, Charité Universitätsmedizin Berlin (CPCOR), Berlin, Germany; German Center for Mental Health (DZPG, Germany
| | | | - Mark Woodward
- School of Public Health, University of Sydney, Sydney, Australia; The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Michiel L Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Peter J Blankestijn
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
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Lau DCW, Shaw E, McMullen S, Cowling T, Witges K, Amitay EL, Steubl D, Girard LP. Acute and chronic complication profiles among patients with chronic kidney disease in Alberta, Canada: a retrospective observational study. BMC Nephrol 2024; 25:244. [PMID: 39080608 PMCID: PMC11288078 DOI: 10.1186/s12882-024-03682-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 07/20/2024] [Indexed: 08/03/2024] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) poses a substantial burden to individuals, caregivers, and healthcare systems. CKD is associated with higher risk for adverse events, including renal failure, cardiovascular disease, and death. This study aims to describe comorbidities and complications in patients with CKD. METHODS We conducted a retrospective observational study linking administrative health databases in Alberta, Canada. Adults with CKD were identified (April 1, 2010 and March 31, 2019) and indexed on the first diagnostic code or laboratory test date meeting the CKD algorithm criteria. Cardiovascular, renal, diabetic, and other comorbidities were described in the two years before index; complications were described for events after index date. Complications were stratified by CKD stage, atherosclerotic cardiovascular disease (ASCVD), and type 2 diabetes mellitus (T2DM) status at index. RESULTS The cohort included 588,170 patients. Common chronic comorbidities were hypertension (36.9%) and T2DM (24.1%), while 11.4% and 2.6% had ASCVD and chronic heart failure, respectively. Common acute complications were infection (58.2%) and cardiovascular hospitalization (24.4%), with rates (95% confidence interval [CI]) of 29.4 (29.3-29.5) and 8.37 (8.32-8.42) per 100 person-years, respectively. Common chronic complications were dyslipidemia (17.3%), anemia (14.7%), and hypertension (11.1%), with rates (95% CI) of 11.9 (11.7-12.1), 4.76 (4.69-4.83), and 13.0 (12.8-13.3) per 100 person-years, respectively. Patients with more advanced CKD, ASCVD, and T2DM at index exhibited higher complication rates. CONCLUSIONS Over two-thirds of patients with CKD experienced complications, with higher rates observed in those with cardio-renal-metabolic comorbidities. Strategies to mitigate risk factors and complications can reduce patient burden.
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Affiliation(s)
- David C W Lau
- Division of Endocrinology and Metabolism, Department of Medicine, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
| | - Eileen Shaw
- Medlior Health Outcomes Research Ltd, Suite 300 - 160 Quarry Park Blvd. SE, Calgary, AB, Canada.
| | - Suzanne McMullen
- Medlior Health Outcomes Research Ltd, Suite 300 - 160 Quarry Park Blvd. SE, Calgary, AB, Canada
| | - Tara Cowling
- Medlior Health Outcomes Research Ltd, Suite 300 - 160 Quarry Park Blvd. SE, Calgary, AB, Canada
| | - Kelcie Witges
- Medlior Health Outcomes Research Ltd, Suite 300 - 160 Quarry Park Blvd. SE, Calgary, AB, Canada
| | - Efrat L Amitay
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | - Dominik Steubl
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
- Department of Nephrology, Hospital rechts der Isar, Technical University Munich, Munich, Germany
| | - Louis P Girard
- Division of Nephrology, Department of Medicine, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
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Nigussie EW, Abera EG, Woldemariam MB. Burden and determinants of renal dysfunction and in-hospital mortality among acute stroke patients in Ethiopia: A hospital-based observational study. Medicine (Baltimore) 2024; 103:e39140. [PMID: 39058854 PMCID: PMC11272293 DOI: 10.1097/md.0000000000039140] [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: 06/05/2024] [Accepted: 07/09/2024] [Indexed: 07/28/2024] Open
Abstract
Stroke, a leading global cause of mortality and neurological impairment, is often complicated by renal failure, exacerbating in-hospital risks and mortality. Limited understanding exists regarding renal failure prevalence in Ethiopian acute stroke patients. This study examines renal function abnormalities in acute stroke patients at Jimma Medical Center (JMC). A hospital-based cross-sectional study was conducted at JMC from December 5, 2023, to March 15, 2024. A structured data collection tool was developed after comprehensive review of pertinent literature, encompassing variables pertinent to the study objectives. Following data quality assurance, information was coded and inputted into EpiData version 3.1, subsequently analyzed using Statistical Package for Social Sciences (SPSS) version 26.0. Multivariable logistic regression analysis was performed to adjust for confounding variables, with statistical significance set at P < .05. The mean age of participants was 60.5 ± 15.5 years, with 129 (64.5%) being male. Forty-five participants (22.5%, 95% confidence interval [CI] = 16.9, 28.9) exhibited renal dysfunction. Advanced age (≥70 years), hypertension, diabetes mellitus (DM), cardiac disease, history of transient ischemic attack (TIA)/stroke, and hemorrhagic stroke type were identified as significant predictors of renal dysfunction among hospitalized stroke patients. The mortality rate was 3.7 times higher in stroke patients with renal dysfunction compared to those with normal renal function (adjusted odds ratio [AOR] = 3.7, 95% CI: 1.41, 6.22). Renal function abnormalities were prevalent among hospitalized acute stroke patients, emphasizing the significance of renal dysfunction as a frequent comorbidity. Older age, hypertension, DM, cardiac disease, history of TIA/stroke, and hemorrhagic stroke type emerged as statistically significant predictors of renal dysfunction. Furthermore, renal dysfunction was identified as a significant predictor of in-hospital mortality following stroke.
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Affiliation(s)
| | - Eyob Girma Abera
- Department of Public Health, Jimma University, Jimma, Oromia, Ethiopia
- Jimma University Clinical Trial Unit, Jimma, Oromia, Ethiopia
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Ma D, Zhang J, Du L, Shi J, Liu Z, Qin J, Chen X, Guo M. Colquhounia root tablet improves diabetic kidney disease by regulating epithelial-mesenchymal transition via the PTEN/PI3K/AKT pathway. Front Pharmacol 2024; 15:1418588. [PMID: 39130629 PMCID: PMC11310013 DOI: 10.3389/fphar.2024.1418588] [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: 04/16/2024] [Accepted: 07/17/2024] [Indexed: 08/13/2024] Open
Abstract
Background Diabetic kidney disease (DKD) is a severe microvascular complication of diabetes mellitus that can lead to end-stage renal disease. Colquhounia root tablet (CRT) has shown therapeutic potential in treating DKD, but its efficacy and underlying mechanisms remain to be elucidated. Methods A randomized controlled clinical trial was conducted on 61 DKD patients. The treatment group received CRT in addition to standard therapy, while the control group received standard therapy alone. Treatment efficacy and adverse events were evaluated after 3 months. Additionally, in vitro experiments using human renal tubular epithelial cells (HK-2) were performed to investigate the effect of CRT on high glucose (HG)-induced epithelial-mesenchymal transition (EMT) and the involvement of the PTEN/PI3K/AKT signaling pathway. Results CRT treatment significantly improved proteinuria and increased the effective treatment rate in DKD patients compared to the control group, with no significant difference in adverse events. Moreover, CRT reversed HG-induced EMT in HK-2 cells, as evidenced by the downregulation of α-SMA and upregulation of E-cadherin at both mRNA and protein levels. Mechanistically, CRT increased PTEN expression and inhibited the PI3K/AKT pathway, similar to the effects of the PI3K inhibitor LY29400. The combination of CRT and LY29400 further enhanced PTEN mRNA expression under HG conditions. Conclusion CRT effectively improves proteinuria in DKD patients and ameliorates HG-induced EMT in HK-2 cells. The underlying mechanism may involve the upregulation of PTEN and subsequent inhibition of the PI3K/AKT signaling pathway. These findings provide new insights into the therapeutic potential of CRT for DKD treatment.
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Affiliation(s)
- Donghong Ma
- Department of Nephrology, The First Affiliated Hospital of Xinxiang Medical University, Weihui, Henan Province, China
- Xinxiang Key Laboratory of Precise Therapy for Diabetic Kidney Disease, The First Affiliated Hospital of Xinxiang Medical University, Weihui, Henan Province, China
| | - Jiao Zhang
- Department of Nephrology, The First Affiliated Hospital of Xinxiang Medical University, Weihui, Henan Province, China
| | - Lu Du
- Department of Nephrology, The First Affiliated Hospital of Xinxiang Medical University, Weihui, Henan Province, China
| | - Jingjing Shi
- Department of Nephrology, The First Affiliated Hospital of Xinxiang Medical University, Weihui, Henan Province, China
| | - Zhaoyan Liu
- Department of Nephrology, The First Affiliated Hospital of Xinxiang Medical University, Weihui, Henan Province, China
- Xinxiang Key Laboratory of Precise Therapy for Diabetic Kidney Disease, The First Affiliated Hospital of Xinxiang Medical University, Weihui, Henan Province, China
| | - Jilin Qin
- Department of Nephrology, The First Affiliated Hospital of Xinxiang Medical University, Weihui, Henan Province, China
- Xinxiang Key Laboratory of Precise Therapy for Diabetic Kidney Disease, The First Affiliated Hospital of Xinxiang Medical University, Weihui, Henan Province, China
| | - Xiaoxiao Chen
- Department of Nephrology, The First Affiliated Hospital of Xinxiang Medical University, Weihui, Henan Province, China
- Xinxiang Key Laboratory of Precise Therapy for Diabetic Kidney Disease, The First Affiliated Hospital of Xinxiang Medical University, Weihui, Henan Province, China
| | - Minghao Guo
- Department of Nephrology, The First Affiliated Hospital of Xinxiang Medical University, Weihui, Henan Province, China
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Maity I, Sati H, Singh G, Bhowmik D, Agarwal SK, Bagchi S. Burden of Chronic Kidney Disease of Undetermined Aetiology (CKDu) in a Tertiary Care Public Hospital in North India. Nephron Clin Pract 2024:1-8. [PMID: 38964302 DOI: 10.1159/000539317] [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: 05/26/2023] [Accepted: 05/05/2024] [Indexed: 07/06/2024] Open
Abstract
INTRODUCTION Chronic kidney disease of undetermined aetiology (CKDu) is an important public health problem. Indian data are mostly based on studies from rural regions in south and east India. We examined the burden and profile of CKDu in patients attending a tertiary care hospital in north India. METHODS We assessed records of consecutive new CKD patients registered in a nephrology clinic from January 2015 to June 2022. Patients were classified as having CKDu based on predefined inclusion and exclusion criteria. Clinical and laboratory parameters at presentation and kidney biopsy when done were noted. RESULTS Records of 32,369 patients with CKD were screened, and 29,663 were included (2,706 excluded due to inadequate data). A total of 370 (1.2%) patients were categorized as CKDu. Mean age was 41 ± 14.7 years, 58.1% being male. Of them, 158 (42.7%) patients were in CKD stage 3, 89 (24.1%) in stage 4, 84 (22.7%) in stage 5, and 39 (10.5%) were dialysis dependent at presentation; 232 (62.7%) patients had proteinuria <0.5 gm/day and 138 (37.3%) between 0.5 and 1 gm/day. Renal histology was available for 65 CKDu patients: 62 had chronic tubulointerstitial nephritis (CTIN) and 3 had non-specific changes. CONCLUSION When defined using strict criteria with intensive diagnostic workup, burden of CKDu is low in our hospital-based cohort of CKD patients. CTIN is the predominant histopathological finding in kidney biopsy.
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Affiliation(s)
- Indradip Maity
- Department of Nephrology, All India of Medical Sciences, New Delhi, India
| | - Hemchand Sati
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Geetika Singh
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Dipankar Bhowmik
- Department of Nephrology, All India of Medical Sciences, New Delhi, India
| | | | - Soumita Bagchi
- Department of Nephrology, All India of Medical Sciences, New Delhi, India
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Huang S, Huang X, Liu Z, Yao C, Liu J, He M, Xu X, Zhang T, Wang J, Jiang L, Chen HJ, Xie X. Advances in Multifunctional Electronic Catheters for Precise and Intelligent Diagnosis and Therapy in Minimally Invasive Surgery. ACS NANO 2024; 18:18129-18150. [PMID: 38954632 DOI: 10.1021/acsnano.4c03871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/04/2024]
Abstract
The advent of catheter-based minimally invasive surgical instruments has provided an effective means of diagnosing and treating human disease. However, conventional medical catheter devices are limited in functionalities, hindering their ability to gather tissue information or perform precise treatment during surgery. Recently, electronic catheters have integrated various sensing and therapeutic technologies through micro/nanoelectronics, expanding their capabilities. As micro/nanoelectronic devices become more miniaturized, flexible, and stable, electronic surgical catheters are evolving from simple tools to multiplexed sensing and theranostics for surgical applications. The review on multifunctional electronic surgical catheters is lacking and thus is not conducive to the reader's comprehensive understanding of the development trend in this field. This review covers the advances in multifunctional electronic catheters for precise and intelligent diagnosis and therapy in minimally invasive surgery. It starts with the summary of clinical minimally invasive surgical instruments, followed by the background of current clinical catheter devices for sensing and therapeutic applications. Next, intelligent electronic catheters with integrated electronic components are reviewed in terms of electronic catheters for diagnosis, therapy, and multifunctional applications. It highlights the present status and development potential of catheter-based minimally invasive surgical devices, while also illustrating several significant challenges that remain to be overcome.
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Affiliation(s)
- Shuang Huang
- Guangdong Provincial Key Laboratory of Sensor Technology and Biomedical Instrument, School of Biomedical Engineering, Sun Yat-Sen University, Shenzhen 518107, China
- State Key Laboratory of Optoelectronic Materials and Technologies, Guangdong Province Key Laboratory of Display Material and Technology, School of Electronics and Information Technology, Sun Yat-sen University, Guangzhou 510006, China
| | - Xinshuo Huang
- State Key Laboratory of Optoelectronic Materials and Technologies, Guangdong Province Key Laboratory of Display Material and Technology, School of Electronics and Information Technology, Sun Yat-sen University, Guangzhou 510006, China
| | - Zhengjie Liu
- State Key Laboratory of Optoelectronic Materials and Technologies, Guangdong Province Key Laboratory of Display Material and Technology, School of Electronics and Information Technology, Sun Yat-sen University, Guangzhou 510006, China
| | - Chuanjie Yao
- State Key Laboratory of Optoelectronic Materials and Technologies, Guangdong Province Key Laboratory of Display Material and Technology, School of Electronics and Information Technology, Sun Yat-sen University, Guangzhou 510006, China
| | - Jing Liu
- The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Mengyi He
- State Key Laboratory of Optoelectronic Materials and Technologies, Guangdong Province Key Laboratory of Display Material and Technology, School of Electronics and Information Technology, Sun Yat-sen University, Guangzhou 510006, China
| | - Xingyuan Xu
- State Key Laboratory of Optoelectronic Materials and Technologies, Guangdong Province Key Laboratory of Display Material and Technology, School of Electronics and Information Technology, Sun Yat-sen University, Guangzhou 510006, China
| | - Tao Zhang
- Guangdong Provincial Key Laboratory of Sensor Technology and Biomedical Instrument, School of Biomedical Engineering, Sun Yat-Sen University, Shenzhen 518107, China
- State Key Laboratory of Optoelectronic Materials and Technologies, Guangdong Province Key Laboratory of Display Material and Technology, School of Electronics and Information Technology, Sun Yat-sen University, Guangzhou 510006, China
| | - Ji Wang
- The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Lelun Jiang
- Guangdong Provincial Key Laboratory of Sensor Technology and Biomedical Instrument, School of Biomedical Engineering, Sun Yat-Sen University, Shenzhen 518107, China
| | - Hui-Jiuan Chen
- State Key Laboratory of Optoelectronic Materials and Technologies, Guangdong Province Key Laboratory of Display Material and Technology, School of Electronics and Information Technology, Sun Yat-sen University, Guangzhou 510006, China
| | - Xi Xie
- Guangdong Provincial Key Laboratory of Sensor Technology and Biomedical Instrument, School of Biomedical Engineering, Sun Yat-Sen University, Shenzhen 518107, China
- State Key Laboratory of Optoelectronic Materials and Technologies, Guangdong Province Key Laboratory of Display Material and Technology, School of Electronics and Information Technology, Sun Yat-sen University, Guangzhou 510006, China
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Na DH, Cui S, Fang X, Lee H, Eum SH, Shin YJ, Lim SW, Yang CW, Chung BH. Advancements in Research on Genetic Kidney Diseases Using Human-Induced Pluripotent Stem Cell-Derived Kidney Organoids. Cells 2024; 13:1190. [PMID: 39056771 PMCID: PMC11274677 DOI: 10.3390/cells13141190] [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: 05/14/2024] [Revised: 07/09/2024] [Accepted: 07/11/2024] [Indexed: 07/28/2024] Open
Abstract
Genetic or hereditary kidney disease stands as a pivotal cause of chronic kidney disease (CKD). The proliferation and widespread utilization of DNA testing in clinical settings have notably eased the diagnosis of genetic kidney diseases, which were once elusive but are now increasingly identified in cases previously deemed CKD of unknown etiology. However, despite these diagnostic strides, research into disease pathogenesis and novel drug development faces significant hurdles, chiefly due to the dearth of appropriate animal models and the challenges posed by limited patient cohorts in clinical studies. Conversely, the advent and utilization of human-induced pluripotent stem cells (hiPSCs) offer a promising avenue for genetic kidney disease research. Particularly, the development of hiPSC-derived kidney organoid systems presents a novel platform for investigating various forms of genetic kidney diseases. Moreover, the integration of the CRISPR/Cas9 technique into this system holds immense potential for efficient research on genetic kidney diseases. This review aims to explore the applications of in vitro kidney organoids generated from hiPSCs in the study of diverse genetic kidney diseases. Additionally, it will delve into the limitations of this research platform and outline future perspectives for advancing research in this crucial area.
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Affiliation(s)
- Do Hyun Na
- Transplantation Research Center, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (D.H.N.); (S.C.); (X.F.); (H.L.); (S.H.E.); (Y.J.S.); (S.W.L.); (C.W.Y.)
- Division of Nephrology, Department of Internal Medicine, Seoul St. Mary’s Hospital, The College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Sheng Cui
- Transplantation Research Center, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (D.H.N.); (S.C.); (X.F.); (H.L.); (S.H.E.); (Y.J.S.); (S.W.L.); (C.W.Y.)
| | - Xianying Fang
- Transplantation Research Center, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (D.H.N.); (S.C.); (X.F.); (H.L.); (S.H.E.); (Y.J.S.); (S.W.L.); (C.W.Y.)
| | - Hanbi Lee
- Transplantation Research Center, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (D.H.N.); (S.C.); (X.F.); (H.L.); (S.H.E.); (Y.J.S.); (S.W.L.); (C.W.Y.)
- Division of Nephrology, Department of Internal Medicine, Seoul St. Mary’s Hospital, The College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Sang Hun Eum
- Transplantation Research Center, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (D.H.N.); (S.C.); (X.F.); (H.L.); (S.H.E.); (Y.J.S.); (S.W.L.); (C.W.Y.)
- Division of Nephrology, Department of Internal Medicine, Incheon St. Mary’s Hospital, The College of Medicine, The Catholic University of Korea, Incheon 21431, Republic of Korea
| | - Yoo Jin Shin
- Transplantation Research Center, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (D.H.N.); (S.C.); (X.F.); (H.L.); (S.H.E.); (Y.J.S.); (S.W.L.); (C.W.Y.)
| | - Sun Woo Lim
- Transplantation Research Center, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (D.H.N.); (S.C.); (X.F.); (H.L.); (S.H.E.); (Y.J.S.); (S.W.L.); (C.W.Y.)
| | - Chul Woo Yang
- Transplantation Research Center, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (D.H.N.); (S.C.); (X.F.); (H.L.); (S.H.E.); (Y.J.S.); (S.W.L.); (C.W.Y.)
- Division of Nephrology, Department of Internal Medicine, Seoul St. Mary’s Hospital, The College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Byung Ha Chung
- Transplantation Research Center, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (D.H.N.); (S.C.); (X.F.); (H.L.); (S.H.E.); (Y.J.S.); (S.W.L.); (C.W.Y.)
- Division of Nephrology, Department of Internal Medicine, Seoul St. Mary’s Hospital, The College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
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Chen W, Howard K, Gorham G, Abeyaratne A, Zhao Y, Adegboye O, Kangaharan N, Talukder MRR, Taylor S, Cass A. Costs and healthcare use of patients with chronic kidney disease in the Northern Territory, Australia. BMC Health Serv Res 2024; 24:791. [PMID: 38982437 PMCID: PMC11234693 DOI: 10.1186/s12913-024-11258-8] [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: 11/13/2023] [Accepted: 06/27/2024] [Indexed: 07/11/2024] Open
Abstract
BACKGROUND The burden of chronic kidney disease (CKD) is high in the Northern Territory (NT), Australia. This study aims to describe the healthcare use and associated costs of people at risk of CKD (e.g. acute kidney injury, diabetes, hypertension, and cardiovascular disease) or living with CKD in the NT, from a healthcare funder perspective. METHODS We included a retrospective cohort of patients at risk of, or living with CKD, on 1 January 2017. Patients on kidney replacement therapy were excluded from the study. Data from the Territory Kidney Care database, encompassing patients from public hospitals and primary health care services across the NT was used to conduct costing. Annual healthcare costs, including hospital, primary health care, medication, and investigation costs were described over a one-year follow-up period. Factors associated with high total annual healthcare costs were identified with a cost prediction model. RESULTS Among 37,398 patients included in this study, 23,419 had a risk factor for CKD while 13,979 had CKD (stages 1 to 5, not on kidney replacement therapy). The overall mean (± SD) age was 45 years (± 17), and a large proportion of the study cohort were First Nations people (68%). Common comorbidities in the overall cohort included diabetes (36%), hypertension (32%), and coronary artery disease (11%). Annual healthcare cost was lowest in those at risk of CKD (AUD$7,958 per person) and highest in those with CKD stage 5 (AUD$67,117 per person). Inpatient care contributed to the majority (76%) of all healthcare costs. Predictors of increased total annual healthcare cost included more advanced stages of CKD, and the presence of comorbidities. In CKD stage 5, the additional cost per person per year was + $53,634 (95%CI 32,769 to 89,482, p < 0.001) compared to people in the at risk group without CKD. CONCLUSION The total healthcare costs in advanced stages of CKD is high, even when patients are not on dialysis. There remains a need for effective primary prevention and early intervention strategies targeting CKD and related chronic conditions.
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Affiliation(s)
- Winnie Chen
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, Darwin, NT, Australia.
- Menzies Centre for Health Policy and Economics, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
| | - Kirsten Howard
- Menzies Centre for Health Policy and Economics, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Gillian Gorham
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, Darwin, NT, Australia
| | - Asanga Abeyaratne
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, Darwin, NT, Australia
- NT Health, Darwin, Australia
| | | | - Oyelola Adegboye
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, Darwin, NT, Australia
| | | | | | - Sean Taylor
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, Darwin, NT, Australia
- NT Health, Darwin, Australia
| | - Alan Cass
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, Darwin, NT, Australia
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Pedreira-Robles G, Morín-Fraile V, Bach-Pascual A, Graells-Sans A, Garcimartín P. «I can't imagine it without my nurse»: Experiences of people with chronic kidney disease in the evaluation process as kidney transplant candidates. Res Nurs Health 2024. [PMID: 38970457 DOI: 10.1002/nur.22414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 06/03/2024] [Accepted: 06/23/2024] [Indexed: 07/08/2024]
Abstract
This qualitative study aimed to explore the experiences of 11 adults with chronic kidney disease (CKD) undergoing evaluation for kidney transplant (KT) and examine the role played by the nurse in the process. Employing a descriptive phenomenology approach, semi-structured interviews were conducted between October 2022 and July 2023. Thematic analysis, facilitated by Atlas. ti software, revealed a systemic management diagram with "The candidate for kidney transplant and their reality" at the center, followed by "The process of chronic kidney disease and kidney transplantation," and concluding with the most distal category centered on "The kidney transplant access nurse." This organizational framework provided insights into the layers of relationships between emerging themes. The findings underscored the complexity and multidimensionality of the CKD and KT process, emphasizing the nurse's pivotal role as a guide and protector throughout the evaluation process for accessing kidney transplantation. The convergence of results with existing literature highlighted the need to address challenges such as lack of time, resources, and emotional support to enhance the quality of care. Recognizing the nurse's crucial importance in this process, the study emphasizes the significance of addressing these challenges to improve patient care and calls for attention to the nurse's role in guiding individuals through the intricate journey of CKD and kidney transplantation.
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Affiliation(s)
- Guillermo Pedreira-Robles
- Nephrology department, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
- ESIMar (Mar Nursing School). Parc de Salut Mar, Universitat Pompeu Fabra affiliated, Barcelona, Spain
- Social Determinants and Health Education Research Group (SDHEd), Hospital del Mar Institute for Medical Research (IMIM), Barcelona, Spain
- Nursing and Health PhD Program, University of Barcelona, Barcelona, Spain
| | - Victoria Morín-Fraile
- Department of Public Health, Mental Health, and Maternal and Child Health, Faculty of Nursing, University of Barcelona, Barcelona, Spain
| | - Anna Bach-Pascual
- Nephrology department, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
| | - Ariadna Graells-Sans
- ESIMar (Mar Nursing School). Parc de Salut Mar, Universitat Pompeu Fabra affiliated, Barcelona, Spain
- Social Determinants and Health Education Research Group (SDHEd), Hospital del Mar Institute for Medical Research (IMIM), Barcelona, Spain
| | - Paloma Garcimartín
- Nursing department, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
- Research Group in Nursing Care, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Biomedical Network Research Center for Cardiovascular Diseases, (CIBERCV, Carlos III Health Institute), Madrid, Spain
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Singh A, Verma M, Das M, Parija PP, Nayak S, Jha V. Prevalence and associated factors of impaired kidney functions among children and adolescents in India: insights from the Comprehensive National Nutrition Survey (CNNS) 2016-18. BMC Pediatr 2024; 24:429. [PMID: 38965471 PMCID: PMC11223285 DOI: 10.1186/s12887-024-04903-y] [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: 05/17/2023] [Accepted: 06/21/2024] [Indexed: 07/06/2024] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) is a significant public health problem. The burden of CKD in children and adolescents in India is not well described. We used data from the recent Comprehensive National Nutrition Survey (CNNS) to estimate the prevalence of impaired kidney function (IKF) and its determinants in children and adolescents between the ages of 5 and 19. METHODS CNNS 2016-18 adopted a multi-stage sampling design using probability proportional to size sampling procedure after geographical stratification of urban and rural areas. Serum creatinine was tested once in 24,690 children and adolescents aged 5-19 years. The estimated glomerular filtration rate (eGFR) was derived using the revised Schwartz equation. The eGFR value below 60 ml/min/1.73 m2 is defined as IKF. Bivariate analysis was done to depict the weighted prevalence, and multivariable logistic regression examined the predictors of IKF. RESULTS The mean eGFR in the study population was 113.3 + 41.4 mL/min/1.73 m2. The overall prevalence of IKF was 4.9%. The prevalence in the 5-9, 10-14, and 15-19 year age groups was 5.6%, 3.4% and 5.2%, respectively. Regression analysis showed age, rural residence, non-reserved social caste, less educated mothers, Islam religion, children with severe stunting or being overweight/obese, and residence in Southern India to be predictors of IKF. CONCLUSIONS The prevalence of IKF among children and adolescents in India is high compared to available global estimates. In the absence of repeated eGFR-based estimates, these nationally representative estimates are intriguing and call for further assessment of socio-demographic disparities, genetics, and risk behaviours to have better clinical insights and public health preparedness.
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Affiliation(s)
- Angad Singh
- International Institute for Population Sciences, Mumbai, India
| | - Madhur Verma
- Community and Family Medicine, All India Institute of Medical Sciences Bathinda, Punjab, India.
| | - Milan Das
- International Institute for Population Sciences, Mumbai, India
| | - Pragyan Paramita Parija
- Community and Family Medicine, All India Institute of Medical Sciences Vijaypur, Jammu, India
| | - Saurabh Nayak
- Nephrology, All India Institute of Medical Sciences Bathinda, Punjab, India
| | - Vivekanand Jha
- The George Institute for Global Health India, UNSW, New Delhi, India
- Manipal Academy of Higher Education, Manipal, India
- Faculty of Medicine, Imperial College London, London, UK
- Faculty of Medicine, University of New South Wales, Sydney, Australia
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Li X, Yang W, Ma K, Zheng Z, Liu X, Hu B, Liu H, Zhao Q, Han Y, Xiao Z, Chen R, Li H, Huang S, Liu J, Wang C, Yin L, Meng Y. Circulating B Cell-Derived Small RNA Delivered by Extracellular Vesicles: A Dialogue Mechanism for Long-Range Targeted Renal Mitochondrial Injury in Obesity. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2024:e2402526. [PMID: 38958071 DOI: 10.1002/smll.202402526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 05/24/2024] [Indexed: 07/04/2024]
Abstract
The intricate processes that govern the interactions between peripatetic immune cells and distal renal injury in obesity are not fully understood. Employing transcriptomic analysis of circulating extracellular vesicles (EVs), a marked amplification of small RNA (miR-3960) is discerned within CD3-CD19+ B cells. This RNA is found to be preferentially augmented in kidney tissues, contrasting with its subdued expression in other organs. By synthesizing dual-luciferase reporter assay with co-immunoprecipitation analysis, it is pinpointed that miR-3960 specifically targets the nuclear gene TRMT5, a pivotal actor in the methylation of mitochondrial tRNA. This liaison instigates aberrations in the post-transcriptional modifications of mitochondrial tRNA, engendering deficiencies within the electron respiratory chain, primarily attributable to the diminution of the mitochondrial bioenergetic compound (NDUFA7) complex I. Such perturbations lead to a compromised mitochondrial respiratory capacity in renal tubular cells, thereby exacerbating tubular injury. In contrast, EV blockade or miR-3960 depletion markedly alleviates renal tubular injury in obesity. This investigation unveils a hitherto unexplored pathway by which obesity-induced circulating immune cells remotely manipulate mitochondrial metabolism in target organs. The strategic targeting of obese EVs or infiltrative immune cells and their specifically secreted RNAs emerges as a promising therapeutic avenue to forestall obesity-related renal afflictions.
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Affiliation(s)
- Xiaqing Li
- Institute of Nephrology and Blood Purification, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, Guangdong, 510632, China
- Nephrology department, The Fifth Affiliated Hospital (Heyuan Shenhe People's Hospital), Jinan University, Heyuan, Guangdong, 517000, China
| | - Wah Yang
- Department of Obesity and Metabolic Disorders, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, Guangdong, 510632, China
- Institute of Obesity and Metabolic Disorders, Jinan University, Guangzhou, Guangdong, 510632, China
| | - Ke Ma
- Institute of Nephrology and Blood Purification, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, Guangdong, 510632, China
- Nephrology department, The Fifth Affiliated Hospital (Heyuan Shenhe People's Hospital), Jinan University, Heyuan, Guangdong, 517000, China
| | - Zirun Zheng
- Institute of Nephrology and Blood Purification, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, Guangdong, 510632, China
- Nephrology department, The Fifth Affiliated Hospital (Heyuan Shenhe People's Hospital), Jinan University, Heyuan, Guangdong, 517000, China
| | - Xiayun Liu
- Institute of Nephrology and Blood Purification, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, Guangdong, 510632, China
- Nephrology department, The Fifth Affiliated Hospital (Heyuan Shenhe People's Hospital), Jinan University, Heyuan, Guangdong, 517000, China
| | - Bo Hu
- Institute of Nephrology and Blood Purification, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, Guangdong, 510632, China
| | - Huanhuan Liu
- Institute of Nephrology and Blood Purification, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, Guangdong, 510632, China
| | - Qian Zhao
- Department of Infectious Diseases and Hepatology Center, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, 510400, China
| | - Yi Han
- Traditional Chinese Medicine Department, People's Hospital of Yanjiang District, Ziyang, Sichuan, 641300, China
| | - Zhangzhang Xiao
- Institute of Nephrology and Blood Purification, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, Guangdong, 510632, China
- Department of Nephrology, Houjie Hospital of Dongguan, Dongguan, Guangdong, 523945, China
| | - Ruichang Chen
- Department of Emergency Medicine, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, Guangdong, 510632, China
| | - Hongyue Li
- Institute of Nephrology and Blood Purification, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, Guangdong, 510632, China
- Nephrology department, The Fifth Affiliated Hospital (Heyuan Shenhe People's Hospital), Jinan University, Heyuan, Guangdong, 517000, China
| | - Sibo Huang
- Health Management Center, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, Guangdong, 510632, China
| | - Jinfeng Liu
- Department of Gastroenterology, Binhaiwan Central Hospital of Dongguan, Dongguan, Guangdong, 523000, China
| | - Cunchuan Wang
- Department of Obesity and Metabolic Disorders, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, Guangdong, 510632, China
- Institute of Obesity and Metabolic Disorders, Jinan University, Guangzhou, Guangdong, 510632, China
| | - Lianghong Yin
- Institute of Nephrology and Blood Purification, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, Guangdong, 510632, China
- Huangpu Institute of Materials, Guangzhou, Guangdong, 510663, China
| | - Yu Meng
- Institute of Nephrology and Blood Purification, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, Guangdong, 510632, China
- Nephrology department, The Fifth Affiliated Hospital (Heyuan Shenhe People's Hospital), Jinan University, Heyuan, Guangdong, 517000, China
- Nephrology Department and Guangdong Provincial Key Laboratory of Spine and Spinal Cord Reconstruction, The Fifth Affiliated Hospital (Heyuan Shenhe People's Hospital), Jinan University, Heyuan, Guangdong, 517000, China
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Chang YP, Lin CC, Wu JH, Hsieh YH, Chou KH, Su CT. The impact of photobiomodulation on sleep and life quality in hemodialysis patients: A randomized controlled trial. Lasers Med Sci 2024; 39:169. [PMID: 38958682 DOI: 10.1007/s10103-024-04114-y] [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: 04/02/2024] [Accepted: 06/23/2024] [Indexed: 07/04/2024]
Abstract
The quality of life (QoL) and sleep quality are closely linked to the physical and psychological health of end-stage renal disease (ESRD) patients, especially those underwent hemodialysis (HD) therapy. This study aims to investigate the impact of 830 nm laser treatment on improving QoL and sleep quality in HD patients. Forty ESRD patients participated in this study. 830 nm laser was used to radiate on the palm (at dose of 256.10 J/cm2), ST 36 and KI 1 acupoints (at dose of 109.76 J/cm2) of HD patients, and QoL and sleep quality questionnaires were utilized to assess changes following the treatment. After 830 nm laser radiation, lower global Pittsburgh Sleep Quality Index and Athens Insomnia Scale scores were observed, accompanied by higher physical and mental component summary scores in MOS 36-item short-form health survey version 2 and a global World Health Organization Quality of Life Brief Version score. The laser group also showed significant improvements in QoL and sleep quality indicators. Additionally, pain levels decreased on the third day and after one month according to visual analogue scale. This study revealed the positive effects of 830 nm laser on palm, KI 1 and ST 36 acupoints for improving the QoL and sleep quality in ESRD patients underwent HD treatment. The results suggest that 830 nm laser applied to specific targets could be used as a complementary and alternative approach to increase the QoL and sleep quality in ESRD patients.
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Affiliation(s)
- Yi-Ping Chang
- Department of Nephrology, Taoyuan Branch of Taipei Veterans General Hospital, Taoyuan, Taiwan
- Department of Healthcare Information and Management, Ming Chuan University, Taoyuan, 33348, Taiwan
| | - Chih-Ching Lin
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, 11217, Taiwan
- School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, 11217, Taiwan
| | - Jih-Huah Wu
- Department of Biomedical Engineering, Ming Chuan University, Taoyuan, 33348, Taiwan
| | - Ya-Hui Hsieh
- Department of Healthcare Information and Management, Ming Chuan University, Taoyuan, 33348, Taiwan
| | - Kai-Hsiang Chou
- Department of Healthcare Information and Management, Ming Chuan University, Taoyuan, 33348, Taiwan
| | - Chuan-Tsung Su
- Department of Healthcare Information and Management, Ming Chuan University, Taoyuan, 33348, Taiwan.
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Zhao Y, Wang YH, Tu WC, Wang DW, Lu MJ, Shao Y. Costunolide Inhibits Chronic Kidney Disease Development by Attenuating IKKβ/NF-κB Pathway. Drug Des Devel Ther 2024; 18:2693-2712. [PMID: 38974121 PMCID: PMC11227330 DOI: 10.2147/dddt.s466092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 06/25/2024] [Indexed: 07/09/2024] Open
Abstract
Background Chronic kidney disease (CKD) is a significant worldwide health concern that leads to high mortality rates. The bioactive substance costunolide (CTD) has demonstrated several pharmacological effects and holds promise as a CKD treatment. This study aims to investigate the impact of CTD on CKD and delve into its mechanisms of action. Methods Unilateral ureteral obstruction (UUO) methods and renal fibrosis mice models were created. Various concentrations of CTD were injected into UUO mice models to investigate the therapeutic effects of CTD on renal fibrosis of mice. Then, renal morphology, pathological changes, and the expression of genes related to fibrosis, inflammation and ferroptosis were analysed. RNA sequencing was utilized to identify the main biological processes and pathways involved in renal injury. Finally, both overexpression and inhibition of IKKβ were studied to examine their respective effects on fibrosis and inflammation in both in vitro and in vivo models. Results CTD treatment was found to significantly alleviate fibrosis, inflammation and ferroptosis in UUO-induced renal fibrosis mice models. The results of RNA sequencing suggested that the IKKβ acted as key regulatory factor in renal injury and the expression of IKKβ was increased in vitro and in vivo renal fibrosis model. Functionally, down-regulated IKKβ expression inhibits ferroptosis, inflammatory cytokine production and collagen deposition. Conversely, IKKβ overexpression exacerbates progressive renal fibrosis. Mechanistically, CTD alleviated renal fibrosis and inflammation by inhibiting the expression of IKKβ and attenuating IKKβ/NF-κB pathway. Conclusion This study demonstrates that CTD could mitigate renal fibrosis, ferroptosis and inflammation in CKD by modulating the IKKβ/NF-κB pathway, which indicates targeting IKKβ has an enormous potential for treating CKD.
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Affiliation(s)
- Yang Zhao
- Department of Urology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, Shanghai, 201800, People’s Republic of China
| | - Yi-Han Wang
- Department of Urology, Sixth People’s Hospital South Campus Affiliated to Shanghai Jiao Tong University, Shanghai, People’s Republic of China
| | - Wei-Chao Tu
- Department of Urology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, Shanghai, 201800, People’s Republic of China
| | - Da-Wei Wang
- Department of Urology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, Shanghai, 201800, People’s Republic of China
| | - Mu-Jun Lu
- Department of Urology and Andrology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People’s Republic of China
- Shanghai Institute of Andrology, Shanghai, People’s Republic of China
| | - Yuan Shao
- Department of Urology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, Shanghai, 201800, People’s Republic of China
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Toyama M, Satoh M, Nakayama S, Hashimoto H, Muroya T, Murakami T, Hirose T, Obara T, Nakaya N, Mori T, Ohkubo T, Imai Y, Hozawa A, Metoki H. Combined effects of blood pressure and glucose status on the risk of chronic kidney disease. Hypertens Res 2024; 47:1831-1841. [PMID: 38671217 PMCID: PMC11224015 DOI: 10.1038/s41440-024-01683-x] [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: 09/07/2023] [Revised: 03/24/2024] [Accepted: 03/31/2024] [Indexed: 04/28/2024]
Abstract
This study aimed to assess the combined effects of blood pressure (BP) and glucose status on chronic kidney disease (CKD) incidence in young and middle-aged adults. We examined data from 1,297,341 Japanese individuals aged <60 years (60.1% men; mean age 41.4 ± 9.3 years) with no history of CKD at baseline. The interval-censored Cox proportional hazards model with covariates was used. During a median follow-up period of 2.1 years, new onset CKD (estimated glomerular filtration rate <60 ml/min/1.73 m2 and/or proteinuria) occurred in 80,187 participants. In participants without antihypertensive treatment (AHT), the adjusted hazard ratios (95% confidence interval) per 1-standard deviation, that is, 15 mmHg increase in systolic BP for CKD incidence, were 1.08 (1.07-1.09), 1.12 (1.10-1.13), and 1.15 (1.12-1.18) in normoglycemia, borderline glycemia, and diabetes groups, respectively. These ratios were significantly higher in the borderline glycemia and diabetes groups compared with those in the normoglycemia group (interaction p < 0.0001). The interaction between BP and borderline glycemia was evident when the outcome definition was restricted to proteinuria. In participants under AHT, systolic BP was most strongly associated with CKD risk in the diabetes group, although no significant interaction was observed. High BP and high glucose status may synergistically increase the incidence of CKD. Strict BP management may play an important role in the early prevention of CKD in individuals with worse glucose status within the young and middle-aged population. This large-scale longitudinal cohort study showed high BP and diabetes synergistically increased the risk of CKD in individuals without AHT. Strict BP management may play an important role in the early prevention of CKD in individuals with worse glucose status within the young and middle-aged population.
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Affiliation(s)
- Maya Toyama
- Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
- Division of Public Health, Hygiene and Epidemiology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
- Department of Nephrology, Self-Defense Forces Sendai Hospital, Sendai, Japan
| | - Michihiro Satoh
- Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan.
- Division of Public Health, Hygiene and Epidemiology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan.
- Department of Pharmacy, Tohoku Medical and Pharmaceutical University Hospital, Sendai, Japan.
| | - Shingo Nakayama
- Division of Public Health, Hygiene and Epidemiology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
- Division of Nephrology and Endocrinology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Hideaki Hashimoto
- Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
- Division of Public Health, Hygiene and Epidemiology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
- Division of Nephrology and Endocrinology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Tomoko Muroya
- Division of Public Health, Hygiene and Epidemiology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
- Division of Internal Medicine, Izumi Hospital, Sendai, Japan
| | - Takahisa Murakami
- Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
- Division of Public Health, Hygiene and Epidemiology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
- Division of Aging and Geriatric Dentistry, Department of Rehabilitation Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Takuo Hirose
- Division of Nephrology and Endocrinology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
- Department of Endocrinology and Applied Medical Science, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Taku Obara
- Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
- Department of Pharmaceutical Sciences, Tohoku University Hospital, Sendai, Japan
| | - Naoki Nakaya
- Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Takefumi Mori
- Division of Nephrology and Endocrinology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Takayoshi Ohkubo
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan
- Tohoku Institute for Management of Blood Pressure, Sendai, Japan
| | - Yutaka Imai
- Tohoku Institute for Management of Blood Pressure, Sendai, Japan
| | - Atsushi Hozawa
- Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Hirohito Metoki
- Division of Public Health, Hygiene and Epidemiology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
- Tohoku Institute for Management of Blood Pressure, Sendai, Japan
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Zhu B, Shi Y, Song N, Zhao S, Shen B, Wang J, Zhang W, Lu Y, Fang Y, Ding X, Li Y. Associations between metabolic profiles and incident CKD in the Chinese population aged 45-85 years. Int Urol Nephrol 2024; 56:2325-2336. [PMID: 38367131 DOI: 10.1007/s11255-023-03916-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 12/14/2023] [Indexed: 02/19/2024]
Abstract
PURPOSE The roles of metabolic indices in predicting chronic kidney disease (CKD) were lacking. This study aimed to examine the concomitant impact of metabolic and novel anthropometric indices on incident CKD in the Chinese populations. METHODS This prospective cohort study included 1825 males and 2218 females aged between 45 and 85 years, derived from the ongoing prospectively cohort of China Health and Retirement Longitudinal Study (CHARLS), from 2011 to 2015. The outcome was defined as an estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2. RESULTS During the 5-years follow-up period, 3.0% (55/1825) of males and 4.1% (90/2218) of the females developed CKD. After multivariable adjustment, elevated triglyceride (TG), low high-density lipoprotein cholesterol (HDL-C), serum uric acid (sUA), elevated visceral fat index (VFI), elevated body shape index (BSI) and elevated body roundness index (BRI) in males, and sUA, and BRI in females were the independent predictors for CKD. Composite scores, composed of sUA, history of cardiovascular disease (CVD), waist circumstance (WC), HDL-C, and BRI in males and sUA, hypertension, and BRI in females were constructed that could accurately predict CKD. CONCLUSION Our study found that elevated levels of TG, sUA, BSI, BRI, and diminished HDL in males and elevated levels of sUA, and BRI in females, are indicative of the incident CKD. The composite score, integrating a history of disease, metabolic indices, and noval anthropometric indices, could accurately differentiate individuals with and without incident CKD, proving useful for CKD care and management.
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Affiliation(s)
- Bowen Zhu
- Department of Nephrology, Zhongshan Hospital, Fudan University, No.180 Fenglin Road, Shanghai, 200032, China
- Shanghai Medical Center of Kidney, Shanghai, China
- Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, China
| | - Yiqin Shi
- Department of Nephrology, Zhongshan Hospital, Fudan University, No.180 Fenglin Road, Shanghai, 200032, China
- Shanghai Medical Center of Kidney, Shanghai, China
- Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, China
| | - Nana Song
- Department of Nephrology, Zhongshan Hospital, Fudan University, No.180 Fenglin Road, Shanghai, 200032, China
- Shanghai Medical Center of Kidney, Shanghai, China
- Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, China
| | - Shuan Zhao
- Department of Nephrology, Zhongshan Hospital, Fudan University, No.180 Fenglin Road, Shanghai, 200032, China
- Shanghai Medical Center of Kidney, Shanghai, China
- Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, China
| | - Bo Shen
- Department of Nephrology, Zhongshan Hospital, Fudan University, No.180 Fenglin Road, Shanghai, 200032, China
- Shanghai Medical Center of Kidney, Shanghai, China
- Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, China
| | - Jialin Wang
- Department of Nephrology, Zhongshan Hospital, Fudan University, No.180 Fenglin Road, Shanghai, 200032, China
- Shanghai Medical Center of Kidney, Shanghai, China
- Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, China
| | - Weidong Zhang
- Department of Nephrology, Zhongshan Hospital, Fudan University, No.180 Fenglin Road, Shanghai, 200032, China
- Shanghai Medical Center of Kidney, Shanghai, China
- Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, China
| | - Yufei Lu
- Department of Nephrology, Zhongshan Hospital, Fudan University, No.180 Fenglin Road, Shanghai, 200032, China
- Shanghai Medical Center of Kidney, Shanghai, China
- Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, China
| | - Yi Fang
- Department of Nephrology, Zhongshan Hospital, Fudan University, No.180 Fenglin Road, Shanghai, 200032, China
- Shanghai Medical Center of Kidney, Shanghai, China
- Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, China
| | - Xiaoqiang Ding
- Department of Nephrology, Zhongshan Hospital, Fudan University, No.180 Fenglin Road, Shanghai, 200032, China.
- Shanghai Medical Center of Kidney, Shanghai, China.
- Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, China.
| | - Yang Li
- Department of Nephrology, Zhongshan Hospital, Fudan University, No.180 Fenglin Road, Shanghai, 200032, China.
- Shanghai Medical Center of Kidney, Shanghai, China.
- Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, China.
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Usmani S, Ahmed N, Gnanasegaran G, Marafi F, Bani-Mustafa A, Van den Wyngaert T. Assessment of regional and total skeletal metabolism using 18F-NaF PET/CT in patients with chronic kidney disease. Ann Nucl Med 2024; 38:563-573. [PMID: 38676905 DOI: 10.1007/s12149-024-01929-1] [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: 02/17/2024] [Accepted: 04/08/2024] [Indexed: 04/29/2024]
Abstract
OBJECTIVE The study aims to assess regional and total bone metabolic activity in patients with chronic kidney disease using Na[18F]F PET and correlation between semi-quantitative indices and blood parameters. METHODS Seventy-two subjects (mean age 61.8 ± 13.8 years) were included. Of these 24/72 patients had end-stage renal disease (ESRD) (GFR < 15 mL/min/1.73 m2), 38/72 had chronic kidney disease (CKD) (GFR between 60 and 15 mL/min/1.73 m2), and 10/72 were controls with normal renal function. All subjects underwent Na[18F]F PET-CT with a dose activity of 0.06 mCi/Kg. Regional and total skeletal metabolism were assessed with mean SUVs in a skeletal volume of interest (VOI), bone to soft tissue index (B/S), global SUV mean (GSUV mean) of the whole bone, and uptake in the femoral neck. RESULTS Statistically significant differences were observed in a number of 18F-NaF metrics like femoral neck metabolism in CKD and ERSD groups in comparison to control in right (P = 0.003) and left femur (P = 0.006), bone to soft tissue index in the femur (P = 0.016) and GSUV5 (P = 0.006). There is also a significant difference in SUV mean in lumbar vertebrae (L1-L4) among CKD, ESRD, and controls. There was a moderate correlation between 18F-NaF PET scan uptake and blood parameters such as ALP and PTH. Na[18F]F uptake parameters were significantly different in low versus high bone turnover state. CONCLUSIONS The assessment of total skeleton and regional metabolism and bone turnover in CKD patients is feasible with Na[18F]F PET. Na[18F]F can help to detect early changes in bone metabolism and assess the progression of bone disease in this complex condition. Quantification with Na[18F]F PET might provide better assessment of the bone turnover. The difference in Na[18F]F uptake in CKD compared to controls is likely related to a change in bone turnover which, however, requires further validation.
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Affiliation(s)
- Sharjeel Usmani
- Department of Nuclear Medicine, Sultan Qaboos Comprehensive Cancer Care and Research Center, Muscat, Oman.
- Hull York Medical School, Hull, UK.
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
| | - Najeeb Ahmed
- Department of Nuclear Medicine, Jack Brignall PET/CT Centre, Castle Hill Hospital, Cottingham, UK
- Hull York Medical School, Hull, UK
| | | | - Fahad Marafi
- Department of Nuclear Medicine, Jaber Al-Ahmad Molecular Imaging Center, Kuwait, Kuwait
| | | | - Tim Van den Wyngaert
- Department of Nuclear Medicine, Antwerp University Hospital, Edegem, Belgium
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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Ali J, Shah S, Nadeem M, Mahmood A, Ahmad U. A Comparative Study of the Epidemiology and Risk Factors of Chronic Kidney Disease Among Rural and Urban Residents in Peshawar, Pakistan. Cureus 2024; 16:e64215. [PMID: 39131032 PMCID: PMC11310797 DOI: 10.7759/cureus.64215] [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] [Accepted: 07/09/2024] [Indexed: 08/13/2024] Open
Abstract
Background and objective Chronic kidney disease (CKD) poses a significant global public health challenge, especially among the Asian population who experience higher prevalence and more rapid disease progression. This study aimed to compare the epidemiology and risk factors associated with CKD between rural and urban residents in Peshawar, Pakistan. Materials and methods A cross-sectional study involving adult patients with CKD was conducted at a public tertiary care hospital in Peshawar between July 2023 and January 2024. To collect data, a tool was developed based on existing literature. CKD was defined as follows: a low estimated glomerular filtration rate (eGFR) below 60 mL/min per 1.73 m2, albuminuria (urine albumin-creatinine ratio >3 mg/mmol), or a combination of both low eGFR and albuminuria. The prevalence of moderate to severe CKD, adjusted for place of residence, was calculated. Statistical analysis was performed using SPSS Statistics V. 26 (IBM Corp., Armonk, NY). Results Among the study sample, 114 (41.45%) patients hailed from rural areas while 161 (58.55%) resided in urban areas. Urban patients had a higher prevalence of albuminuria levels below 30 mg/g than rural patients (83.2% vs. 76.3%, p=0.00). Additionally, the mean eGFR was slightly higher among rural residents. Rural patients had a higher prevalence of hypertension, and there was a noticeable disparity in the occurrence of kidney stones, with rural residents experiencing a greater incidence. Patients living in urban areas showed a higher level of understanding of risk factors and reported taking preventive measures for CKD. Factors associated with moderate to severe CKD included living in urban areas and having a medical history of diabetes and hypertension (p=0.00). No significant association was observed between behavioral factors and the severity of CKD. Conclusions Urban residents exhibited higher rates of CKD and albuminuria and had a greater awareness of CKD risk factors. In contrast, rural areas had a slightly higher mean eGFR and greater prevalence of hypertension and kidney stones. Diabetes and hypertension were key predictors of moderate to severe CKD.
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Affiliation(s)
- Junaid Ali
- General Medicine, Khyber Medical University, Peshawar, PAK
| | - Shahin Shah
- General Medicine, Medlife Medical Center, Abu Dhabi, ARE
| | - Muhammad Nadeem
- International Fellow Training, University Hospitals Birmingham NHS Foundation Trust, Birmingham, GBR
| | - Abroo Mahmood
- General Medicine, Advocare Northbrunswick Medical Associates, Abu Dhabi, ARE
| | - Umair Ahmad
- Medicine, Khyber Pakhtunkhwa Health Department, Peshawar, PAK
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Song Y, Wang Y, Li J, Shen Y, Hou Y, Fu Z, Fang L, Jin B, Chen L. CD226 promotes renal fibrosis by regulating macrophage activation and migration. J Leukoc Biol 2024; 116:103-117. [PMID: 38660893 DOI: 10.1093/jleuko/qiae054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 01/29/2024] [Accepted: 02/21/2024] [Indexed: 04/26/2024] Open
Abstract
It has been found that CD226 plays an important role in regulating macrophage function, but its expression and function in macrophages during renal fibrogenesis have not been studied. Our data demonstrated that CD226 expression in macrophages was obviously upregulated in the unilateral ureteral obstruction model, while CD226 deficiency attenuated collagen deposition in renal interstitium along with fewer M1 within renal cortex and renal medulla and a lower level of proinflammatory factors compared to that of control littermates. Further studies demonstrated that Cd226-/- bone marrow-derived macrophages transferring could significantly reduce the tubular injury, collagen deposition, and proinflammatory cytokine secretion compared with that of Cd226+/+ bone marrow-derived macrophages transferring in the unilateral ureteral obstruction model. Mechanistic investigations revealed that CD226 promoted proinflammatory M1 macrophage accumulation in the kidney via suppressing KLF4 expression in macrophages. Therefore, our results uncovered a pathogenic role of CD226 during the development of chronic kidney disease by promoting monocyte infiltration from peripheral blood into the kidney and enhancing macrophage activation toward the inflammatory phenotype by suppressing KLF4 expression.
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Affiliation(s)
- Yun Song
- Department of Immunology, Air Force Medical University, No.169, Changle West Road, Xincheng District, Xi'an 710032, ShaanXi, China
| | - Yazhen Wang
- Department of Immunology, Air Force Medical University, No.169, Changle West Road, Xincheng District, Xi'an 710032, ShaanXi, China
| | - Juan Li
- College of Life Sciences, Northwest University, No.229, Taibai North Road, Beilin District, Xi'an 710069, ShaanXi, China
| | - Yuting Shen
- Department of Immunology, Air Force Medical University, No.169, Changle West Road, Xincheng District, Xi'an 710032, ShaanXi, China
| | - Yongli Hou
- Department of Immunology, Air Force Medical University, No.169, Changle West Road, Xincheng District, Xi'an 710032, ShaanXi, China
| | - Zhaoyue Fu
- Department of Immunology, Air Force Medical University, No.169, Changle West Road, Xincheng District, Xi'an 710032, ShaanXi, China
| | - Liang Fang
- Department of Immunology, Air Force Medical University, No.169, Changle West Road, Xincheng District, Xi'an 710032, ShaanXi, China
| | - Boquan Jin
- Department of Immunology, Air Force Medical University, No.169, Changle West Road, Xincheng District, Xi'an 710032, ShaanXi, China
| | - Lihua Chen
- Department of Immunology, Air Force Medical University, No.169, Changle West Road, Xincheng District, Xi'an 710032, ShaanXi, China
- College of Life Sciences, Northwest University, No.229, Taibai North Road, Beilin District, Xi'an 710069, ShaanXi, China
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50
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Vestergaard AHS, Jensen SK, Heide-Jørgensen U, Frederiksen LE, Birn H, Jarbøl DE, Søndergaard J, Persson F, Thomsen RW, Christiansen CF. Risk factor analysis for a rapid progression of chronic kidney disease. Nephrol Dial Transplant 2024; 39:1150-1158. [PMID: 38168720 PMCID: PMC11210987 DOI: 10.1093/ndt/gfad271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) is a growing global health concern. Identifying individuals in routine clinical care with new-onset CKD at high risk of rapid progression of the disease is imperative to guide allocation of prophylactic interventions, but community-based data are limited. We aimed to examine the risk of rapid progression, kidney failure, hospitalization and death among adults with incident CKD stage G3 and to clarify the association between predefined risk markers and rapid CKD progression. METHODS Using plasma creatinine measurements for the entire Danish population from both hospitals and primary care, we conducted a nationwide, population-based cohort study, including adults in Denmark with incident CKD stage G3 in 2017-2020. We estimated 3-year risks of rapid progression (defined by a confirmed decline in estimated glomerular filtration rate of ≥5 mL/min/1.73 m2/year), kidney failure, all-cause hospitalization and death. To examine risk markers, we constructed a heat map showing the risk of rapid progression based on predefined markers: albuminuria, sex, diabetes and hypertension/cardiovascular disease. RESULTS Among 133 443 individuals with incident CKD stage G3, the 3-year risk of rapid progression was 14.6% [95% confidence interval (CI) 14.4-14.8]. The 3-year risks of kidney failure, hospitalization and death were 0.3% (95% CI 0.3-0.4), 53.3% (95% CI 53.0-53.6) and 18.1% (95% CI 17.9-18.4), respectively. In the heat map, the 3-year risk of rapid progression ranged from 7% in females without albuminuria, hypertension/cardiovascular disease or diabetes, to 46%-47% in males and females with severe albuminuria, diabetes and hypertension/cardiovascular disease. CONCLUSION This population-based study shows that CKD stage G3 is associated with considerable morbidity in a community-based setting and underscores the need for optimized prophylactic interventions among such patients. Moreover, our data highlight the potential of using easily accessible markers in routine clinical care to identify individuals who are at high risk of rapid progression.
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Affiliation(s)
- Anne H S Vestergaard
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Simon K Jensen
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Uffe Heide-Jørgensen
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Line E Frederiksen
- Cardiovascular, Renal and Metabolism, Medical Department, BioPharmaceuticals, AstraZeneca, Copenhagen, Denmark
| | - Henrik Birn
- Departments of Clinical Medicine and Biomedicine, Aarhus University, Aarhus, Denmark
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Dorte E Jarbøl
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Jens Søndergaard
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | | | - Reimar W Thomsen
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Christian F Christiansen
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
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